Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines

Massimo Filippi; Paolo Preziosa; Brenda L Banwell; Frederik Barkhof; Olga Ciccarelli; Nicola De Stefano; Jeroen J G Geurts; Friedemann Paul; Daniel S Reich; Ahmed T Toosy; Anthony Traboulsee; Mike P Wattjes; Tarek A Yousry; Achim Gass; Catherine Lubetzki; Brian G Weinshenker; Maria A Rocca

doi:10.1093/brain/awz144

Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines

Brain. 2019 Jul 1;142(7):1858-1875. doi: 10.1093/brain/awz144.

Authors

Massimo Filippi^{1

2

3}, Paolo Preziosa^{1

3}, Brenda L Banwell⁴, Frederik Barkhof^{5

6}, Olga Ciccarelli^{7

8}, Nicola De Stefano⁹, Jeroen J G Geurts¹⁰, Friedemann Paul¹¹, Daniel S Reich¹², Ahmed T Toosy⁷, Anthony Traboulsee^{13

14}, Mike P Wattjes¹⁵, Tarek A Yousry^{16

17}, Achim Gass¹⁸, Catherine Lubetzki¹⁹, Brian G Weinshenker²⁰, Maria A Rocca^{1

2}

Affiliations

¹ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
² Neurology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
³ Vita-Salute San Raffaele University, Milan, Italy.
⁴ Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
⁵ Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
⁶ Institutes of Neurology and Healthcare Engineering, University College London, London, UK.
⁷ Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, UK.
⁸ National Institute for Health Research University College London Hospitals Biomedical Research Center, National Institute for Health Research, London, UK.
⁹ Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
¹⁰ Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹¹ NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité -Universitätsmedizin Berlin, Berlin, Germany.
¹² Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
¹³ MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁴ Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁵ Department of Neuroradiology, Hannover Medical School, Hannover, Germany.
¹⁶ Division of Neuroradiology and Neurophysics, UCL Institute of Neurology, London, UK.
¹⁷ Lysholm Department of Neuroradiology, London, UK.
¹⁸ Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
¹⁹ Sorbonne University, AP-HP Pitié-Salpétriére Hospital, Department of Neurology, 75013 Paris, France.
²⁰ Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Abstract

MRI has improved the diagnostic work-up of multiple sclerosis, but inappropriate image interpretation and application of MRI diagnostic criteria contribute to misdiagnosis. Some diseases, now recognized as conditions distinct from multiple sclerosis, may satisfy the MRI criteria for multiple sclerosis (e.g. neuromyelitis optica spectrum disorders, Susac syndrome), thus making the diagnosis of multiple sclerosis more challenging, especially if biomarker testing (such as serum anti-AQP4 antibodies) is not informative. Improvements in MRI technology contribute and promise to better define the typical features of multiple sclerosis lesions (e.g. juxtacortical and periventricular location, cortical involvement). Greater understanding of some key aspects of multiple sclerosis pathobiology has allowed the identification of characteristics more specific to multiple sclerosis (e.g. central vein sign, subpial demyelination and lesional rims), which are not included in the current multiple sclerosis diagnostic criteria. In this review, we provide the clinicians and researchers with a practical guide to enhance the proper recognition of multiple sclerosis lesions, including a thorough definition and illustration of typical MRI features, as well as a discussion of red flags suggestive of alternative diagnoses. We also discuss the possible place of emerging qualitative features of lesions which may become important in the near future.

Keywords: diagnostic criteria; guidelines; lesions; magnetic resonance imaging; multiple sclerosis.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Multiple Sclerosis / diagnostic imaging*
Neuroimaging
Practice Guidelines as Topic*

Abstract

Publication types

MeSH terms

Grants and funding