Table 2:

Standardized brain MRI protocol (diagnosis and routine follow-up of MS)

Field strengthScans should be of good quality, with adequate SNR and resolution (in-sections, pixel resolution of ≤1 × 1 mm)
Scan prescriptionUse the subcallosal plane to prescribe or reformat axial oblique sections (Fig 1)
CoverageWhole-brain coverage
Section thickness and gap≤3 mm, No gap (for 2D acquisition or 3D reconstruction)
Core sequencesAnatomic 3D inversion recovery–prepared T1 gradient echo (eg, 1.0- to 1.5-mm thickness)
Gadolinium single dose, 0.1 mmol/kg given for 30 secondsa
3D sagittal T2WI FLAIRb (eg, 1.0- to 1.5-mm thickness)
3D T2WI b (eg, 1.0- to 1.5-mm thickness)
2D axial DWI (≤5-mm sections, no gap)
3D FLASH (non-IR prep) postgadoliniumb (eg, 1.0- to 1.5-mm thickness)
3D series would be typically reconstructed to 3-mm thickness for display and subsequent comparison for lesion counts
Optional sequencesAxial proton attenuation
Pre- or postgadolinium axial T1 spin-echo (for chronic black holes)
SWI for identification of central vein within T2 lesions
  • Note:—IR indicates inversion recovery.

  • a Minimum 5-minute delay before obtaining postgadolinium T1. The 3D sagittal FLAIR may be acquired immediately after contrast injection before the 3D FLASH series.

  • b If unable to perform a 3D acquisition, then perform 2D axial and sagittal FLAIR, axial fast spin-echo proton attenuation/T2, and axial post-gadolinium T1WI spin-echo at ≤3-mm section thickness.