title: Adherence to MRI protocol consensus guidelines in multiple sclerosis: an Australian multi-centre study.
abstract: BACKGROUND
  Multiple sclerosis (MS) is a debilitating disease that causes significant morbidity within a young demographic. Diagnostic guidelines for MS have evolved, and imaging has played an increasingly important role in diagnosis over the last two decades. For imaging to contribute to diagnosis in a meaningful way, it must be reproducible. Consensus guidelines for MRI in MS exist to define correct sequence type and imaging technique, but it is not clear to what extent they are followed. This study reviewed MRI studies performed on Australian individuals presenting with a first clinical diagnosis of central nervous system demyelination (FCD) for adherence to published guidelines and discussed practical implementation of MS guidelines in light of recent updates.
  
  
  METHODS
  The Ausimmune study was a prospective case control study of Australian participants presenting with FCD from 2003 to 2006. Baseline cranial and spinal cord MRI studies of 226 case participants from four separate Australian regions were reviewed. MRI sequences were classified according to anatomical location, slice plane, tissue weighting and use of gadolinium-containing contrast media. Results were compared with the 2003 Consortium of Multiple Sclerosis Centres MRI protocol for the diagnosis of MS.
  
  
  RESULTS
  The composition of core cranial MRI sequences performed varied across the 226 scans. Of the studies, 91% included sagittal fluid attenuated inversion recovery (FLAIR) sequences. Cranial axial T2-weighted, axial FLAIR and axial proton density-weighted sequences were performed in 88%, 60% and 16% (respectively) of scans. Only 25% of the studies included a T1-weighted contrast-enhanced sequence. Concordance with the guidelines in all sequences was very low (2).
  
  
  CONCLUSIONS
  Only a small number of MRI investigations performed included all of the sequences stipulated by consensus guidelines. This is likely due to poor awareness in the imaging community of the guidelines and the rationale behind certain sequences. Radiologists with a sub-speciality interest in neuroradiology should take ownership of this issue and ensure that recommended imaging guidelines are followed.
authors.affiliation: Department of Medical Imaging, Royal Brisbane and Women's Hospital, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Curley
authors.forename: Lawrence
authors.initials: L
authors.lastname: Josey
authors.forename: Robyn
authors.initials: R
authors.lastname: Lucas
authors.forename: Keith
authors.initials: K
authors.lastname: Dear
authors.forename: Bruce V
authors.initials: BV
authors.lastname: Taylor
authors.forename: Alan
authors.initials: A
authors.lastname: Coulthard
authors.forename: Caron
authors.initials: C
authors.lastname: Chapman
authors.forename: Alan
authors.initials: A
authors.lastname: Coulthard
authors.forename: Keith
authors.initials: K
authors.lastname: Dear
authors.forename: Terry
authors.initials: T
authors.lastname: Dwyer
authors.forename: Trevor
authors.initials: T
authors.lastname: Kilpatrick
authors.forename: Robyn
authors.initials: R
authors.lastname: Lucas
authors.forename: Tony
authors.initials: T
authors.lastname: McMichael
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pender
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Ponsonby
authors.forename: Bruce
authors.initials: B
authors.lastname: Taylor
authors.forename: Patricia
authors.initials: P
authors.lastname: Valery
authors.forename: Ingrid
authors.initials: I
authors.lastname: van der Mei
authors.forename: David
authors.initials: D
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult