Clinical guidelines for brain and spinal cord MRI in MS
| Guidelines |
|---|
| Baseline studies for patients with a CIS and/or suspected MS |
| Brain MRI protocol with gadolinium at baseline and |
| Spinal cord MRI if transverse myelitis, insufficient features on brain MRI to support diagnosis, or age older than 40 years with nonspecific brain MRI findings |
| A cervical cord MRI performed simultaneously with the brain MRI would be advantageous in the evaluation of patients with or without transverse myelitis and would reduce the number of patients requiring a subsequent MRI appointment |
| Orbital MRI if severe optic neuritis with poor recovery |
| Timing of a follow-up brain MRI protocol for patients with a CIS and/or suspected MS to look for evidence of dissemination in time |
| 6–12 Months for high-risk CIS (eg, ≥2 ovoid lesions on first MRI) |
| 12–24 Months for low-risk CIS (ie, normal brain MRI findings) and/or uncertain clinical syndrome with suspicious brain MRI features (eg, RIS) |
| Timing of brain MRI protocol with gadolinium for patients with an established diagnosis of MS |
| No recent prior imaging available (eg, patient with MS transferring to a new clinic) |
| Postpartum to establish a new baseline |
| Prior to starting or switching disease-modifying therapy |
| Approximately 6 months after switching disease-modifying therapy to establish a new baseline on the new therapy |
| Every 1–2 years while on disease-modifying therapy to assess subclinical disease activity |
| Unexpected clinical deterioration or reassessment of original diagnosisa |
| Timing of PML surveillance brain MRI protocol |
| Every 12 months for patients negative for serum JC virus antibody |
| Every 3–6 months for patients positive for serum JC virus antibody and ≥18 months on natalizumabb |
Note:—JC indicates John Cunningham; RIS, radiologic isolated syndrome.
↵a Routine spinal cord follow-up not required unless syndrome is predominately recurrent transverse myelitis.
↵b The brain MRI protocol for monitoring patients on disease modifying therapies includes the PML surveillance sequences.