MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines

Abstract

In patients presenting with a clinically isolated syndrome, MRI can support and substitute clinical information in the diagnosis of multiple sclerosis by showing disease dissemination in space and time and by helping to exclude disorders that can mimic multiple sclerosis. MRI criteria were first included in the diagnostic work-up for multiple sclerosis in 2001, and since then several modifications to the criteria have been proposed in an attempt to simplify lesion-count models for showing disease dissemination in space, change the timing of MRI scanning to show dissemination in time, and increase the value of spinal cord imaging. Since the last update of these criteria, new data on the use of MRI to establish dissemination in space and time have become available, and MRI technology has improved. State-of-the-art MRI findings in these patients were discussed in a MAGNIMS workshop, the goal of which was to provide an evidence-based and expert-opinion consensus on proposed modifications to MRI criteria for the diagnosis of multiple sclerosis.

Figure 1

Examples of lesion classification based on integrated analysis of double inversion recovery (DIR) (left column) and magnetization-prepared rapid acquisition with gradient echo (MPRAGE) (middle and right columns) sequences. Top row: a hyperintense lesion close to the cortex (white arrow) is visible on DIR, but MPRAGE shows that the lesion is located in the white matter. Middle row: a hyperintense lesion close to the cortex (white arrow) is visible on DIR, and MPRAGE shows that the location abuts the cortex (juxtacortical). Bottom row: a hyperintense lesion close to the cortex (white arrow) is visible on DIR, and MPRAGE shows that the lesion is intracortical. Under the proposed system, the lesions in the middle and bottom rows would be classified as “cortical/juxtacortical.”

Figure 2

Sagittal intermediate and T2-weighted dual echo fast-spin echo images of the spinal cord in a patient with multiple sclerosis. Note the presence of abnormalities both at the cervical and thoracic level of the cord.

Figure 3

7T T2*-weighted gradient-echo and phase axial images of a 36-year-old woman with relapsing-remitting MS. A periventricular non-enhancing lesion with a paramagnetic rim (white arrows) is displayed. A prominent central vein is visible on all images. The lesion maintains the same morphological features in a medium-term follow up (magnified boxes).

Figure 4

Noncontrast 3T FLAIR* images (axial, sagittal and coronal views) in a 33-year-old woman with MS. A conspicuous central vessel is clearly visible in the majority of hyperintense lesions. The definition of “perivenular” lesion requires the visualization of the central vessel in at least two perpendicular views (arrows in magnified boxes).