CMSC: MRI Protocol Recommendations

Attendees at the 2017 Annual Meeting of the Consortium of Multiple Sclerosis Centers heard there are revised recommended guidelines for the use of MRI (magnetic resonance imaging) in diagnosing and tracking progression in multiple sclerosis.  David K.B. Li. MD, FRCPC, introduced the revised recommendations for standardized protocol for MRI’s.

Dr. Anthony Traboulsee and Dr. David Li were two of the experts who worked on new MRI recommendations for CMSC.

Dr. Li has been in the field of radiology since the 1980’s and has championed the need for standardized protocol. He said the challenge is ‘how to use MRI in practical and cost effective ways.  In the 90’s there was some ambiguity about the quality of MRIs.  People were using different protocols and we couldn’t compare different MRIs. Through the Consortium, we had experts and clinicians from around the world, both neurologist and radiologists, come together to review our knowledge of MRIs.”

The Four U's

Dr. Li has adopted a theme for the revisions, based on four U’s – Universally Useful, Usable and Used.  He said the challenge was to make the guidelines useful and usable for everyone.  This is the fifth version of the recommendations – they were established in 2001 and the most recent version was adopted in 2015

“To be useful we want to be sure the guidelines are helpful and beneficial both for the patients and the people looking at the MRIs (neurologists and radiologists). Usable means the guidelines should be reasonable and practical,” said Dr. Li.    The final U – Used  - is a point Dr Li emphasized.  “There is no point in coming up with recommendations if no one uses them.  This probably has been the hardest part, getting people to accept those guidelines.” This U represents Used, and being acceptable and adopted.

Comparing MRIs

Dr. Li said the most important thing is MRIs done for diagnosis and for monitoring disease progression can be compared to previous MRI’s if the protocol is followed. “Someone has a scan from ten years ago, how do you compare it to one done today? When we first started using MRIs 25 years ago, the (imaging) slices were 10mm thick and now we can do them in 1mm,” said Dr. Li.  The thinner slice seen through MRI imaging allows a clearer look at lesions in the brain.  Dr. Li is excited about new scanners that allow for 3D acquisition of brain scans, saying this allows a better understanding of atrophy and ultimately is more useful for determining disease progression and if the disease modifying therapy the patient is on is effective.

The revision continues to state that the strength of the MRI machine is not critical, and the important part is using a standardized protocol. This standardization includes the issuing of reports post-MRI, that include common terminology to describe the findings and comparison with previous MRIs. The recommended description includes lesion type, location, size, shape, character, and number, and a qualitative assessment of T2, T1 and brain volume/atrophy.  The other part of the radiologist’s report should compare the results to previous MRI studies.

Consistency in Records

The whole concept of the CMSC recommendations is to allow consistency in the records, regardless of where the person with MS has their imaging done. By comparing previous MRIs, the doctors can construct the natural history of a person’s disease course with MS.

“If you do scans and they are different it becomes hard to compare if you change the way you acquire it using different scanners,” said Dr. Li.  “You know the saying garbage in, garbage out.  If you have good data being collected, it can be used 3, 5 or even 10 years from now.”

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