From the Guidelines
MRI brain with and without contrast is essential for diagnosing and monitoring multiple sclerosis (MS). This approach is supported by the Magnims consensus guidelines on the use of MRI in MS, which recommend a standardized brain MRI protocol including pre-contrast and post-contrast sequences 1. The protocol should include axial T1-weighted and dual-echo T2-weighted sequences, followed by contrast-enhanced sagittal, axial 2D T2-weighted fluid-attenuated inversion recovery (FLAIR), and axial T1-weighted sequences. The use of contrast agent, usually gadolinium-based, helps to highlight active inflammatory lesions, which is crucial for determining disease activity and progression. Key findings that support the use of MRI with and without contrast in MS diagnosis include:
- A substantial proportion (>40%) of MS lesions show a central vein, and venocentric patterns during gadolinium injection were observed in as many as 95% of MS lesions 1
- White matter signal abnormalities on susceptibility-weighted imaging (SWI) tend to be more predictive of conversion to clinically definite MS than are T2 lesions 1
- Venocentric and hypointense rim lesions are specific findings that are useful for differentiating patients with clinically isolated syndrome (CIS) or MS from those with other neurological disorders 1 The complete protocol allows neurologists to distinguish between old and new lesions, which is crucial for diagnosis, determining disease progression, and making treatment decisions. The recommended MRI protocol with and without contrast should be performed to ensure accurate diagnosis and monitoring of MS.
From the Research
MRI Brain with and without Contrast for Multiple Sclerosis
- The use of MRI in the diagnosis and monitoring of multiple sclerosis (MS) is well established 2, 3, 4.
- MRI is widely used for prognostic evaluation, treatment efficacy, and safety monitoring in MS patients 2, 5, 3.
- The role of brain and spinal cord MRI in the diagnosis of MS is well established, and new MR techniques and markers will further improve the diagnostic value 2.
- MRI with and without contrast is used to evaluate inflammatory and neurodegenerative processes in the brain and spinal cord 3, 4.
- Gadolinium-enhancing lesions at baseline MRI are predictors of disease-modifying treatment efficacy in patients with relapsing-remitting MS 5.
- The conversion of new brain lesions to black holes (BH) is a marker of demyelination/axonal loss in MS, and MRI can be used to study the development and evolution of new BH 6.
Key Findings
- A lower number of gadolinium-enhancing lesions at baseline MRI is a predictor of disease-modifying treatment efficacy in patients with relapsing-remitting MS 5.
- The majority of new brain lesions in patients with MS do not convert to chronic black holes (CBH), but about a quarter have conversion rates from acute BH to CBH greater than 20% 6.
- MRI is a powerful tool for treatment monitoring, safety assessment, and prognostication of disease progression in MS patients 2, 3, 4.