Diagnostic approach in multiple sclerosis with MRI: an update.

Area of Science:

• Neurology
• Radiology
• Immunology

Background:

• Neurological examination and medical history are initial diagnostic steps for multiple sclerosis (MS).
• MRI has become crucial in MS diagnosis, especially with the McDonald criteria.
• Accurate and early MS diagnosis is essential for effective disease-modifying therapies.

Purpose of the Study:

• To review the significance of MRI in the diagnostic workup of MS in clinical practice.
• To summarize recommended MRI protocols for baseline and follow-up examinations.
• To highlight typical and atypical MRI findings for MS diagnosis and differential diagnosis.

Main Methods:

• Review of current literature on MRI in MS diagnosis.
• Summarization of recommended MRI protocols.
• Identification of characteristic MS lesion patterns ('green flags') and atypical findings ('red flags').
• Emphasis on differential diagnosis, including neuromyelitis optica spectrum disorders (NMOSD).

Main Results:

• MRI plays a prominent role in the diagnostic workflow for MS.
• Typical MS lesion patterns in four central nervous system compartments are presented.
• Recognition of 'red flags' (atypical findings) and NMOSD-specific markers (Aquaporin-4-IgG) is critical.
• Misdiagnosis can lead to inappropriate treatment and worsened outcomes, particularly in NMOSD.

Conclusions:

• MRI is indispensable for accurate and timely MS diagnosis.
• Distinguishing MS from other conditions like NMOSD using MRI and serological markers is paramount.
• Correct diagnosis ensures appropriate treatment selection, optimizing patient prognosis and preventing iatrogenic harm.