Skip to main content
SpringerLink
Log in

MRI and multiple sclerosis––the evolving role of MRI in the diagnosis and management of MS: the radiologist’s perspective

  • Review Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Magnetic resonance imaging (MRI) plays an integral role in the management of multiple sclerosis (MS), from both diagnostic and therapeutic perspectives. This 2-part review aims to detail the evolving and expanding role of MRI for both radiologists and neurologists. In this article, we discuss the diagnostic criteria for MS relevant to radiologists, as well as its varying imaging manifestations. The role of MRI in therapeutic modification and complications are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1: McDonald criteria, dissemination in space (DIS)
Fig. 2: McDonald criteria, dissemination in time (DIT)
Fig. 3: Dawson fingers
Fig. 4: Unilateral optic neuritis
Fig. 5: Natalizumab-related progressive multifocal leukoencephalopathy

Similar content being viewed by others

References

  1. Filippi M, Rocca MA (2011) MR imaging of multiple sclerosis. Radiology 259(3):659–681

    Article  PubMed  Google Scholar 

  2. Wattjes MP, Steenwijk MD, Stangel M (2015) MRI in the diagnosis and monitoring of multiple sclerosis: an update. Clin Neuroradiol 25(Suppl 2):157–165

    Article  PubMed  Google Scholar 

  3. Ge Y (2006) Multiple sclerosis: the role of MR imaging. AJNR Am J Neuroradiol 27(6):1165–1176

    PubMed  CAS  Google Scholar 

  4. Frohman EM, Racke MK, Raine CS (2006) Multiple sclerosis––the plaque and its pathogenesis. N Engl J Med 354(9):942–955

    Article  PubMed  CAS  Google Scholar 

  5. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cotton F, Weiner HL, Jolesz FA, Guttmann CR (2003) MRI contrast uptake in new lesions in relapsing-remitting MS followed at weekly intervals. Neurology 60(4):640–646

    Article  PubMed  Google Scholar 

  7. Rovira A, Wattjes MP, Tintore M, Tur C, Yousry TA, Sormani MP, De Stefano N, Filippi M, Auger C, Rocca MA, Barkhof F, Fazekas F, Kappos L, Polman C, Miller D, Montalban X (2015) Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. Nat Rev Neurol 11(8):471–482

    Article  PubMed  Google Scholar 

  8. Traboulsee A, Simon JH, Stone L, Fisher E, Jones DE, Malhotra A, Newsome SD, Oh J, Reich DS, Richert N, Rammohan K, Khan O, Radue EW, Ford C, Halper J, Li D (2016) 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. AJNR Am J Neuroradiol 37(3):394–401

    Article  PubMed  CAS  Google Scholar 

  9. Wattjes MP, Rovira A, Miller D, Yousry TA, Sormani MP, de Stefano MP, Tintore M, Auger C, Tur C, Filippi M, Rocca MA, Fazekas F, Kappos L, Polman C, Frederik B, Xavier M (2015) Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis––establishing disease prognosis and monitoring patients. Nat Rev Neurol 11(10):597–606

    PubMed  CAS  Google Scholar 

  10. Ali EN, Buckle GJ (2009) Neuroimaging in multiple sclerosis. Neurol Clin 27(1):203–219 ix

    Article  PubMed  Google Scholar 

  11. Rovira A, Auger C, Alonso J (2013) Magnetic resonance monitoring of lesion evolution in multiple sclerosis. Ther Adv Neurol Disord 6(5):298–310

    Article  PubMed  PubMed Central  Google Scholar 

  12. van Munster CE, Jonkman LE, Weinstein HC, Uitdehaag BM, Geurts JJ (2015) Gray matter damage in multiple sclerosis: impact on clinical symptoms. Neuroscience 303:446–461

    Article  PubMed  CAS  Google Scholar 

  13. Calabrese M, Filippi M, Gallo P (2010) Cortical lesions in multiple sclerosis. Nat Rev Neurol 6(8):438–444

    Article  PubMed  Google Scholar 

  14. Calabrese M, Castellaro M (2017) Cortical gray matter MR imaging in multiple sclerosis. Neuroimaging Clin N Am 27(2):301–312

    Article  PubMed  Google Scholar 

  15. Kutzelnigg A, Lucchinetti CF, Stadelmann C, Bruck W, Rauschka H, Bergmann M, Schmidbauer M, Parisi JE, Lassmann H (2005) Cortical demyelination and diffuse white matter injury in multiple sclerosis. Brain 128(Pt 11):2705–2712

    Article  PubMed  Google Scholar 

  16. Peterson JW, Bo L, Mork S, Chang A, Trapp BD (2001) Transected neurites, apoptotic neurons, and reduced inflammation in cortical multiple sclerosis lesions. Ann Neurol 50(3):389–400

    Article  PubMed  CAS  Google Scholar 

  17. Calabrese M, De Stefano N, Atzori M, Bernardi V, Mattisi I, Barachino L, Morra A, Rinaldi L, Romualdi C, Perini P, Battistin L, Gallo P (2007) Detection of cortical inflammatory lesions by double inversion recovery magnetic resonance imaging in patients with multiple sclerosis. Arch Neurol 64(10):1416–1422

