Review Article

Neurological Sciences

, Volume 34, Issue 12, pp 2085-2093

First online:

Guidelines from The Italian Neurological and Neuroradiological Societies for the use of magnetic resonance imaging in daily life clinical practice of multiple sclerosis patients

  • Massimo FilippiAffiliated withNeuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele UniversityDepartment of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University Email author 
  • , Maria A. RoccaAffiliated withNeuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele UniversityDepartment of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University
  • , Stefano BastianelloAffiliated withDepartment of Neuroradiology, IRCCS National Neurological Institute C. Mondino Foundation, University of Pavia
  • , Giancarlo ComiAffiliated withDepartment of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University
  • , Paolo GalloAffiliated withThe Multiple Sclerosis Centre of Veneto Region, First Neurological Clinic, Department of Neurosciences, University Hospital of Padova
  • , Massimo GallucciAffiliated withDepartment of Neuroradiology, “San Salvatore” Hospital
  • , Angelo GhezziAffiliated withMultiple Sclerosis Center, Hospital of Gallarate
  • , Maria Giovanna MarrosuAffiliated withDepartment of Public Health, Clinical and Molecular Medicine, Multiple Sclerosis Center, University of Cagliari
  • , Giorgio MinonzioAffiliated withDepartment of Neuroradiology, Hospital of Gallarate
    • , Patrizia PantanoAffiliated withNeuroradiology Section, Sapienza University of Rome
    • , Carlo PozzilliAffiliated withDepartment of Neurology and Psychiatry, Sapienza University of Rome
    • , Gioacchino TedeschiAffiliated withDepartment of Neurology, Second University of Naples
    • , Maria TrojanoAffiliated withDepartment of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari
    • , Andrea FaliniAffiliated withDepartment of Neuroradiology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University
    • , Nicola De StefanoAffiliated withDepartment of Medicine, Surgery and Neuroscience, University of Siena

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Abstract

MRI is highly sensitive in detecting focal white matter lesions in multiple sclerosis (MS). For this reason, it has been formally included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, through the definition of ad hoc sets of criteria to show disease dissemination in space and time. MRI is used in virtually all clinical trials of the disease as a surrogate measure of treatment response. Several guidelines have been published to help characterizing the imaging features on conventional MR sequences of “typical” MS lesions and work has also been performed to identify “red flags” which should alert the clinicians to exclude possible alternative conditions. Despite this, the application of the available guidelines and criteria in daily life clinical practice is still limited and varies among and within countries (including Italy) due to regulatory issues and heterogeneity of MRI facilities. It is crucial for neurologists and neuroradiologists to become familiar with these criteria to improve the quality of their diagnostic assessment. In patients with established MS, the main problem is to define standard procedures for monitoring the course of the disease and treatment response. This review aims at providing daily life guidelines to clinicians for a correct application of MRI in the workup of patients suspected of having MS as well as in the monitoring of disease evolution in those with established MS. It also offers clues for the standardization of MRI studies and relative reporting to be applied at a national level.

Keywords

Multiple sclerosis Clinically isolated syndromes Magnetic resonance imaging Diagnosis Monitoring