Table 5:

Clinical guidelines for brain and spinal cord MRI in MS

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.