Diagnosis and management of multiple sclerosis: MRI in clinical practice
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ORIGINAL COMMUNICATION
Diagnosis and management of multiple sclerosis: MRI in clinical practice Valentina Tomassini1,2 · Audrey Sinclair3 · Vijay Sawlani4 · James Overell5 · Owen R. Pearson6 · Julie Hall7 · Joe Guadagno8 Received: 17 January 2020 / Revised: 12 May 2020 / Accepted: 18 May 2020 © The Author(s) 2020
Abstract Background Recent changes in the understanding and management of multiple sclerosis (MS) have increased the role of MRI in supporting diagnosis and disease monitoring. However, published guidelines on the use of MRI in MS do not translate easily into different clinical settings and considerable variation in practice remains. Here, informed by published guidelines for the use of MRI in MS, we identified a clinically informative MRI protocol applicable in a variety of clinical settings, from district general hospitals to tertiary centres. Methods MS specialists geographically representing the UK National Health Service and with expertise in MRI examined existing guidelines on the use of MRI in MS and identification of challenges in their applications in various clinical settings informed the formulation of a feasible MRI protocol. Results We identified a minimum set of MRI information, based on clinical relevance, as well as on applicability to various clinical settings. This informed the selection of MRI acquisitions for scanning protocols, differentiated on the basis of their purpose and stage of the disease, and indication of timing for scans. Advice on standardisation of MRI requests and reporting, and proposed timing and frequency of MRI scans were generated. Conclusions The proposed MRI protocol can adapt to a range of clinical settings, aiding the impetus towards standardisation of practice and offering an example of research-informed service improvement to support optimisation of resources. Other neurological conditions, where a gap still exists between published guidelines and their clinical implementation, may benefit from this same approach. Keywords Multiple sclerosis · MRI · Clinical practice · Diagnosis · Monitoring · Disease-modifying treatments
Introduction
Valentina Tomassini and Audrey Sinclair have contributed equally to this work. Given their different expertise that is relevant to this work, they also share correspondence for this manuscript.
Magnetic resonance imaging (MRI) is routinely used in clinical practice to detect and monitor inflammatory lesions in patients with multiple sclerosis (MS) [1]. Diagnostic criteria,
* Valentina Tomassini [email protected]
3
Department of Neuroradiology, St Georges Hospital, London, UK
* Audrey Sinclair [email protected]
4
Queen Elizabeth Hospital, Birmingham, UK
5
University of Glasgow, Glasgow, UK
1
6
Morriston Hospital, Swansea and Neath Port Talbot Hospitals, Port Talbot, UK
7
Royal Victoria Infirmary, Newcastle, UK
8
Newcastle Hospitals, Newcastle, UK
2
Department of Neurosciences, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies (
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