CoChat
Sign Up
Cited by 113Multiple Sclerosis Research StudiesAdvanced MRI Techniques and ApplicationsAdvanced Neuroimaging Techniques and Applications

2024 MAGNIMS–CMSC–NAIMS consensus recommendations on the use of MRI for the diagnosis of multiple sclerosis

Open access
Barkhof, Frederik, Reich, Daniel S, Oh, Jiwon, Rocca, Maria A, Li, David K B, Sati, Pascal, Azevedo, Christina J, Bagnato, Francesca +26 more·2025·The Lancet Neurology
DOI 10.1016/s1474-4422(25)00304-7
Open this paper in CoChat — free account

Abstract

MRI plays an increasingly important role in the diagnosis of multiple sclerosis. We discuss the expanded role of MRI in the 2024 McDonald diagnostic criteria for multiple sclerosis, which include the optic nerve as a fifth anatomical location, in addition to the periventricular, juxtacortical or cortical, infratentorial, and spinal cord regions. The diagnosis of multiple sclerosis can now be confirmed when the criteria of dissemination in space are fulfilled with the detection of typical lesions in at least four locations without additional evidence. We recommend appropriate imaging strategies and MRI acquisition protocols for all aspects of multiple sclerosis diagnosis, including fat-saturated sequences for detection of symptomatic optic nerve lesions. Diagnostic imaging should always cover the brain and spinal cord and include susceptibility-sensitive sequences for the assessment of the central vein sign and paramagnetic rim lesions, which can be especially helpful in cases when conventional imaging findings are insufficient to establish a diagnosis. We discuss how to handle the diagnosis of radiologically isolated presentations of multiple sclerosis, which are included in the 2024 criteria. We present recommendations for image interpretation and avoidance of misdiagnosis, and extend the recommendations to the use of MRI in the diagnosis of multiple sclerosis in older people, children, people with vascular comorbidities or migraine, and people living outside Europe and North America. Finally, we provide recommendations for standardisation of MRI acquisition and communication of results to enable an earlier diagnosis while maintaining high diagnostic specificity.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/s1474-4422(25)00304-7

Cites

6 of 6 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 94

  1. [2]2. Montalban X, Lebrun-Frenay C, Oh J. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria. Lancet Neurol. 2025 in press.
  2. [3]3. Filippi M, Rocca MA, Ciccarelli O, De Stefano N, Evangelou N, Kappos L, et al. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol. 2016 Mar;15(3):292 -303.
  3. [5]5. Wattjes MP, Ciccarelli O, Reich DS, Banwell B, de Stefano N, Enzinger C, et al. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol. 2021 Aug;20(8):653 -70.
  4. [6]6. Solomon AJ, Naismith RT, Cross AH. Misdiagnosis of multiple sclerosis. Neurology. 2019 Jan 1;92(1):26 -33.
  5. [9]9. Ontaneda D, Sati P, Raza P, Kilbane M, Gombos E, Alvarez E, et al. Central vein sign: A diagnostic biomarker in multiple sclerosis (CAVS-MS) study protocol for a prospective multicenter trial. NeuroImage Clin. 2021;32:102834.
  6. [10]10. Traboulsee A, Li D. Addressing Concerns Regarding the Use of Gadolinium in a Standardized MRI Protocol for the Diagnosis and Follow-Up of Multiple Sclerosis. AJNR Am J Neuroradiol. 2016 Dec;37(12):E82 -3.
  7. [11]11. Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB, International Society for Magnetic Resonance in Medicine. Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol. 2017 Jul;16(7):564 -70.
  8. [12]12. Sati P, Thomasson DM, Li N, Pham DL, Biassou NM, Reich DS, et al. Rapid, highresolution, whole-brain, susceptibility-based MRI of multiple sclerosis. Mult Scler Houndmills Basingstoke Engl. 2014 Oct;20(11):1464 -70.
  9. [13]13. Sati P, George IC, Shea CD, Gaitán MI, Reich DS. FLAIR*: a combined MR contrast technique for visualizing white matter lesions and parenchymal veins. Radiology. 2012 Dec;265(3):926 -32.