    Article  PubMed  Google Scholar 

  18. Sethi V, Yousry TA, Muhlert N, Ron M, Golay X, Wheeler-Kingshott C, Miller DH, Chard DT (2012) Improved detection of cortical MS lesions with phase-sensitive inversion recovery MRI. J Neurol Neurosurg Psychiatry 83(9):877–882

    Article  PubMed  Google Scholar 

  19. Calabrese M, Rocca MA, Atzori M, Mattisi I, Bernardi V, Favaretto A, Barachino L, Romualdi C, Rinaldi L, Perini P, Gallo P, Filippi M (2009) Cortical lesions in primary progressive multiple sclerosis: a 2-year longitudinal MR study. Neurology 72(15):1330–1336

    Article  PubMed  CAS  Google Scholar 

  20. Nelson F, Datta S, Garcia N, Rozario NL, Perez F, Cutter G, Narayana PA, Wolinsky JS (2011) Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis. Mult Scler (Houndmills, Basingstoke, Engl) 17(9):1122–1129

    Article  Google Scholar 

  21. Jonkman LE, Klaver R, Fleysher L, Inglese M, Geurts JJ (2015) Ultra-high-field MRI visualization of cortical multiple sclerosis lesions with T2 and T2*: a postmortem MRI and histopathology study. AJNR Am J Neuroradiol 36(11):2062–2067

    Article  PubMed  CAS  Google Scholar 

  22. Seewann A, Kooi EJ, Roosendaal SD, Pouwels PJ, Wattjes MP, van der Valk P, Barkhof F, Polman CH, Geurts JJ (2012) Postmortem verification of MS cortical lesion detection with 3D DIR. Neurology 78(5):302–308

    Article  PubMed  CAS  Google Scholar 

  23. Geurts JJ, Bo L, Pouwels PJ, Castelijns JA, Polman CH, Barkhof F (2005) Cortical lesions in multiple sclerosis: combined postmortem MR imaging and histopathology. AJNR Am J Neuroradiol 26(3):572–577

    PubMed  Google Scholar 

  24. Kilsdonk ID, Jonkman LE, Klaver R, van Veluw SJ, Zwanenburg JJ, Kuijer JP, Pouwels PJ, Twisk JW, Wattjes MP, Luijten PR, Barkhof F, Geurts JJ (2016) Increased cortical grey matter lesion detection in multiple sclerosis with 7 T MRI: a post-mortem verification study. Brain 139(Pt 5):1472–1481

    Article  PubMed  Google Scholar 

  25. Gaitan MI, Shea CD, Evangelou IE, Stone RD, Fenton KM, Bielekova B, Massacesi L, Reich DS (2011) Evolution of the blood-brain barrier in newly forming multiple sclerosis lesions. Ann Neurol 70(1):22–29

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Masdeu JC, Quinto C, Olivera C, Tenner M, Leslie D, Visintainer P (2000) Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology 54(7):1427–1433

    Article  PubMed  CAS  Google Scholar 

  27. Bot JC, Barkhof F, Polman CH, Lycklama A, Nijeholt GJ, de Groot V, Bergers E, Ader HJ, Castelijns JA (2004) Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology 62(2):226–233

    Article  PubMed  CAS  Google Scholar 

  28. Bermel RA, Naismith RT (2015) Using MRI to make informed clinical decisions in multiple sclerosis care. Curr Opin Neurol 28(3):244–249

    Article  PubMed  Google Scholar 

  29. Chen JJ, Carletti F, Young V, McKean D, Quaghebeur G (2016) MRI differential diagnosis of suspected multiple sclerosis. Clin Radiol 71(9):815–827

    Article  PubMed  CAS  Google Scholar 

  30. Tartaglino LM, Friedman DP, Flanders AE, Lublin FD, Knobler RL, Liem M (1995) Multiple sclerosis in the spinal cord: MR appearance and correlation with clinical parameters. Radiology 195(3):725–732

    Article  PubMed  CAS  Google Scholar 

  31. Marques IB, Matias F, Silva ED, Cunha L, Sousa L (2014) Risk of multiple sclerosis after optic neuritis in patients with normal baseline brain MRI. J Clin Neurosci 21(4):583–586

    Article  PubMed  Google Scholar 

  32. Petzold A, Wattjes MP, Costello F, Flores-Rivera J, Fraser CL, Fujihara K, Leavitt J, Marignier R, Paul F, Schippling S, Sindic C, Villoslada P, Weinshenker B, Plant GT (2014) The investigation of acute optic neuritis: a review and proposed protocol. Nat Rev Neurol 10(8):447–458

    Article  PubMed  Google Scholar 

  33. Hickman SJ, Brierley CM, Brex PA, MacManus DG, Scolding NJ, Compston DA, Miller DH (2002) Continuing optic nerve atrophy following optic neuritis: a serial MRI study. Mult Scler (Houndmills, Basingstoke, Engl) 8(4):339–342

