Consortium of MS Centers MRI Protocol for the Diagnosis and Follow-up of MS
by Anthony Traboulsee, MD; David Li, MD; Joseph Frank, MD; Jack Simon, MD; Patricia Coyle, MD; Jerry Wolinsky, MD; Donald Paty, MD
I. CLINICAL GUIDELINES for Brain and Spinal Cord MRI in MS
Baseline evaluation: • Brain MRI recommended (with gadolinium) • Spinal Cord MRI if presenting symptoms are at the level of the spinal cord and have not resolved, or if the Brain MRI is non-diagnostic.
Follow-up evaluation: • Brain MRI recommended to demonstrate new disease activity
Follow-up of MS: • Unexpected clinical worsening • Re-assessment of disease burden before starting or modifying therapy • Suspicion of a secondary diagnosis
II. MRI PROTOCOLS for Brain and Spinal Cord
Field Strength: 1.0 Tesla or higher recommended for brain or spinal cord. (Note: 1T open ring magnets have an effective field strength of approximately 0.7 Tesla and are only recommended when patients can not tolerate the closed magnet).
Slice Thickness: < 3mm and no gap and in plane resolution of < 1mm x 1 mm for both Brain and spinal cord. (Note: < 5mm and no gap is acceptable for Brain MRI for centers that are unable to acquire 3mm slices in the allotted time).
Scan Orientation and Coverage: Reproducible coverage and orientation for the axial slices using the subcallosal line as a reference on an appropriate Sagittal localizer is critical for longitudinal comparisons.
Brain MRI Sequences: 1st: Sagittal FLAIR (fluid attenuating inversion recovery). 2nd: Axial PD/T2 (proton density and T2 weighted T1 usually 80ms) 3rd: Axial FLAIR 4th: Gadolinium enhanced T1 (if suspicious lesions seen on FLAIR). Note: all 4 sequences recommended for a diagnostic MRI in suspected MS. The Sagittal FLAIR and gadolinium enhanced T1 are optional in the follow-up study for established MS.
Gadolinium: • The recommended dose is 0.1 mmol/kg IV • The minimum delay after giving gadolinium is 5 minutes before acquiring the axial T1 weighted axial post contrast images. • Gadolinium does not need to be given for a spinal cord MRI if it follows a contrast Brain MRI study.
Time saving strategies: • Omit the axial Fast Spin Echo PD • Only cover the corpus callosum with the Sagittal FLAIR. • Acquire the axial FLAIR after giving gadolinium and before the axial T1 weighted axial post contrast images.
Report: The report should use common language and be descriptive including: • Lesion number, location, size, shape, character and a qualitative assessment of brain atrophy. • Comparison with previous studies for new, enlarging and/or enhancing lesions and atrophy. • Interpretation and differential diagnosis.
An optional standardized reporting table may be helpful to the radiologist and neurologist.
Archival and Storage: Copies of these MRI studies should be retained permanently and be available. They should be stored in a standard format (example DICOM). It may be useful for patients to keep their own studies on portable digital media.
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