  10. [14]14. George IC, Sati P, Absinta M, Cortese IC, Sweeney EM, Shea CD, et al. Clinical 3tesla FLAIR* MRI improves diagnostic accuracy in multiple sclerosis. Mult Scler - Houndmills Basingstoke Engl. 2016 Oct;22(12):1578 -86.
  11. [15]15. Clarke MA, Pareto D, Pessini-Ferreira L, Arrambide G, Alberich M, Crescenzo F, et al. Value of 3T Susceptibility-Weighted Imaging in the Diagnosis of Multiple Sclerosis. AJNR Am J Neuroradiol. 2020 Jun;41(6):1001 -8.
  12. [16]16. Castellaro M, Tamanti A, Pisani AI, Pizzini FB, Crescenzo F, Calabrese M. The Use of the Central Vein Sign in the Diagnosis of Multiple Sclerosis: A Systematic Review and Meta-analysis. Diagn Basel Switz. 2020 Nov 29;10(12):1025.
  13. [17]17. Daboul L, O'Donnell CM, Cao Q, Amin M, Rodrigues P, Derbyshire J, et al. Effect of GBCA Use on Detection and Diagnostic Performance of the Central Vein Sign: Evaluation Using a 3-T FLAIR* Sequence in Patients With Suspected Multiple Sclerosis. AJR Am J Roentgenol. 2023 Jan;220(1):115 -25.
  14. [18]18. do Amaral LLF, Fragoso DC, Nunes RH, Littig IA, da Rocha AJ. GadoliniumEnhanced Susceptibility-Weighted Imaging in Multiple Sclerosis: Optimizing the Recognition of Active Plaques for Different MR Imaging Sequences. AJNR Am J Neuroradiol. 2019 Apr;40(4):614 -9.
  15. [19]19. Geurts JJG, Roosendaal SD, Calabrese M, Ciccarelli O, Agosta F, Chard DT, et al. Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology. 2011 Feb 1;76(5):418 -24.
  16. [20]20. Sethi V, Yousry TA, Muhlert N, Ron M, Golay X, Wheeler-Kingshott C, et al. Improved detection of cortical MS lesions with phase-sensitive inversion recovery MRI. J Neurol Neurosurg Psychiatry. 2012 Sep;83(9):877 -82.
  17. [21]21. Nelson F, Poonawalla A, Datta S, Wolinsky J, Narayana P. Is 3D MPRAGE better than the combination DIR/PSIR for cortical lesion detection at 3T MRI? Mult Scler Relat Disord. 2014 Mar;3(2):253 -7.
  18. [22]22. Eisele P, Szabo K, Griebe M, Rossmanith C, Förster A, Hennerici M, et al. Reduced diffusion in a subset of acute MS lesions: a serial multiparametric MRI study. AJNR Am J Neuroradiol. 2012 Aug;33(7):1369 -73.
  19. [23]23. Bot JCJ, Barkhof F. Spinal-cord MRI in multiple sclerosis: conventional and nonconventional MR techniques. Neuroimaging Clin N Am. 2009 Feb;19(1):81 -99.
  20. [24]24. Hodel J, Outteryck O, Bocher AL, Zéphir H, Lambert O, Benadjaoud MA, et al. Comparison of 3D double inversion recovery and 2D STIR FLAIR MR sequences for the imaging of optic neuritis: pilot study. Eur Radiol. 2014 Dec;24(12):3069 -75.
  21. [25]25. Riederer I, Mühlau M, Hoshi MM, Zimmer C, Kleine JF. Detecting optic nerve lesions in clinically isolated syndrome and multiple sclerosis: double-inversion recovery magnetic resonance imaging in comparison with visually evoked potentials. J Neurol. 2019 Jan;266(1):148 -56.
  22. [26]26. London F, Zéphir H, Hadhoum N, Lannoy J, Vermersch P, Pruvo JP, et al. Optic nerve double inversion recovery hypersignal in patients with clinically isolated syndrome is associated with asymptomatic gadolinium-enhanced lesion. Mult Scler Houndmills Basingstoke Engl. 2019 Dec;25(14):1888 -95.
