title: Canadian Expert Panel Recommendations for MRI Use in MS Diagnosis and Monitoring.
abstract: BACKGROUND
  A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal.
  
  
  METHODS
  To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists.
  
  
  RESULTS
  This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system.
  
  
  CONCLUSIONS
  The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.
authors.affiliation: 1Division of Neurology,UBC Hospital/University of British Columbia,Vancouver,British Columbia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Traboulsee
authors.affiliation: 2Université de Montréal Neuroradiologue/Neuroradiologist - Hôpital Notre-Dame,Centre Hospitalier de l'Université de Montréal,Montreal,Quebec,Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Létourneau-Guillon
authors.affiliation: 3Department of Neurology,The Ottawa Hospital/University of Ottawa and the Ottawa Hospital Research Institute,Ottawa,Ontario,Canada.
authors.forename: Mark Steven
authors.initials: MS
authors.lastname: Freedman
authors.affiliation: 4Multiple Sclerosis (MS) Clinic and Evoked Potentials Laboratory,Medical Advisory - MS Society of Canada,and Department of Medicine - University of Toronto,Toronto,Ontario.
authors.forename: Paul W
authors.initials: PW
authors.lastname: O'Connor
authors.affiliation: 5Keenan Research Centre of the Li Ka Shing Knowledge Institute,St. Michael's Hospital,Toronto,Ontario,Canada.
authors.forename: Aditya
authors.initials: A
authors.lastname: Bharatha
authors.affiliation: 6Division of Neuroradiology,Department of Radiology,The Ottawa Hospital/University of Ottawa,Ottawa,Ontario,Canada.
authors.forename: Santanu
authors.initials: S
authors.lastname: Chakraborty
authors.affiliation: 7Centre Hospitalier de l'Université de Montréal/ Department of Neuroscience,Université de Montréal,Montréal,Québec,Canada.
authors.forename: J Marc
authors.initials: JM
authors.lastname: Girard
authors.affiliation: 8Division of Neurology,4D Kaye Edmonton Clinic,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Giuliani
authors.affiliation: 9Radiology,Clinical Neurosciences, and Surgery,Foothills Medical Centre/University of Calgary,Calgary,Alberta,Canada.
authors.forename: John T
authors.initials: JT
authors.lastname: Lysack
authors.affiliation: 10Department of Internal Medicine (Neurology),Health Sciences Centre/University of Manitoba,Winnipeg,Manitoba,Canada.
authors.forename: James J
authors.initials: JJ
authors.lastname: Marriott
authors.affiliation: 11Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada.
authors.forename: Luanne M
authors.initials: LM
authors.lastname: Metz
authors.affiliation: 12University of Western Ontario MS Clinic,London Health Sciences Centre/Western University,London,Ontario,Canada.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Morrow
authors.affiliation: 13Faculty of Medicine (Neurology),St. Michael's Hospital/University of Toronto,Toronto,Ontario,Canada.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Oh
authors.affiliation: 14Department of Medical Imaging,London Health Sciences Centre/Western University,London,Ontario,Canada.
authors.forename: Manas
authors.initials: M
authors.lastname: Sharma
authors.affiliation: 15Department of Diagnostic Radiology,QEII Health Sciences Centre/Dalhousie University,Halifax,Nova Scotia,Canada.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Vandorpe
authors.affiliation: 16Department of Radiology,Vancouver General Hospital/University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: Talia Alexandra
authors.initials: TA
authors.lastname: Vertinsky
authors.affiliation: 17Department of Radiology,Health Sciences Centre/University of Manitoba,Winnipeg,Manitoba,Canada.
authors.forename: Vikram S
authors.initials: VS
authors.lastname: Wadhwa
authors.affiliation: 18SCRIPT,Toronto,Ontario,Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: von Riedemann
authors.affiliation: 19Department of Radiology/Division of Neurology,University of British Columbia,Vancouver,British Columbia,Canada.
authors.forename: David K B
authors.initials: DK
authors.lastname: Li
mesh_terms: D001921:Brain / Q000473:pathology; D002170:Canada; D002985:Clinical Protocols; D032921:Consensus; D003287:Contrast Media; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008991:Monitoring, Physiologic; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: neuroimaging