Article Figures & Data
Tables
Sequence Diagnostic Scan for Clinically Isolated Syndrome MS Baseline or Follow-up Scan Comment 1 3 plane (or other) scout Recommended Recommended Set up axial sections through subcallosal line* 2 Sagittal Fast FLAIR Recommended Optional Sagittal FLAIR sensitive to early MS pathology, such as in corpus callosum 3 Axial FSE PD/T2 Recommended Recommended TE1 minimum (eg, ≤30 ms) TE2 (usually ≥80 ms) PD series sensitive to infratentorial lesions that may be missed by FLAIR series 4 Axial Fast FLAIR Recommended Recommended Sensitive to white matter lesions and especially juxtacortical–cortical lesions 5 Axial pregadolinium T1 Optional Optional Considered routine for most neuroimaging studies 6 3D T1 Optional Optional Some centers use this for atrophy measures. 7 Axial gadolinium-enhanced T1 Recommended Optional Standard dose of 0.1 mmol/kg injected over 30 s; scan starting minimum 5 min after start of injection Note.—FSE indicates fast spin-echo (or turbo spin-echo); PD, proton density-weighted (long TR, short TE sequence); T2, T2-weighted (long TR, long TE sequence); T1, T1-weighted (short TR, short TE sequence). Section thickness for sequences 3–6 is ≤3 mm with no intersection gaps when feasible. Partition thickness for 3D sequence 6 is ≤1.5 mm. In-plane resolution is approximately ≤1 × 1 mm.
* The subcallosal line joins the undersurface of the front (rostrum) and back (splenium) of the corpus callosum.
When Acquired Immediately Following an Enhanced Brain MRI* When Acquired without a Preceding Enhanced Brain MRI Sequence Recommendation Sequence Recommendation 1 3 plane (or other scout) Recommended 1 3 plane (or other scout) Recommended 2 Postcontrast sagittal T1 Recommended 2 Precontrast sagittal T1 Recommended 3 Postcontrast sagittal FSE PD/T2† Recommended 3 Precontrast sagittal FSE PD/T2† Recommended 4 Postcontrast axial T1 Through suspicious lesions 4 Precontrast Axial FSE PD/T2‡ Through suspicious lesions 5 Postcontrast axial FSE PD/T2‡ Through suspicious lesions 5 3D T1§ Optional 6 Postcontrast 3D T1§ Optional 6 Postcontrast-enhanced sagittal T1‖ Recommended 7 Postcontrast-enhanced axial T1 Through suspicious lesion(s) Note.—FSE indicates fast spin-echo (or turbo spin-echo); PD, proton density-weighted (long TR, short TE sequence); T2, T2-weighted (long TR, long TE sequence); T1, T1-weighted (short TR, short TE sequence).
* Indications are (1) main presenting symptoms are at the level of the spinal cord, and these have not resolved (2) if the brain MRI results are equivocal. No additional intravenous contrast is required if the spinal cord study immediately follows the contrast-enhanced brain MRI, as gain is very limited. The segment to be studied (cervical and/or thoracic) is based on clinical findings. Sagittal section thickness is 3-mm (no gap).
† PD series may depict lesions less apparent on heavily T2-weighted series.
‡ Increases confidence in the findings of sagittal series; may provide classic lesion characteristics.
§ For volumetric analysis if desired.
‖ Standard dose of 0.1 mmole/kg injected over 30 s; scan starting 5 min after start of injection.
Magnetic resonance imaging criteria for dissemination in space Three of 4 of the following: 1. One gadolinium-enhancing lesion or 9 T2-hyperintense lesions if there is no gadolinium-enhancing lesion 2. At least one infratentorial lesion 3. At least one juxtacortical lesion 4. At least 3 periventricular lesions (Note: One spinal cord lesion can be substituted for one brain lesion.) Magnetic Resonance Imaging Criteria for Dissemination of Lesions in Time 1 If a first scan occurs 3 mo or more after the onset of the clinical event, the presence of an enhancing lesion is sufficient to demonstrate dissemination in time, provided that it is not at the site implicated in the original clinical event. If there is no enhancing lesion at this time, a follow-up scan is required. The timing of this follow-up scan is not crucial, but 3 mo is recommended. A new T2 or enhancing lesion at this time then fulfills the criterion for dissemination in time. 2 If the first scan is performed less than 3 mo after the onset of the clinical event, a second scan done 3 mo or more after the clinical event showing a new enhancing lesion provides sufficient evidence for dissemination in time. However, if no enhancing lesion is seen at this second scan, a further scan not less than 3 mo after the first scan that shows a new T2 lesion or an enhancing lesion will suffice.
In this issue
Jump to section
Related Articles
Cited By...
- Diffusion Histology Imaging to Improve Lesion Detection and Classification in Multiple Sclerosis
- An overview of the quality assurance and quality control of magnetic resonance imaging data for the Ontario Neurodegenerative Disease Research Initiative (ONDRI): pipeline development and neuroinformatics
- Improving Detection of Multiple Sclerosis Lesions in the Posterior Fossa Using an Optimized 3D-FLAIR Sequence at 3T
- MIMoSA: A Method for Inter-Modal Segmentation Analysis
- Do All Patients with Multiple Sclerosis Benefit from the Use of Contrast on Serial Follow-Up MR Imaging? A Retrospective Analysis
- Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 1--Mechanisms, Efficacy, and Safety
- Improved Lesion Detection by Using Axial T2-Weighted MRI with Full Spinal Cord Coverage in Multiple Sclerosis
- 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
- FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection
- Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo
- Quality improvement in neurology: Multiple sclerosis quality measures: Executive summary
- MS Lesions Are Better Detected with 3D T1 Gradient-Echo Than with 2D T1 Spin-Echo Gadolinium-Enhanced Imaging at 3T
- Double Inversion Recovery Sequence of the Cervical Spinal Cord in Multiple Sclerosis and Related Inflammatory Diseases
- Simple MRI Metrics Contribute to Optimal Care of the Patient with Multiple Sclerosis
- Optimized T1-MPRAGE Sequence for Better Visualization of Spinal Cord Multiple Sclerosis Lesions at 3T
- Development of a Standardized MRI Scoring Tool for CNS Demyelination in Children
- Multicontrast MR Imaging at 7T in Multiple Sclerosis: Highest Lesion Detection in Cortical Gray Matter with 3D-FLAIR
- Automatic Lesion Incidence Estimation and Detection in Multiple Sclerosis Using Multisequence Longitudinal MRI
- MR Imaging in Multiple Sclerosis: Review and Recommendations for Current Practice
- Can clinical outcomes be used to detect neuroprotection in multiple sclerosis?
- 3D MRI in multiple sclerosis: a study of three sequences at 3 T