  23. [28]28. Heinemann J, Yankov D, Solomon AJ, Rauer S, Wiendl H, Dersch R. McDonald criteria application by German neurologists suggests a need for further training. Mult Scler Relat Disord. 2025 Feb;94:106304.
  24. [29]29. Filippi M, Preziosa P, Banwell BL, Barkhof F, Ciccarelli O, De Stefano N, et al. Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain J Neurol. 2019 Jul 1;142(7):1858 -75.
  25. [30]30. Ontaneda D, Raza PC, Mahajan KR, Arnold DL, Dwyer MG, Gauthier SA, et al. Deep grey matter injury in multiple sclerosis: a NAIMS consensus statement. Brain J Neurol. 2021 Aug 17;144(7):1974 -84.
  26. [32]32. Rovira À, Barkhof F. Multiple Sclerosis and Variants. In: Barkhof F, Jager R, Thurnher M, Rovira Cañellas A, editors. Clinical Neuroradiology: The ESNR Textbook [Internet]. Cham: Springer International Publishing; 2018 [cited 2024 Jul 23]. p. 1 -41. Available from: https://doi.org/10.1007/978-3-319-61423-6\_70-1 · DOI
  27. [33]33. Horowitz AL, Kaplan RD, Grewe G, White RT, Salberg LM. The ovoid lesion: a new MR observation in patients with multiple sclerosis. AJNR Am J Neuroradiol. 1989;10(2):303 -5.
  28. [35]35. Rovira À, Sastre-Garriga J, Auger C, Rovira A. Idiopathic inflammatory demyelinating diseases of the brainstem. Semin Ultrasound CT MR. 2013 Apr;34(2):123 -30.
  29. [36]36. Cotton. MRI contrast uptake in new lesions in relapsing-remitting MS followed at weekly intervals. Available from: https://pubmed.ncbi.nlm.nih.gov/12601106/
  30. [37]37. Masdeu JC, Quinto C, Olivera C, Tenner M, Leslie D, Visintainer P. Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology. 2000 Apr 11;54(7):1427 -33.
  31. [38]38. Gaitán MI, Shea CD, Evangelou IE, Stone RD, Fenton KM, Bielekova B, et al. Evolution of the blood-brain barrier in newly forming multiple sclerosis lesions. Ann Neurol. 2011 Jul;70(1):22 -9.
  32. [39]39. Foster MA, Pontillo G, Davagnanam I, Collorone S, Prados F, Kanber B, et al. Improving criteria for dissemination in space in multiple sclerosis by including additional regions. Ann Clin Transl Neurol. 2024 Oct;11(10):2572 -82.
  33. [40]40. Tan IL, van Schijndel RA, Pouwels PJ, van Walderveen MA, Reichenbach JR, Manoliu RA, et al. MR venography of multiple sclerosis. AJNR Am J Neuroradiol. 2000;21(6):1039 -42.
  34. [41]41. Sinnecker T, Clarke MA, Meier D, Enzinger C, Calabrese M, De Stefano N, et al. Evaluation of the Central Vein Sign as a Diagnostic Imaging Biomarker in Multiple Sclerosis. JAMA Neurol. 2019 Dec 1;76(12):1446 -56.
  35. [42]42. Suthiphosuwan S, Sati P, Guenette M, Montalban X, Reich DS, Bharatha A, et al. The Central Vein Sign in Radiologically Isolated Syndrome. AJNR Am J Neuroradiol. 2019 May;40(5):776 -83.
  36. [43]43. Boccia VD, Lapucci C, Cellerino M, Tazza F, Rossi A, Schiavi S, et al. Evaluating the central vein sign in paediatric-onset multiple sclerosis: A case series study. Mult Scler Houndmills Basingstoke Engl. 2023 Mar;29(3):475 -8.
  37. [44]44. Maggi P, Absinta M, Sati P, Perrotta G, Massacesi L, Dachy B, et al. The 'central vein sign' in patients with diagnostic 'red flags' for multiple sclerosis: A prospective multicenter 3T study. Mult Scler Houndmills Basingstoke Engl. 2020 Apr;26(4):421 -32.
