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Tony Traboulsee, FRCPC Neurology for the CMSC work group

How should MRI be used for the management of MS patients?. I only use MRI for diagnosis."My patients have an MRI at least once a year so that I can see how active their MS has been."I order an MRI if a patient isn't doing well on therapy and change therapies if the MRI looks bad.". Dr. A. Tra

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Tony Traboulsee, FRCPC Neurology for the CMSC work group

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    1. 1/121/12

    2. How should MRI be used for the management of MS patients? “I only use MRI for diagnosis.” “My patients have an MRI at least once a year so that I can see how active their MS has been.” “I order an MRI if a patient isn’t doing well on therapy and change therapies if the MRI looks bad.” 2/122/12

    3. Vancouver CMSC MRI Guidelines

    4. A non-standardized MRI can be a non-informative follow-up MRI. “Three newly appreciated small T2 hyperintensities may represent interval lesions, but their detection on today’s exam may also be technical in nature since contiguous slices are not obtained on axial imaging at this time.” Caution if MRI and CSF are normal 1 – 3 MRIs required Gd lesion > 3 months after clinical attack OR New T2 or Gd lesion > 3 months after 1st MRI 2 – 3 MRIs required Positive 1st MRI AND Gd lesion > 3 months after clinical attack Negative MRI and CSF is very low risk for developingCaution if MRI and CSF are normal 1 – 3 MRIs required Gd lesion > 3 months after clinical attack OR New T2 or Gd lesion > 3 months after 1st MRI 2 – 3 MRIs required Positive 1st MRI AND Gd lesion > 3 months after clinical attack Negative MRI and CSF is very low risk for developing

    5. Consortium of MS Centers Consensus Meeting, Vancouver, Canada, November 2nd-4th, 2001 CMSC MRI Protocol for the Diagnosis and Follow-up of MS

    6. Vancouver CMSC MRI Guidelines

    8. Vancouver CMSC MRI Guidelines

    9. Vancouver CMSC MRI Guidelines All MRIs for MS should be done according to a standardized protocol.

    14. Vancouver CMSC MRI Guidelines Indications for a brain MRI: The initial evaluation and diagnosis of suspected MS. The baseline evaluation of a patient with definite MS.

    15. Vancouver CMSC MRI Guidelines Routine follow-up MRI is not recommended

    16. Vancouver CMSC MRI Guidelines - 2 The referring physician should indicate: Suspected MS Baseline evaluation of MS Follow-up of MS The radiology report should be descriptive.

    18. Vancouver CMSC MRI Guidelines A copy of these MRI studies should be retained permanently.

    19. Implementing the guidelines

    20. Conclusions A standardized MRI protocol is essential for gathering meaningful follow-up information. Gadolinium provides additional information and is especially useful for a diagnostic MRI. Additional evidence is required to bridge the gap between the role of serial MRI in population studies and the role for individual patient follow-up.

    21. Acknowledgements The development of the MRI guidelines is through the generous support of the Consortium of MS Centres (www.mscare.org)

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