Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Magnetic resonance imaging (MRI) is vital for diagnosing multiple sclerosis (MS), but misinterpretations and outdated criteria lead to misdiagnosis.
• Conditions like neuromyelitis optica spectrum disorders and Susac syndrome can mimic MS on MRI, complicating diagnosis, especially when biomarkers are inconclusive.
• Existing MRI criteria for MS may not encompass all characteristic lesion features.

Purpose of the Study:

• To provide a practical guide for clinicians and researchers to improve the accurate recognition of multiple sclerosis lesions on MRI.
• To discuss typical and emerging MRI features specific to multiple sclerosis.
• To highlight red flags for alternative diagnoses that may mimic multiple sclerosis.

Main Methods:

• Review of current literature and MRI diagnostic criteria for multiple sclerosis.
• Illustration and definition of characteristic MRI features of multiple sclerosis lesions, including juxtacortical, periventricular, and cortical locations.
• Discussion of specific pathological features such as the central vein sign, subpial demyelination, and lesional rims.

Main Results:

• Improvements in MRI technology allow for better characterization of MS lesion locations and involvement.
• Specific pathological features (central vein sign, subpial demyelination, lesional rims) are increasingly recognized as more specific to MS.
• Certain conditions can fulfill current MRI criteria for MS, necessitating careful differential diagnosis.

Conclusions:

• Enhanced understanding and application of MRI features can improve the accuracy of multiple sclerosis diagnosis.
• Incorporating emerging qualitative MRI findings may refine diagnostic criteria in the future.
• Distinguishing MS from mimic conditions requires a comprehensive approach, integrating imaging, clinical, and biomarker data.