  38. [45]45. Sati P, Oh J, Constable RT, Evangelou N, Guttmann CRG, Henry RG, et al. The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative. Nat Rev Neurol. 2016 Dec;12(12):714 -22.
  39. [46]46. Bagnato F, Sati P, Helmond C, Elliott C, Gauthier SA G, Harrison D, et al. Imaging chronic active lesions in multiple sclerosis: a consensus statement. Brain J Neurol [Internet]. 2024 Mar 9 [cited 2024 Oct 6];147(9). Available from: https://pubmed.ncbi.nlm.nih.gov/38226694/
  40. [47]47. Suh CH, Kim SJ, Jung SC, Choi CG, Kim HS. The 'Central Vein Sign' on T2* -weighted Images as a Diagnostic Tool in Multiple Sclerosis: A Systematic Review and Meta-analysis using Individual Patient Data. Sci Rep. 2019 Dec 3;9(1):18188.
  41. [48]48. Daboul L, O'Donnell CM, Amin M, Rodrigues P, Derbyshire J, Azevedo C, et al. A multicenter pilot study evaluating simplified central vein assessment for the diagnosis of multiple sclerosis. Mult Scler Houndmills Basingstoke Engl. 2024 Jan;30(1):25 -34.
  42. [49]49. Absinta M, Sati P, Masuzzo F, Nair G, Sethi V, Kolb H, et al. Association of Chronic Active Multiple Sclerosis Lesions With Disability In Vivo. JAMA Neurol. 2019 Dec 1;76(12):1474 -83.
  43. [50]50. Maggi P, Sati P, Nair G, Cortese ICM, Jacobson S, Smith BR, et al. Paramagnetic Rim Lesions are Specific to Multiple Sclerosis: An International Multicenter 3T MRI Study. Ann Neurol. 2020 Nov;88(5):1034 -42.
  44. [51]51. Absinta M, Sati P, Schindler M, Leibovitch EC, Ohayon J, Wu T, et al. Persistent 7tesla phase rim predicts poor outcome in new multiple sclerosis patient lesions. J Clin Invest. 2016 Jul 1;126(7):2597 -609.
  45. [52]52. Sacco S, Virupakshaiah A, Papinutto N, Schoeps VA, Akula A, Zhao H, et al. Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler Houndmills Basingstoke Engl. 2023 Dec;29(14):1736 -47.
  46. [53]53. Oh J, Suthiphosuwan S, Sati P, Absinta M, Dewey B, Guenette M, et al. Cognitive impairment, the central vein sign, and paramagnetic rim lesions in RIS. Mult Scler Houndmills Basingstoke Engl. 2021 Dec;27(14):2199 -208.
  47. [54]54. Absinta M, Maric D, Gharagozloo M, Garton T, Smith MD, Jin J, et al. A lymphocytemicroglia-astrocyte axis in chronic active multiple sclerosis. Nature. 2021 Sep;597(7878):709 -14.
  48. [55]55. Hemond CC, Reich DS, Dundamadappa SK. Paramagnetic Rim Lesions in Multiple Sclerosis: Comparison of Visualization at 1.5-T and 3-T MRI. AJR Am J Roentgenol. 2022 Jul;219(1):120 -31.
  49. [56]56. Meaton I, Altokhis A, Allen CM, Clarke MA, Sinnecker T, Meier D, et al. Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis. Mult Scler Houndmills Basingstoke Engl. 2022 Dec;28(14):2212 -20.
  50. [57]57. Ramanathan S, Prelog K, Barnes EH, Tantsis EM, Reddel SW, Henderson APD, et al. Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis. Mult Scler Houndmills Basingstoke Engl. 2016 Apr;22(4):470 -82.
  51. [58]58. Dutra BG, da Rocha AJ, Nunes RH, Maia ACM. Neuromyelitis Optica Spectrum Disorders: Spectrum of MR Imaging Findings and Their Differential Diagnosis. Radiogr Rev Publ Radiol Soc N Am Inc. 2018;38(1):169 -93.
