title: Multiple sclerosis update: use of MRI for early diagnosis, disease monitoring and assessment of treatment related complications.
abstract: MRI has long been established as the most sensitive in vivo technique for detecting multiple sclerosis (MS) lesions. The 2010 revisions of the McDonald Criteria have simplified imaging criteria, such that a diagnosis of MS can be made on a single contrast-enhanced MRI scan in the appropriate clinical context. New disease-modifying therapies have proven effective in reducing relapse rate and severity. Several of these therapies, most particularly natalizumab, but also dimethyl fumarate and fingolimod, have been associated with progressive multifocal leukoencephalopathy (PML). PML-immune reconstitution inflammatory syndrome (IRIS) has been recognized in patients following cessation of natalizumab owing to PML, and discontinuation for other reasons can lead to the phenomenon of rebound MS. These complications often provide a diagnostic dilemma and have implications for imaging surveillance of patients. We demonstrate how the updated McDonald Criteria aid the diagnosis of MS and describe the imaging characteristics of conditions such as PML and PML-IRIS in the context of MS. Potential imaging surveillance protocols are considered for the diagnosis and assessment of complications. We will explain how changes in MS treatment are leading to new imaging demands in order to monitor patients for disease progression and treatment-related complications.
authors.affiliation: 1 Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Mark S
authors.identifier: http://orcid.org/0000-0003-4256-2178
authors.initials: MS
authors.lastname: Igra
authors.affiliation: 2 Department of Clinical Neurology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Paling
authors.affiliation: 3 Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Mike P
authors.initials: MP
authors.lastname: Wattjes
authors.affiliation: 1 Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Daniel J A
authors.initials: DJA
authors.lastname: Connolly
authors.affiliation: 4 Academic Unit of Radiology, University of Sheffield, Sheffield, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Hoggard
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D003287:Contrast Media; D042241:Early Diagnosis; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced / Q000175:diagnosis*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000188:drug therapy*; D000069442:Natalizumab / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D003287:Contrast Media; D000069442:Natalizumab