MAGNIMS consensus on MRI diagnosis of multiple sclerosis
The magnetic resonance imaging in multiple sclerosis (MAGNIMS), which is a European collaborative research network, published in 2016 new recommendations to upgrade the imaging diagnosis criteria for multiple sclerosis (MS). These came as a consensus, based on evidence-based and expert opinions 2, aiming to improve the last update of McDonald diagnostic criteria in 2010 1.
The new recommendations are focused on the McDonald "dissemination in space" criteria, proposing simultaneously a widening and narrowing of these criteria:
optic neuritis was added to the previous four defined locations characteristic for MS (periventricular, cortical, infratentorial and spinal cord)
- justification: ~25% with a clinically isolated syndrome present with acute optic neuritis
- minimum requirement of three lesions in a periventricular location
- justification: incidental periventricular lesions are also found in healthy individuals and in other conditions (e.g. migraine); the minimum of three lesions increased the diagnosis accuracy in different studies
- cortical location was added together to the previous juxtacortical location
- justification: pathology studies have shown large grey matter involvement in MS and new MRI techniques have improved the sensitivity for the detection of those cortical lesions 3-7, although, there was no consensus on the optimal MRI technique for the detection of cortical lesions, and many cortical lesions remain invisible on 1.5T and 3.0T scanners
- comment: as with the routine scanners the differentiation between cortical and juxtacortical is not reliable, the consensus was that those lesions should be combined in a single term "cortical-juxtacortical"
Regarding both the "dissemination in space" and "dissemination in time":
- no distinction between symptomatic and asymptomatic MRI lesions has to be made, all lesions are now considered when counting for either dissemination in space either dissemination in time
Dissemination in space
The new 2016 MAGNIMS MRI criteria establish disease dissemination in space, by detecting involvement of at least two of the five following areas of the CNS:
- periventricular: ≥3 lesions
- cortical-juxtacortical: ≥1 lesions
- infratentorial: ≥1 lesions
- spinal cord: ≥1 lesions
- optic nerve: ≥1 lesions
Dissemination in time
Dissemination in time can be established in one of two ways:
- a new lesion when compared to a previous scan (irrespective of timing)
- T2 bright lesion and/or gadolinium-enhancing
- presence of enhancing lesion and a non-enhancing T2 bright lesion on any one scan
- 1. Polman CH1, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011 Feb;69(2):292-302. doi: 10.1002/ana.22366.
- 2. Filippi , Rocca MA, Ciccarelli O. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol 2016; 15: 292–303. doi: 10.1016/S1474-4422(15)00393-2
- 3. Geurts JJ, Pouwels PJ, Uitdehaag BM, Polman CH, Barkhof F, Castelijns JA. Intracortical lesions in multiple sclerosis: improved detection with 3D double inversion-recovery MR imaging. Radiology 2005; 236: 254–60.
- 4. Nelson F, Poonawalla AH, Hou P, Huang F, Wolinsky JS, Narayana PA. Improved identifi cation of intracortical lesions in multiple sclerosis with phase-sensitive inversion recovery in combination with fast double inversion recovery MR imaging. AJNR Am J Neuroradiol 2007; 28: 1645–49.
- 5. Sethi V, Yousry TA, Muhlert N, et al. Improved detection of cortical MS lesions with phase-sensitive inversion recovery MRI. J Neurol Neurosurg Psychiatry 2012; 83: 877–82.
- 6. Favaretto A, Poggiali D, Lazzarotto A, Rolma G, Causin F, Gallo P. The parallel analysis of phase sensitive inversion recovery (PSIR) and double inversion recovery (DIR) images signifi cantly improves the detection of cortical lesions in multiple sclerosis (MS) since clinical onset. PLoS One 2015; 10: e0127805.
- 7. Nelson F, Poonawalla A, Hou P, Wolinsky JS, Narayana PA. 3D MPRAGE improves classifi cation of cortical lesions in multiple sclerosis. Mult Scler 2008; 14: 1214–19
- primary demyelinating disorders
- clinically isolated syndrome (CIS)
- radiologically isolated syndrome (RIS)
- multiple sclerosis (MS)
- neuromyelitis optica (NMO) (Devic disease)
- acute disseminated encephalomyelitis (ADEM) and acute haemorrhagic encephalomyelitis (AHEM)
- tumefactive demyelinating lesions
- transverse myelitis
- chronic inflammatory demyelinating polyneuropathy (CIDP)
- Guillain-Barre Syndrome (GBS)
- primary demyelinating disorders