  52. [59]59. Davion JB, Lopes R, Drumez É, Labreuche J, Hadhoum N, Lannoy J, et al. Asymptomatic optic nerve lesions: An underestimated cause of silent retinal atrophy in MS. Neurology. 2020 Jun 9;94(23):e2468 -78.
  53. [60]60. Sartoretti T, Sartoretti E, Rauch S, Binkert C, Wyss M, Czell D, et al. How Common Is Signal-Intensity Increase in Optic Nerve Segments on 3D Double Inversion Recovery Sequences in Visually Asymptomatic Patients with Multiple Sclerosis? AJNR Am J Neuroradiol. 2017 Sep;38(9):1748 -53.
  54. [61]61. Biousse V, Danesh-Meyer HV, Saindane AM, Lamirel C, Newman NJ. Imaging of the optic nerve: technological advances and future prospects. Lancet Neurol. 2022 Dec;21(12):1135 -50.
  55. [62]62. Dubey D, Pittock SJ, Krecke KN, Morris PP, Sechi E, Zalewski NL, et al. Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurol. 2019 Mar 1;76(3):301 -9.
  56. [63]63. Yonezu T, Ito S, Mori M, Ogawa Y, Makino T, Uzawa A, et al. 'Bright spotty lesions' on spinal magnetic resonance imaging differentiate neuromyelitis optica from multiple sclerosis. Mult Scler Houndmills Basingstoke Engl. 2014 Mar;20(3):331 -7.
  57. [64]64. Flanagan EP, Marsh RW, Weinshenker BG. Teaching neuroimages: 'pancake -like' gadolinium enhancement suggests compressive myelopathy due to spondylosis. Neurology. 2013 May 21;80(21):e229.
  58. [65]65. Li X, Krecke KN, Weinshenker BG, Clarke MJ, Zekeridou A, Toledano M, et al. Hemicord White Matter Enhancement and the Croissant Sign in Cervical Spondylotic Myelopathy. Neurology. 2023 Nov 21;101(21):968 -9.
  59. [66]66. Zalewski NL, Krecke KN, Weinshenker BG, Aksamit AJ, Conway BL, McKeon A, et al. Central canal enhancement and the trident sign in spinal cord sarcoidosis. Neurology. 2016 Aug 16;87(7):743 -4.
  60. [68]68. Nyquist PA, Bilgel M, Gottesman R, Yanek LR, Moy TF, Becker LC, et al. Age - differences in periventricular and deep white matter lesions. Neurobiol Aging. 2015 Apr;36(4):1653 -8.
  61. [69]69. Del Brutto OH, Mera RM, Costa AF, Silva P, Del Brutto VJ. Dawson Fingers in Older Adults with Cerebral Small Vessel Disease: A Population Study. Eur Neurol. 2020;83(4):421 -5.
  62. [70]70. Lapucci C, Saitta L, Bommarito G, Sormani MP, Pardini M, Bonzano L, et al. How much do periventricular lesions assist in distinguishing migraine with aura from CIS? Neurology. 2019 Apr 9;92(15):e1739 -44.
  63. [71]71. Absinta M, Rocca MA, Colombo B, Copetti M, De Feo D, Falini A, et al. Patients with migraine do not have MRI-visible cortical lesions. J Neurol. 2012 Dec;259(12):2695 -8.
  64. [72]72. Arrambide G, Tintore M, Auger C, Río J, Castilló J, Vidal-Jordana A, et al. Lesion topographies in multiple sclerosis diagnosis: A reappraisal. Neurology. 2017 Dec 5;89(23):2351 -6.
  65. [73]73. Filippi M, Preziosa P, Meani A, Dalla Costa G, Mesaros S, Drulovic J, et al. Performance of the 2017 and 2010 Revised McDonald Criteria in Predicting MS Diagnosis After a Clinically Isolated Syndrome: A MAGNIMS Study. Neurology. 2022 Jan 4;98(1):e1 -14.
