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10:54 CET
SA 5b - Current guidelines and diagnostic criteria in multiple sclerosis (MS)
Thursday, March 1, 08:30 - 10:00
Room: E2
Moderator: A. Rovira-Cañellas (Barcelona/ES)

Chairperson's introduction
A. Rovira-Cañellas; Barcelona/ES
Learning Objectives

1. To appreciate the importance of an accurate diagnosis of MS.
2. To learn about the value of diagnostic criteria for MS.
3. To understand the relevance of MRI for monitoring and predicting treatment response.
4. To become familiar with treatment-related adverse effects.


In the last few years, techniques and clinical implementation of MR imaging of multiple sclerosis (MS) have markedly evolved based on the relative large amount of new published data from clinical trials and observational studies, which assessed the value of this tool in the early and accurate diagnosis of MS. However, the role of MR imaging in MS goes far beyond the diagnostic process and differential diagnosis. MR imaging can also provide useful prognostic information in terms of long term disability prediction. Moreover, with the introduction of the new generation of immunomodulating/immunosuppressive drugs for the treatment of MS, MR imaging also plays an important role in treatment monitoring. This includes the prediction of treatment response, the assessment of treatment efficacy and treatment safety. In this state of the art symposium, the speakers will present up to date on the diagnostic criteria of MS, and on the value of MR imaging for monitoring and predicting treatment response and in the detection of treatment related adverse effects. All these information should help radiologists in the standardization and optimization of the use of MR imaging in the management of MS in clinical practice.

Update on new clinical diagnostic criteria
C. Enzinger; Graz/AT
Learning Objectives

1. To understand the scientific data underlying the evolution of the current diagnostic criteria.
2. To recognise chances and implications linked with the use of the new diagnostic criteria.
3. To become aware of the challenges implicated with the application of the new diagnostic criteria.


In the diagnostic process applied to people suspected to have multiple sclerosis (MS), MRI of the brain and spinal cord has become an indispensable tool to objectively demonstrate lesions disseminated in time and space, which are considered as a hallmark of the disease. MRI has been formally integrated in the diagnostic criteria first in 2001 by an international panel and - based on accumulating scientific evidence - revisions of these criteria have been provided in 2005, 2010 and, most recently, in 2017. The presentation will briefly review the scientific data underlying the evolution of the current diagnostic criteria, highlight the chances (e.g., rapid diagnosis) and implications (e.g., establishing early therapy) linked with their use, and raise awareness of the challenges (overdiagnosis) and pitfalls (misdiagnosis) potentially associated with the application of the new diagnostic criteria.

MRI for MS monitoring: the use of guidelines in clinical practice
M. P. Wattjes; Hannover/DE
Learning Objectives

1. To understand the importance of standardisation in terms of image acquisition and scan intervals in MS monitoring.
2. To learn about the most relevant and possible future MRI outcome measures for MS treatment monitoring purposes.
3. To appreciate the potential role of MRI in predicting MS treatment response.


Magnetic resonance imaging (MRI) plays an important role in the diagnosis of multiple sclerosis and has been incorporated into the McDonald diagnostic criteria for MS. The role of MRI in MS disease monitoring, particularly for MS treatment monitoring purposes, has been less clear defined. The need for standardization in terms of MR acquisition, scan intervals and image interpretation in MS pharmacovigilance is further stressed by the increasing numbers of MS therapeutics in the postmarketing setting. Therefore, MRI in MS pharmacovigilance is becoming increasingly important. The main goals of the use of MRI for this purpose are treatment efficacy monitoring, prediction of treatment response, and safety monitoring. Recent guidelines provided by the MAGNIMS collaboration (www.magnims.eu) and the consortium of MS centers (CMSC) provide some guidance how to implement MRI in the setting of MS pharmacovigilance. The standardized implementation of these guidelines in clinical practice will be of great help for (neuro)radiologists, neurologists, and patients.

MRI in monitoring treatment complications
J. Hodel; Créteil/FR
Learning Objectives

1. To learn about the most important treatment-related adverse events and their incidence.
2. To learn about the imaging pattern of these adverse events.
3. To become familiar with the algorithms used to monitor these side events and the central role of imaging in them.


Several immunosuppressive therapies are available in MS patients with a risk of progressive multifocal leukoencephalopathy (PML). MRI is crucial for the follow-up of treated patients because recognition of PML before the onset of clinical symptoms has important implications for patient care. The diagnosis of presymptomatic PML remains highly challenging due to the coexistence of MS lesions and the various imaging patterns observed at the early stages of disease. Recognition of the most predictive imaging features and comparison with previous MRI data may facilitate the detection of presymptomatic PML. Hyperintensity on diffusion-weighted images, punctate lesions and involvement of U fibers are highly predictive features. Brain magnetic susceptibility changes may be explained by the increased iron deposition and could also constitute a useful tool for the diagnosis of PML. Such imaging findings may be the first imaging feature of PML at the presymptomatic stage. A dedicated MRI protocol including optimized diffusion and high-resolution MR sequences may potentially improve the sensitivity of MRI for the diagnosis of presymptomatic PML.

Panel discussion: Do we need MRI to monitor and predict treatment response in MS?
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