Background: Standardized magnetic resonance imaging (MRI) guidelines published in 2015 by the MAGNIMS group and in 2016 by the CMSC are important for the diagnosis and monitoring of patients with multiple sclerosis (MS) and for the appropriate use of MRI in routine clinical practice.
Objectives: To present the international consensus 2021 revisions of the guidelines on MRI in MS, which now merge recommendations from MAGNIMS, CMSC, and NAIMS.
Methods: Two panels of experts convened on two occasions to update existing guidelines for a standardized MRI protocol. One panel convened in Graz, Austria in April 2019 to review and update the MAGNIMS guidelines. A second panel met separately and independently in Newark, NJ, USA in October 2019 to update the CMSC guidelines and to discuss advocacy efforts. Subsequently, the leadership of the MAGNIMS, NAIMS, and CMSC working groups combined their efforts to reach an international consensus.
Results: Discuss and updates include advances in using MRI to establish and earlier diagnosis of MS, including the 2017 revisions of the McDonald diagnostic criteria; safety concerns regarding intravenous gadolinium-based contrast agents; and the value of spinal cord MRI for diagnostic, prognostic and monitoring purposes suggest a changing role of MRI for MS patient management and care. The revised guidelines on MRI in MS merges recommendations from MAGNIMS, CMSC, and NAIMS to improve the use of MRI for diagnosis, prognosis and monitoring of individuals with MS. 3D acquisitions are emphasized for optimal comparison over time. Core brain sequences include a 3D-T2wFLAIR for lesion identification and monitoring treatment effectiveness. Gadolinium-based contrast is recommended for diagnostic studies and judicious use for routine monitoring of MS patients. Additional DWI sequences are recommended for PML safety monitoring. Optional sequences that could be incorporated into future recommendations include high resolution 3D-T1w for brain atrophy monitoring; DIR/PSIR for identifying cortical lesions; and SWI for the central vein sign evaluation. The international consensus guidelines strive for global acceptance of a useful and usable standard of care for patients with MS.
Conclusions: Dissemination of the 2021 evidence-based MAGNIMS-CMSC-NAIMS international consensus guidelines through congresses would be a welcome addition to the advocacy efforts in promoting the use of standardized MRI in MS diagnosis and follow-up of people with MS
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