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Updated: Jul 15, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
MRI features of pediatric multiple sclerosis
B Banwell1, M Shroff, J M Ness
1Departments of Paediatrics (Neurology), The Hospital for Sick Children, Toronto, ON, Canada. brenda.banwell@sickkids.ca
Background:
MRI has revolutionized the diagnostic accuracy of multiple sclerosis (MS) in adults, and is now used extensively to evaluate efficacy of immunomodulatory therapies. Although MRI has also been used to aid in the diagnosis and care of children with MS, the MRI features of MS in children are less well understood.
Methods:
The present review summarizes the available literature on MRI in pediatric MS, outlines the specific features of other disorders affecting the CNS white matter in children, compares the MRI appearance of MS in children to seminal neuroimaging studies in adult-onset MS, and discusses the potential role of advanced MRI technologies in delineating the underlying pathobiology of acquired demyelinating disease in children.
Results:
Although the MRI features of MS in children have similarity to adult-onset MS, children tend to have fewer lesions and a lower propensity for lesions to enhance with gadolinium. The MRI findings in children presenting with a clinical phenotype of acute disseminated encephalomyelitis may be indistinguishable from the first attack of MS.
Conclusions:
MRI criteria specific for pediatric-onset multiple sclerosis (MS) and criteria predictive of MS outcome in children experiencing a first demyelinating event will be challenged by the overlap in MRI features between acute monophasic demyelinating syndromes and MS, particularly in younger children. Emergence of new clinically silent lesions on MRI scans separated by at least 3 months is characteristic of MS. Newer MRI techniques evaluating white matter biochemistry and integrity in the youngest MS patients may provide new insights into the relative contributions of inflammation and neurodegeneration in MS.
Insights
Pediatric multiple sclerosis (MS) diagnosis using MRI is challenging due to overlapping features with other conditions. New MRI techniques may offer better insights into inflammation and neurodegeneration in children with MS.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Magnetic Resonance Imaging (MRI) significantly improved multiple sclerosis (MS) diagnosis in adults.
- MRI is crucial for evaluating treatment efficacy in adult MS.
- Understanding MRI features of MS in children is less developed compared to adults.
Purpose of the Study:
- Review MRI findings in pediatric MS.
- Differentiate pediatric MS from other CNS white matter disorders.
- Compare pediatric MS MRI features to adult-onset MS.
- Explore advanced MRI for understanding pediatric demyelinating diseases.
Main Methods:
- Literature review of MRI in pediatric MS.
- Comparison of MRI features in pediatric MS versus adult MS.
- Analysis of advanced MRI techniques for pathobiology.
Main Results:
- Pediatric MS shows similarities to adult MS but with fewer lesions and less gadolinium enhancement.
- MRI findings in acute disseminated encephalomyelitis can mimic early MS in children.
- Distinguishing initial MS attacks from monophasic demyelinating syndromes is difficult in young children.
Conclusions:
- MRI criteria for pediatric MS are challenged by overlapping features with other demyelinating syndromes.
- The appearance of new, silent lesions on serial MRI scans (≥3 months apart) is characteristic of MS.
- Advanced MRI techniques assessing white matter biochemistry and integrity may elucidate inflammation and neurodegeneration roles in pediatric MS.
Related Concept Videos
01:19Multiple Sclerosis l: Introduction
01:24Magnetic Resonance Imaging