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New Recommendations on MRI Diagnosis of MS


New revisions to the MRI criteria for the diagnosis of multiple sclerosis (MS) have been proposed.

The revisions, published online in The Lancet Neurology on January 25, have been put forward by the European collaborative research network that studies MRI in MS (MAGNIMS).

MAGNIMS member and coauthor of the paper, Maria A. Rocca, MD, San Raffaele Scientific Institute, Milan, Italy, explained to Medscape Medical News that diagnosis of MS relies on proof of disease "dissemination in space and time" — meaning symptoms or lesions need to be seen in different locations and at different times.

The new recommendations for MRI diagnosis mainly relate to the "dissemination in space" criteria, which Dr Rocca says currently lead to MS being overdiagnosed. "We have proposed slightly stricter conditions for some of these criteria, which we believe will lead to more accurate diagnosis," she said.

The recommendations are the product of discussions at a MAGNIMS workshop that had the goal of providing an "evidence-based and expert-opinion consensus on proposed modifications to MRI criteria for the diagnosis of multiple sclerosis." Travel expenses for the workshop were paid by Novartis through a provider.

The author of an accompanying editorial, Dr Robert J. Fox, Cleveland Clinic, Ohio, who is not part of the MAGNIMS group, told Medscape Medical News that the new recommendations were a "helpful step forward" in diagnosing MS.

He explained that MRI has become an invaluable tool for MS diagnosis and following the evolution of the disease over time. "But how MRI is used to confirm or exclude MS and the specific criteria needed for an MS diagnosis change over time as new studies are reported."

He noted that if there is more than one clinical episode in different locations in the body, an MRI is not needed to diagnose MS. "But it is helpful to confirm the diagnosis and to stage the disease. But if there has been only one clinical symptom, then an MRI is often conducted to look for characteristic lesions to confirm the diagnosis."

There has always been the requirement that lesions should be found in at least two different locations, Dr Fox added. "The new recommendations still specify this requirement but instead of four different possible locations to consider they have added in another one — the optic nerve. This will widen the diagnosis a little. But they have also raised the requirements when considering lesions in the periventricular space, which will narrow the diagnosis. The net result is that an MS diagnosis should now be more precise."

The new document recommends that to fulfil the "dissemination in space," at least two of the following are required:

  • Three or more periventricular lesions;
  • One or more infratentorial lesion;
  • One or more spinal cord lesion;
  • One or more optic nerve lesion; and
  • One or more cortical or juxtacortical lesion.

Story Source: The above story is based on materials provided by MEDSCAPE
Note: Materials may be edited for content and length

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