Harmonized magnetic resonance imaging protocols for multiple sclerosis: HARMONY-MS, a pilot project

Area of Science:

• Neuroimaging
• Clinical Practice Guidelines
• Health Services Research

Background:

• Magnetic Resonance Imaging (MRI) is crucial for multiple sclerosis (MS) management.
• Current MRI practices in MS often deviate from established guidelines.
• Large-scale studies evaluating harmonized MRI protocols are limited.

Purpose of the Study:

• To assess the impact of harmonized MRI referral and acquisition protocols in MS care.
• To evaluate changes in MRI utilization, costs, and clinical outcomes.
• To determine the feasibility of a scalable model for guideline-concordant MS imaging.

Main Methods:

• Retrospective observational study of CNS MRI examinations in a large Italian healthcare system (N=143,592).
• Analysis of MRI volumes, scanner time, and gadolinium expenditure using statistical models (Poisson, Gamma, ITS).
• Evaluation of clinical outcomes including relapse rates, MRI inflammatory activity, and No Evidence of Disease (NEDA-3), and disease-modifying therapy (DMT) initiation.

Main Results:

• Contrast-enhanced MRI and gadolinium studies decreased by over 90%; total MRI volume reduced by 86%.
• Significant reductions in scanner time and gadolinium expenditure were observed.
• Annualized relapse rate (ARR) decreased, while NEDA-3 and first-line high-efficacy DMT use increased significantly.

Conclusions:

• The HARMONY-MS program successfully reduced contrast use, unnecessary imaging, and healthcare costs.
• The study demonstrates a scalable model for guideline-adherent MS MRI practices.
• This approach supports stable clinical outcomes and promotes earlier initiation of effective DMTs.