INDIANAPOLIS — For the first time since 2009, a group of experts have published revisions to the guidelines for magnetic resonance imaging (MRI) in multiple sclerosis (MS), which stress the need for a standardized protocol in the diagnosis and follow-up of this patient population. Details of the revised guidelines were provided in a presentation at the Consortium of Multiple Sclerosis Centers 2015 Annual Meeting.
“Over the last 10 years, technology has improved such that we can get higher-quality imaging. As a result, if we can get people to use a standardized protocol, we can use that higher-quality imaging to accurately compare over time,” lead guideline author Anthony Traboulsee, MD, of UBC Hospital in Vancouver, Canada, told Neurology Advisor. “There has also been more evidence that … new disease activity can influence treatment decisions [and] can let us know whether patients are on sufficient therapy or if they need an escalation of their therapy. That is probably the most dramatic change in the field — there is now more of a consensus that MRI is very useful and not just sort of useful.”
According to guideline author David K.B. Li, MD, of the UBC MS/MRI Research Group and UBC Hospital in Vancouver, Canada, the goal of these new updates was to standardize as much as possible, given the limitations that there will be technical improvements.
“The aim was to make things as backwardly and forwardly compatible as possible, so that you can compare and be absolutely certain that a change in terms of a new abnormality is because there has been a change as opposed to anything technical,” Li said.
In addition to reemphasizing the importance of obtaining the highest quality of images possible, the new set of guidelines also stress that scans should be obtained as similarly as possible from one study to the next. “In other words, [scans] should be reproducible in terms of brain coverage, so the whole brain needs to be covered and in terms of position of the scan,” Li said.
A key change with the updates, he said, is that previously, physicians were allowed to obtain scans at a 5 mm slice thickness to save time. “But the change now with the most recent revision is that 3 mm is what is recommended,” he said.
Another change involves the acquisition of scans in three rather than two dimensions, or volume instead of a slice.
“When you obtain in a volume, you can still determine the intervals of those planes under review,” Li said. “The three-dimensional acquisitions tend to be obtained in 1 to 1.5 mm intervals — which is where the field is today.”
Traboulsee added that the guidelines have also introduced a new quick sequence to look for a rare but serious complication of MS treatment called progressive multifocal leukoencephalopathy (PML).
“With the more effective drugs we now have for MS, they are really good at controlling MS but they sometimes carry significant risks, such as [PML],” he said. “We now have provided guidance on how to monitor for [PML], so that if it’s detected early, we might be able to prevent death.”
Going forward, although acknowledging that these guidelines will likely change again as technology continues to get better, Traboulsee said they have designed this protocol to have a timelessness so that any future changes will be able to take advantage of the data.
“The data collection now won’t be lost because there is a new technique in the future,” he said. “We have taken that into consideration such that all data collection now will be useful with any changes to the protocol in the future.”
The revised guidelines are scheduled for publication in the American Journal of Neuroradiology.
- Li DKB. Consortium of MS Centres Guidelines: Revised Standardized MRI Protocol for the Diagnosis and Follow-up of MS. Presented at: Consortium of Multiple Sclerosis Centers Annual Meeting 2015; May 27-30, 2015; Indianapolis.
- Traboulsee A et al. SUMMARY: Revised Recommendations of the CMSC Task Force for a Standardized MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-up of Multiple Sclerosis. Accessed at: www.mscare.org.