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Updated: May 7, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
[Is MRI monitoring useful in clinical practice in patients with multiple sclerosis? Yes]
1Service de neurologie, centre hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Abstract:
The place of magnetic resonance imaging (MRI) in the monitoring of patients with multiple sclerosis (MS) is not codified except during the diagnostic phase. Several studies in the literature have shown that lesion load measured on an MRI done at the beginning of the disease or its increase during the first years had a predictive value, although moderate, on the occurrence of long-term disability as measured by the EDSS. Early worsening of brain atrophy during the early stages of the disease is predictive of worsening cognitive impairment in the following years. Perform an MRI is not required when setting up a first-line disease-modifying therapy (DMT) such as an immunomodulatory treatment but it is useful because it can be used as a reference scan in case of treatment failure. The indications of second-line DMTs, whether prescribed in naive patients with an active disease or after failure of a first-line DMT, are based on combined criteria incorporating MRI data acquired in the previous 3 months compared with a recent MRI. Thus the practical criteria for failure of first-line DMTs are partly based on MRI. During interferon therapy, identification of disease activity on an MRI conducted 1 year after the start of the treatment can predict treatment failure in combination with clinical criteria, such as relapses occurring during the first year. Finally, MRI is essential to the safety monitoring of patients on natalizumab to detect progressive multifocal leukoencephalopathies (PML). In patients at high risk for PML, tested positive for JC virus antibodies and having received natalizumab for more than 2 years, it could be proposed to do a short MRI with FLAIR and diffusion weighted imaging sequences every 3 months to detect preclinical PML.
Insights
Magnetic resonance imaging (MRI) plays a crucial role in monitoring multiple sclerosis (MS) patients, predicting disability, and guiding treatment decisions. MRI is essential for detecting treatment failure and monitoring for progressive multifocal leukoencephalopathy (PML).
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- The role of magnetic resonance imaging (MRI) in monitoring multiple sclerosis (MS) patients beyond diagnosis is not fully established.
- Existing literature suggests MRI lesion load and brain atrophy predict long-term disability and cognitive decline in MS.
- Current guidelines do not mandate MRI for initiating first-line disease-modifying therapies (DMTs).
Purpose of the Study:
- To elucidate the multifaceted role of MRI in the management of multiple sclerosis (MS).
- To highlight MRI's utility in predicting disease progression, assessing treatment efficacy, and ensuring patient safety.
Main Methods:
- Review of existing literature on MRI applications in multiple sclerosis (MS) monitoring.
- Analysis of MRI's role in predicting disability (EDSS) and cognitive impairment.
- Evaluation of MRI criteria for determining treatment failure and guiding second-line DMT selection.
- Assessment of MRI's importance in safety monitoring, particularly for natalizumab-associated progressive multifocal leukoencephalopathy (PML).
Main Results:
- Early MRI lesion load and its increase predict long-term disability (EDSS) in MS patients.
- Early brain atrophy on MRI predicts future cognitive impairment.
- MRI serves as a reference scan for treatment failure and is integral to selecting second-line DMTs.
- MRI findings, combined with clinical data, predict interferon therapy failure.
- MRI is critical for detecting progressive multifocal leukoencephalopathy (PML) in natalizumab-treated patients.
Conclusions:
- MRI is indispensable for comprehensive multiple sclerosis (MS) management, from diagnosis to long-term monitoring and safety surveillance.
- MRI data significantly informs treatment decisions, including switching therapies and monitoring for adverse events like PML.
- Regular MRI surveillance, especially in high-risk patients, is crucial for optimizing MS care and patient outcomes.
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