La radiologia medica

, Volume 118, Issue 2, pp 251–264 | Cite as

Contribution of magnetic resonance imaging to the diagnosis and monitoring of multiple sclerosis

Neuroradiology / Neuroradiologia

Abstract

Magnetic resonance (MR) imaging is an extremely sensitive modality for detecting focal changes to the white matter (WM) in patients with multiple sclerosis (MS). For this reason, it has become an integral part of the diagnostic workup of patients with clinically isolated syndromes who are at risk of developing definite MS, and it is always recommended in patients with definite MS to confirm the diagnosis and monitor the disease course. Crucial to the use of MR imaging for diagnostic purposes is the identification of lesion features — in terms of site, shape and size — that may be considered suggestive or typical for MS, and thus help in the differential diagnosis with other neurological diseases with similar clinical presentation to MS. This need has led to the publication of several guidelines for characterising MS lesions on both dualecho (T2 and proton density) and T1-weighted sequences after administration of contrast material. Developments in clinical research into MS have highlighted the need to formulate a diagnosis as far as possible on the basis of objective and reproducible criteria. Currently, when making a clinical diagnosis and monitoring patients with suspected MS, neurologists and neuroradiologists make use of specific diagnostic criteria that have changed over the years and will probably continue to be updated. It is therefore crucial for radiologists to become familiar with these criteria in order to improve the quality of their diagnostic assessment. In patients with a definite diagnosis of MS, on the other hand, the main problem is to define standard procedures for monitoring the course of the disease and response to pharmacological treatments. even though no guidelines currently exist, it is possible to suggest some strategies to improve the assessment in this setting.

Keywords

Magnetic resonance imaging Multiple sclerosis Diagnosis Monitoring 

Diagnosi precoce e monitoraggio nella sclerosi multipla: il contributo della risonanza magnetica

Riassunto

La risonanza magnetica (RM) è una metodica estremamente sensibile nel rilevare le alterazioni focali della sostanza bianca (SB) dei pazienti con sclerosi multipla (SM). Per questo motivo, è parte integrante del processo diagnostico in pazienti con sindromi clinicamente isolate (CIS) a rischio di evoluzione verso una forma definita di SM, ed è sempre consigliata nei pazienti con SM conclamata per confermare la diagnosi e per monitorarne l’evoluzione. Uno dei punti fondamentali per l’utilizzo della RM a scopo diagnostico è l’identificazione di caratteristiche di imaging delle lesioni, in termini di sede, forma, e dimensioni, che possano essere considerate suggestive o tipiche di SM, e contribuire cosÌ al processo di diagnosi differenziale verso altre patologie neurologiche, che possono avere un esordio clinico simile a quello della SM. Ciò ha condotto alla pubblicazione di diverse linee-guida per la caratterizzazione delle lesioni della SM sia sulle sequenze pesate in doppio-eco (T2 e densità protonica) che su quelle pesate in T1 dopo somministrazione di mezzo di contrasto. Lo sviluppo della ricerca clinica sulla SM ha da tempo evidenziato la necessità di giungere ad una diagnosi basata su criteri il più possibile oggettivi e riproducibili. Attualmente, neurologi e neuroradiologi basano l’inquadramento clinico e il monitoraggio dei pazienti con un sospetto di SM su specifici criteri diagnostici che si sono andati modificando nel tempo e che molto probabilmente continueranno ad essere aggiornati. è quindi fondamentale che il radiologo acquisisca familiarità con tali criteri al fine di migliorare la qualità della sua valutazione diagnostica. nei pazienti con una diagnosi certa di SM, il problema fondamentale è invece quello di definire delle procedure standard per il monitoraggio del decorso della malattia e della risposta a trattamenti farmacologici. Anche se in questo caso mancano linee-guida definite, è possibile suggerire alcune strategie per migliorare le modalità di valutazione in questo ambito.

Parole chiave

Risonanza magnetica Sclerosi multipla diagnosi Monitoraggio 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References/Bibliografia

  1. 1.
    Schumacher GA (1966) Problems of multiple sclerosis. N Y State J Med 66:1743–1752PubMedGoogle Scholar
  2. 2.
    Poser CM, Paty DW, Scheinberg L et al (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231PubMedCrossRefGoogle Scholar
  3. 3.
    Paty DW, Oger JJ, Kastrukoff LF et al (1988) MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 38:180–185PubMedCrossRefGoogle Scholar
  4. 4.
    Fazekas F, Offenbacher H, Fuchs S et al (1988) Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis. Neurology 38:1822–1825PubMedCrossRefGoogle Scholar
  5. 5.
    Barkhof F, Filippi M, Miller DH et al (1997) Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 120(Pt 11):2059–2069PubMedCrossRefGoogle Scholar
  6. 6.
    McDonald WI, Compston A, Edan G et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127PubMedCrossRefGoogle Scholar
  7. 7.
    Polman CH, Reingold SC, Edan G et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol 58:840–846PubMedCrossRefGoogle Scholar
  8. 8.
    Swanton JK, Rovira A, Tintore M et al (2007) MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study. Lancet Neurol 6:677–686PubMedCrossRefGoogle Scholar
  9. 9.
    Rovira A, Swanton J, Tintore M et al (2009) A single, early magnetic resonance imaging study in the diagnosis of multiple sclerosis. Arch Neurol 66:587–592PubMedCrossRefGoogle Scholar
  10. 10.
    Montalban X, Tintore M, Swanton J et al (2010) MRI criteria for MS in patients with clinically isolated syndromes. Neurology 74:427–434PubMedCrossRefGoogle Scholar
  11. 11.
    Geurts JJ, Pouwels PJ, Uitdehaag BM (2005) Intracortical lesions in multiple sclerosis: improved detection with 3D double inversion-recovery MR imaging. Radiology 236:254–260PubMedCrossRefGoogle Scholar
  12. 12.
    Filippi M, Rocca MA, Calabrese M et al (2010) Intracortical lesions: relevance for new diagnostic criteria for multiple sclerosis. Neurology 75:1988–1994PubMedCrossRefGoogle Scholar
  13. 13.
    Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Ann Neurol 69:292–302PubMedCrossRefGoogle Scholar
  14. 14.
    Rio J, Castillo J, Rovira A et al (2009) Measures in the first year of therapy predict the response to interferon beta in MS. Mult Scler 15:848–853PubMedCrossRefGoogle Scholar
  15. 15.
    Rio J, Comabella M, Montalban X (2009) Predicting responders to therapies for multiple sclerosis. Nat Rev Neurol 5:553–560PubMedCrossRefGoogle Scholar
  16. 16.
    Filippi M, Rocca MA, Arnold DL et al (2006) EFNS guidelines on the use of neuroimaging in the management of multiple sclerosis. Eur J Neurol 13:313–325PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • M. A. Rocca
    • 1
    • 2
  • N. Anzalone
    • 3
  • A. Falini
    • 3
  • M. Filippi
    • 1
    • 2
  1. 1.Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilanItaly
  2. 2.Department of Neurology, San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilanItaly
  3. 3.Neuroradiology Unit, San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilanItaly

Personalised recommendations