Demyelination protocol (MRI)

MRI protocol for demyelinating diseases is a group of MRI sequences put together to best approach these white matter disorders characterized by the destruction or damage of normally myelinated structures. These disorders may be inflammatory, infective, ischaemic or toxic in origin. 

Note: This article is intended to outline some general principles of protocol design. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols, patient factors (e.g. allergy) and time constraints. 


A good protocol for this purpose involves at least:

  • T1
    • sequence: axial; in modern scanners, it can be replaced by a 3D isotropic acquisition 
    • purpose: anatomical, best for assessing volume loss. This is particularly important for multiple sclerosis as brain volume loss is correlated with disease severity and disability 2,3
  • T2
    • sequence: axial, especially focused on posterior fossa
    • purpose: white matter signal abnormality. T2 is more sensitive than FLAIR for infratentorial lesions
    • sequence: axial and sagittal; in modern scanners it can be replaced by a 3D isotropic acquisition
    • purpose: white matter signal abnormality. FLAIR is more sensitive than T2 in detection of juxtacortical and periventricular plaques
    • purpose: active demyelinating MS plaques may demonstrate restricted diffusion
  • SWI or T2*
  • T1 C+ (Gd) 
MRI protocols
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