ACR Appropriateness Criteria® Demyelinating Diseases

Area of Science:

• Neurology
• Radiology
• Immunology

Background:

• Demyelinating diseases, including multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and MOGAD, affect central nervous system myelin.
• MRI is the primary imaging tool for detecting demyelinating lesions, surpassing CT in sensitivity.

Purpose of the Study:

• To review the role of MRI in diagnosing and differentiating CNS demyelinating diseases.
• To highlight advancements in MRI techniques and diagnostic criteria.

Main Methods:

• Review of current literature on MRI in demyelinating diseases.
• Analysis of the 2024 McDonald criteria and American College of Radiology Appropriateness Criteria.
• Discussion of advanced MRI techniques (DTI, MTI, AI) and gadolinium enhancement patterns.

Main Results:

• The 2024 McDonald criteria, incorporating features like the central vein sign, achieve 94% accuracy for MS diagnosis at 3T MRI.
• Gadolinium enhancement patterns and lesion morphology on MRI help differentiate active from chronic lesions and distinguish between MS, NMOSD, and MOGAD.
• Spinal cord MRI shows distinct lesion patterns: short peripheral in MS versus longitudinally extensive in NMOSD.

Conclusions:

• MRI, particularly with advanced techniques and updated criteria, is essential for accurate diagnosis and differentiation of CNS demyelinating diseases.
• Evidence-based guidelines and expert consensus are vital for standardizing imaging and treatment appropriateness.