A Review of Multiple Sclerosis Diagnostic MRI Guidelines | ||
| The Medical Journal of Cairo University | ||
| Volume 93, Issue 09, September 2025 PDF (157.84 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/mjcu.2025.464233 | ||
| Author | ||
| MOHAMED S. NASR ELDIN, Ph.D.; AHMED GOMAA MAHMOUD, M.Sc.; AMR KHAMIS MOHAMMAD, M.Sc.; AZIZA RAMADAN MUSTAFA, M.Sc.; MARIAM ASHRAF ABDEEN, M.Sc. and KARIM HUSSEIN ABDEL AL, M.Sc. | ||
| The Department of Radiology, College of Applied Health Sciences Technology, University of 6 October | ||
| Abstract | ||
| Background: Magnetic Resonance Imaging (MRI) is central to the diagnosis and management of multiple sclero-sis (MS). Conventional MRI sequences such as T2-weighted, T1-weighted, fluid-attenuated inversion recovery (FLAIR), and gadolinium-enhanced scans are well-established in de-tecting MS lesions and demonstrating dissemination in space and time per diagnostic criteria. However, these standard tech-niques have limitations, prompting the development of ad-vanced MRI modalities to Improve sensitivity and specificity for MS pathology. Aim of Study: This review provides a detailed analysis of MRI diagnostic guidelines for MS, comparing traditional se-quences with emerging and advanced techniques. We evaluate each modality’s strengths, limitations, diagnostic value (sensi-tivity/specificity), and recommended use cases. Special con-siderations for pediatric MS imaging are discussed. We aim to furnish neuroimaging researchers, clinicians, and radiologists with an up-to-date reference to inform both clinical practice and future research. Material and Methods: We systematically reviewed recent consensus guidelines and key studies, published between Feb-ruary 2010 and February 2025, on MS MRI, including the 2017 McDonald criteria and 2021 MAGNIMS–CMSC–NAIMS in-ternational recommendations, as well as research on advanced imaging sequences (double inversion recovery, susceptibili-ty-weighted imaging, diffusion tensor imaging, magnetization transfer imaging, 7-Tesla MRI, functional MRI, quantitative susceptibility mapping, myelin water imaging, connectomics, and machine learning-based analyses). Data on lesion detec-tion rates, diagnostic performance, and clinical correlations were extracted to compare modalities. Results: Conventional MRI at 1.5–3T with T2/FLAIR and gadolinium-enhanced T1 sequences remains the corner-stone for MS diagnosis, offering high sensitivity for white matter lesions but limited specificity for MS pathology. Newer 3D-FLAIR sequences at 3T improve lesion detection, especial-ly in periventricular and cortical regions. Advanced techniques provide incremental benefits: for example, double inversion recovery (DIR) improves cortical lesion visibility by 1.5–5× over FLAIR, and susceptibility-based MRI reveals the central vein sign with high specificity for MS lesions. Ultra-high-field 7T MRI further increases sensitivity for small lesions and cor-tical pathology. Diffusion and magnetization transfer imaging offer quantitative biomarkers of microstructural damage. At the same time, functional MRI and connectomic analyses shed light on network reorganization in MS. Conclusion: Conventional sequences, notably 3D-FLAIR and post-contrast T1-weighted imaging, continue to anchor MS diagnostic protocols, while advanced sequences such as DIR and SWI offer valuable adjuncts in complex or re-search-driven cases. Gadolinium use should be judicious and limited to initial diagnosis and selected monitoring needs. Advanced modalities improve detection of cortical and subtle lesions and provide prognostic insights but require further val-idation before widespread clinical adoption. Future directions include integrating higher-field imaging, quantitative markers, and AI-based tools into routine practice to enhance diagnostic precision and disease monitoring. This review highlights ev-idence-based imaging strategies for MS and identifies future directions to enhance MRI’s diagnostic and prognostic utility in this disease. | ||
| Keywords | ||
| Multiple Sclerosis (MS) – Magnetic Reso-nance Imaging (MRI) – Diagnostic Guidelines – Conventional MRI Sequences (T1-weighted; T2-weighted; FLAIR; Gadolin-ium-enhanced) – Advanced MRI Techniques (DIR; SWI; DTI; MTI; 7T MRI; fMRI) – Lesion Detection Diagnostic Perfor-mance – McDonald Criteria – MAGNIMS-CMSC-NAIMS Guidelines | ||
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