    Article  CAS  Google Scholar 

  34. Freedman MS, Selchen D, Arnold DL, Prat A, Banwell B, Yeung M, Morgenthau D, Lapierre Y (2013) Treatment optimization in MS: Canadian MS Working Group updated recommendations. Can J Neurol Sci 40(3):307–323

    Article  PubMed  Google Scholar 

  35. Cross AH, Naismith RT (2014) Established and novel disease-modifying treatments in multiple sclerosis. J Intern Med 275(4):350–363

    Article  PubMed  CAS  Google Scholar 

  36. Wattjes MP, Barkhof F (2014) Diagnosis of natalizumab-associated progressive multifocal leukoencephalopathy using MRI. Curr Opin Neurol 27(3):260–270

    Article  PubMed  CAS  Google Scholar 

  37. Bag AK, Cure JK, Chapman PR, Roberson GH, Shah R (2010) JC virus infection of the brain. AJNR Am J Neuroradiol 31(9):1564–1576

    Article  PubMed  CAS  Google Scholar 

  38. Yousry TA, Pelletier D, Cadavid D, Gass A, Richert ND, Radue EW, Filippi M (2012) Magnetic resonance imaging pattern in natalizumab-associated progressive multifocal leukoencephalopathy. Ann Neurol 72(5):779–787

    Article  PubMed  CAS  Google Scholar 

  39. Fraum TJ, Ludwig DR, Bashir MR, Fowler KJ (2017) Gadolinium-based contrast agents: a comprehensive risk assessment. J Magn Reson Imaging 46(2):338–353

    Article  PubMed  Google Scholar 

  40. Beam AS, Moore KG, Gillis SN, Ford KF, Gray T, Steinwinder AH, Graham A (2017) GBCAs and risk for nephrogenic systemic fibrosis: a literature review. Radiol Technol 88(6):583–589

    PubMed  Google Scholar 

  41. Cowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE (2000) Scleromyxoedema-like cutaneous diseases in renal-dialysis patients. Lancet (Lond, Engl) 356(9234):1000–1001

    Article  CAS  Google Scholar 

  42. Zou Z, Zhang HL, Roditi GH, Leiner T, Kucharczyk W, Prince MR (2011) Nephrogenic systemic fibrosis: review of 370 biopsy-confirmed cases. JACC Cardiovascular imaging 4(11):1206–1216

    Article  PubMed  Google Scholar 

  43. Grobner T (2006) Gadolinium––a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 21(4):1104–1108

    Article  PubMed  CAS  Google Scholar 

  44. Marckmann P, Skov L, Rossen K, Dupont A, Damholt MB, Heaf JG, Thomsen HS (2006) Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 17(9):2359–2362

    Article  PubMed  Google Scholar 

  45. Ramalho J, Ramalho M (2017) Gadolinium deposition and chronic toxicity. Magn Reson Imaging Clin N Am 25(4):765–778

    Article  PubMed  Google Scholar 

  46. Beckett KR, Moriarity AK, Langer JM (2015) Safe use of contrast media: what the radiologist needs to know. Radiographics 35(6):1738–1750

    Article  PubMed  Google Scholar 

  47. McDonald RJ, McDonald JS, Kallmes DF, Jentoft ME, Paolini MA, Murray DL, Williamson EE, Eckel LJ (2017) Gadolinium deposition in human brain tissues after contrast-enhanced MR imaging in adult patients without intracranial abnormalities. Radiology 285(2):546–554

    Article  PubMed  Google Scholar 

  48. Kanda T, Matsuda M, Oba H, Toyoda K, Furui S (2015) Gadolinium deposition after contrast-enhanced MR imaging. Radiology 277(3):924–925

    Article  PubMed  Google Scholar 

  49. Splendiani A, Perri M, Marsecano C, Vellucci V, Michelini G, Barile A, Di Cesare E (2017) Effects of serial macrocyclic-based contrast materials gadoterate meglumine and gadobutrol administrations on gadolinium-related dentate nuclei signal increases in unenhanced T1-weighted brain: a retrospective study in 158 multiple sclerosis (MS) patients. Radiol Med. https://doi.org/10.1007/s11547-017-0816-9

  50. European Medicines Agency (2017) EMA’s final opinion confirms restrictions on use of linear gadolinium agents in body scans. European Medicines Agency, London

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, St. Vincent’s University Hospital, Elm Park, Nutley Lane, Dublin 4, D04 T6F4, Ireland

    Alexis M. Cahalane, Yvonne M. Purcell & Ronan P. Killeen

  2. Department of Neurology, St. Vincent’s University Hospital, Elm Park, Nutley Lane, Dublin 4, D04 T6F4, Ireland

    Hugh Kearney & Christopher McGuigan

Authors
  1. Alexis M. Cahalane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hugh Kearney
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yvonne M. Purcell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher McGuigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ronan P. Killeen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexis M. Cahalane.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cahalane, A.M., Kearney, H., Purcell, Y.M. et al. MRI and multiple sclerosis––the evolving role of MRI in the diagnosis and management of MS: the radiologist’s perspective. Ir J Med Sci 187, 781–787 (2018). https://doi.org/10.1007/s11845-017-1714-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-017-1714-9

Keywords

Search

Navigation