IMG03
International Magnims-CMSC-Naims Consensus Recommendations on the Use of Standardized MRI in MS

Tuesday, October 26, 2021: 3:25 PM
Sandlake (Rosen Shingle Creek)
Anthony Traboulsee, MD, FRCPC , Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
Mike Wattjes, MD PhD , Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
Olga Ciccarelli, MD PhD , Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
Daniel Reich, MD PhD , Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
Brenda Banwell, MD , Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Nicola De Stefano, MD, PhD , University of Siena, Siena, Italy
Christian Enzinger, MD , Neurology, Medical University of Graz, Graz, Austria
Franz Fazekas, MD , Neurology, Medical University of Graz, Graz, Austria
Massimo Filippi, MD , Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
Jette Frederiksen, MD , Neurology, Rigshospitalet, Glostrup - University Hospital of Copenhagen, Copenhagen, Denmark
Claudio Gasperini, MD , Neurology, San Camillo-Forlanini Hospital, Roma, Italy
Yael Hacohen, MD , Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, London, United Kingdom
Ludwig Kappos, MD , Mellen Centre for Multiple Sclerosis, Basel, Switzerland
David Li, MD, FRCPC , Radiology and Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
Kshitij Mankad, MD , Neuroradiology, Great Ormond Street Hospital for Children, London, United Kingdom
Xavier Montalban, MD, PhD , University Hospital, Barcelona, Spain
Scott D. Newsome, DO, MSCS, FAAN, FANA , Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
Jiwon Oh, MD PhD FRCPC , Medicine, Division of Neurology, St. Michael’s Hospital, Univ of Toronto, Toronto, ON, Canada
Jacqueline Palace, DM , NMO Service, John Radcliffe Hospital, Oxford, United Kingdom
Maria A Rocca, MD , Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
Jaume Sastre-Garriga, MD , Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Mar Tintoré, MD, PhD , University Hospital Vall d'Hebron, Barcelona, Spain
Hugo Vrenken, PhD , Radiology & Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
Tarek Yousry, MD , Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
Frederik Barkhof, MD, PhD , Institutes of Neurology and Healthcare Engineering, UCL, London, United Kingdom
Alex Rovira, MD , Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain



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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