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AJNR Am J Neuroradiol. 2016 Mar;37(3):394-401. doi: 10.3174/ajnr.A4539. Epub 2015 Nov 12.

Revised Recommendations of the Consortium of MS Centers Task Force for a Standardized MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-Up of Multiple Sclerosis.

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From the Department of Medicine (Neurology) (A.T.), University of British Columbia, Vancouver, Canada
Portland VA Research Foundation and Oregon Health and Sciences University (J.H.S.), Portland, Oregon.
Mellen Center for MS Treatment and Research (L.S.), Cleveland Clinic, Cleveland, Ohio.
Department of Biomedical Engineering, Cleveland Clinic (E.F.). Cleveland, Ohio.
Department of Neurology, University of Virginia (D.E.J.), Charlottesville, Virginia.
Department of Radiology and Biomedical Imaging, Yale University (A.M.), New Haven, Connecticut.
Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, Maryland.
St. Michael's Hospital (J.O.), University of Toronto, Toronto, Ontario, Canada.
Translational Neuroradiology Unit (D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
Biogen Idec (N.R.), Cambridge, Massachusetts.
University of Miami Multiple Sclerosis Center (K.R.), Miami, Florida.
Department of Neurology (O.K.), Wayne State University School of Medicine, Detroit, Michigan.
Department of Radiology (E.-W.R.), University Hospital, Basel, Switzerland.
University of New Mexico Health Science Center (C.F.), Albuquerque, New Mexico.
Consortium of Multiple Sclerosis Centers (J.H.), Hackensack, New Jersey.
Departments of Radiology (D.L.), University of British Columbia, Vancouver, British Columbia Canada.


An international group of neurologists and radiologists developed revised guidelines for standardized brain and spinal cord MR imaging for the diagnosis and follow-up of MS. A brain MR imaging with gadolinium is recommended for the diagnosis of MS. A spinal cord MR imaging is recommended if the brain MR imaging is nondiagnostic or if the presenting symptoms are at the level of the spinal cord. A follow-up brain MR imaging with gadolinium is recommended to demonstrate dissemination in time and ongoing clinically silent disease activity while on treatment, to evaluate unexpected clinical worsening, to re-assess the original diagnosis, and as a new baseline before starting or modifying therapy. A routine brain MR imaging should be considered every 6 months to 2 years for all patients with relapsing MS. The brain MR imaging protocol includes 3D T1-weighted, 3D T2-FLAIR, 3D T2-weighted, post-single-dose gadolinium-enhanced T1-weighted sequences, and a DWI sequence. The progressive multifocal leukoencephalopathy surveillance protocol includes FLAIR and DWI sequences only. The spinal cord MR imaging protocol includes sagittal T1-weighted and proton attenuation, STIR or phase-sensitive inversion recovery, axial T2- or T2*-weighted imaging through suspicious lesions, and, in some cases, postcontrast gadolinium-enhanced T1-weighted imaging. The clinical question being addressed should be provided in the requisition for the MR imaging. The radiology report should be descriptive, with results referenced to previous studies. MR imaging studies should be permanently retained and available. The current revision incorporates new clinical information and imaging techniques that have become more available.

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