Health Worlds

BANGKOK, Thailand (EGMN)-Magnetic resonance imaging of the brain should be considered every 1-2 years for patients with a confirmed diagnosis of multiple sclerosis, with more frequent imaging if symptoms worsen unexpectedly.
"If a patient has a clinical deterioration that is out of keeping with their disease, you will want to look for a complication of treatment, such as progressive multifocal leukoencephalopathy, or a different issue, such as a stroke in an elderly patient," said Dr. Anthony Traboulsee, who is a co-of updates to the MRI Protocol for the Diagnosis and Follow-Up of Multiple Sclerosis, issued by the Consortium of MS Centers.
The consortium is an international group of neurologists and radiologists, including members of the American Academy of Neurology and the American Society of Neuroradiology. It first released its imaging recommendations in 2003. The new guidelines replace previous revisions from 200 The goal of the document is to establish a uniform, internationally practical imaging protocol for MS patients, said Dr. Traboulsee of the University of British Columbia, Vancouver. "The whole point of developing guidelines is practicality, so that anywhere you are in the world , if you have access to MRI, you can get good imaging for your MS patients. "
The document outlines recommendations for the initial imaging procedure in patients with a clinically isolated syndrome suggestive of the disease, and for follow-up imaging in patients with a confir


med diagnosis.
Patients with a clinically isolated syndrome and suspected MS should have, at the minimum, a brain MRI with gadolinium. A spinal cord MRI may be called for if there is persistent uncertainty about the diagnosis, equivocal findings on the brain MRI, or presenting symptoms at the spinal cord level.
To make the best use of both time and money, the guidelines recommend performing as much of the imaging as possible in a single session. This allows completion of both brain and spinal imaging on a single dose of gadolinium.
The protocol recommends a slice thickness of no more than 3 mm for brain and spinal cord. Core sequences of the brain should include sagittal and axial Fluid Attenuated Inversion Recovery (FLAIR); axial T2; and axial T1 both pre-and post-gadolinium.
Renal function should always be assessed before giving gadolinium, Dr. Traboulsee said at the World Congress of Neurology. "We recommend this because there have been rare cases of poor outcomes following exposure in patients with impaired renal function." The gadolinium dose should be a single infusion of 0.1 mmol / kg given over 30 seconds, with a minimum 5-minute delay before obtaining post-gadolinium T1 images. The FLAIR or T2 studies can be done during this delay.
The guidelines recommend two types of sequences for spinal cord, he said. "Don't just rely on the sagittal T2, but try variations like proton density or Short Tau Inversion Recovery (STIR)."
There are two indications for follow-up MRI in patients with an established diagnosis: acute clinical deterioration, which may be related to treatment reaction or the onset of a concomitant disorder, and planned reassessment.
"How often we should be doing follow-up MRIs - particularly in the early disease course - is where the challenge comes in, because there is not a perfect relationship of new lesions and disease outcome," Dr. Traboulsee said. However, the expert panel recommended that physicians consider annual or biannual studies. A brain MRI with gadolinium should also be performed to reassess disease before starting or modifying medical therapy.
The panel also recommended a spinal cord MRI with gadolinium for patients with clinical evidence of disease activity referable to the spinal cord and without disease activity in the brain.
The guidelines are available at
(c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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Bangkok, Thailand (EGMN) - For patients diagnosed with multiple sclerosis should be given every 1 to 2 years to carry out brain magnetic resonance imaging (MRI) examination, if the symptoms worsen unexpectedly, MRI should be carried out more frequent inspections.
Dr. Anthony Traboulsee Multiple Sclerosis Research Center of Union's "multiple sclerosis diagnosis and follow-up MRI program" one of the s revised, he said: "If the patient does not match the clinical deterioration of their disease, you should consider a No treatment complications, such as progressive multifocal leukoencephalopathy, or whether there is another problem, such as occurred in elderly stroke patients. "
The Alliance is composed of neurologists and radiologists, an international team, including the American Academy of Neurology and member of American Society of Neuroradiology. The league was founded in 2003 issued its first recommendations on imaging. Since 2006, the new guidelines replace the previous version.
"The purpose of the paper is to establish a unified multiple sclerosis patients and feasible in the international imaging solutions," from the University of British Columbia in Vancouver's Traboulsee Ph.D. said, "to develop the guiding principles in its practical significance , so whether you anywhere in the world, if you have MRI, patients with multiple sclerosis can be well on the imaging. "
The document lists the prompt for the multiple sclerosis patients with clinically isolated syndrome were first imaging operation, and patients were followed up imaging confirmed the proposal.
Appeared clinically isolated syndrome and in patients with suspected multiple sclerosis, at least for gadolinium-enhanced brain MRI. If there is continuing on the uncertainty of diagnosis, the brain MRI findings on the examination of suspicious or symptoms at the spinal level, it should be the spinal cord MRI.
To save time and money, the guidelines recommend an image as much as possible. This application can be completed single-dose gadolinium imaging of the brain and spinal cord.
The program recommends conducting brain and spinal cord imaging, slice thickness of not more than 3 mm. Core sequence of the brain should include sagittal and axial fluid-attenuated inversion recovery (FLAIR), axial T2, and before and after application of gadolinium axial T
In the application of gadolinium, be sure to evaluate kidney function, Traboulsee Dr. Congress of Neurology in the world, said: "The reason we made the recommendation, because patients with impaired renal function after exposure to gadolinium, a small number of cases of poor outcome. "Gd should be a single dose infusion of 0.1 mmol / kg, administered within the 30 sec, in access to the T1 images after administration of gadolinium, at least there should be 5 min delay. The delay in the process of research can be FLAIR or T
The guidelines recommend two types of the spinal cord to the sequence, he said. "Do not depend only on the sagittal T2, should also try other changes, such as proton density or short Tau inversion recovery program (STIR)."
Diagnosed patients were followed up on MRI, has two indications: treatment response or may be combined with disease-related acute clinical deterioration, and the planned re-evaluation.
"We should conduct a long follow-up MRI - especially early in the disease - it is a challenge, because the new lesions and disease there is no necessary connection between the outcome," Traboulsee Dr. However, the Committee recommends physicians consider the annual or biannual inspections. Or change at the beginning of medical treatment before, but also the brain should be conducted with gadolinium MRI, to re-evaluate condition.
For related diseases occur with spinal cord and brain, no clinical signs of disease activity in patients, the team also recommended the gadolinium-enhanced spinal MRI.
Accessible Website the guiding principles.


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