  66. [74]74. Cagol A, Cortese R, Barakovic M, Schaedelin S, Ruberte E, Absinta M, et al. Diagnostic Performance of Cortical Lesions and the Central Vein Sign in Multiple Sclerosis. JAMA Neurol. 2024 Feb 1;81(2):143 -53.
  67. [75]75. Geraldes R, Juryńczyk M, Dos Passos GR, Pichler A, Chung K, Hagens M, et al. The role of pontine lesion location in differentiating multiple sclerosis from vascular risk factorrelated small vessel disease. Mult Scler Houndmills Basingstoke Engl. 2021 May;27(6):968 -72.
  68. [76]76. Guisset F, Lolli V, Bugli C, Perrotta G, Absil J, Dachy B, et al. The central vein sign in multiple sclerosis patients with vascular comorbidities. Mult Scler Houndmills Basingstoke Engl. 2021 Jun;27(7):1057 -65.
  69. [77]77. Harrison KL, Gaudioso C, Levasseur VA, Dunham SR, Schanzer N, Keuchel C, et al. Central Vein Sign in Pediatric Multiple Sclerosis and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Pediatr Neurol. 2023 Sep;146:21 -5.
  70. [78]78. Menascu S, Halusková S, Pollak A, Ryska P, Angelucci F, Magalashvili D, et al. Clinical correlation between disease progression and central vein sign in pediatric onset multiple sclerosis: A binational study. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc. 2024 May;50:81 -5.
  71. [79]79. Margoni M, Preziosa P, Storelli L, Gueye M, Moiola L, Filippi M, et al. Paramagnetic rim and core sign lesions in paediatric multiple sclerosis patients. J Neurol Neurosurg Psychiatry. 2023 Oct;94(10):873 -6.
  72. [80]80. Micheletti L, Maldonado FR, Watal P, Toronchik MS, Erripa JI, Princich JP, et al. Utility of paramagnetic rim lesions on 1.5-T susceptibility phase imaging for the diagnosis of pediatric multiple sclerosis. Pediatr Radiol. 2022 Jan;52(1):97 -103.
  73. [81]81. Papp V, Magyari M, Aktas O, Berger T, Broadley SA, Cabre P, et al. Worldwide Incidence and Prevalence of Neuromyelitis Optica: A Systematic Review. Neurology. - 2021 Jan 12;96(2):59 -77.
  74. [82]82. Gaitán MI, Paday Formenti ME, Calandri I, Ysrraelit MC, Yañez P, Correale J. The central vein sign is present in most infratentorial multiple sclerosis plaques. Mult Scler Relat Disord. 2022 Feb;58:103484.
  75. [83]83. Abdel Ghany H, Karam-Allah A, Edward R, Abdel Naseer M, Hegazy MI. Sensitivity and Specificity of Central Vein Sign as a Diagnostic Biomarker in Egyptian Patients with Multiple Sclerosis. Neuropsychiatr Dis Treat. 2022;18:1985 -92.
  76. [84]84. Scalfari A, Romualdi C, Nicholas RS, Mattoscio M, Magliozzi R, Morra A, et al. The cortical damage, early relapses, and onset of the progressive phase in multiple sclerosis. Neurology. 2018 Jun 12;90(24):e2107 -18.
  77. [85]85. Matthews PM, Gupta D, Mittal D, Bai W, Scalfari A, Pollock KG, et al. The association between brain volume loss and disability in multiple sclerosis: A systematic review. Mult Scler Relat Disord. 2023 Jun;74:104714.
  78. [86]86. Tintore M, Rovira A, Arrambide G, Mitjana R, Río J, Auger C, et al. Brainstem lesions in clinically isolated syndromes. Neurology. 2010 Nov 23;75(21):1933 -8.
  79. [87]87. Galassi S, Prosperini L, Logoteta A, Hirsch MN, Fanelli F, De Giglio L, et al. A lesion topography-based approach to predict the outcomes of patients with multiple sclerosis treated with Interferon Beta. Mult Scler Relat Disord. 2016 Jul;8:99 -106.
  80. [88]88. Ostini C, Bovis F, Disanto G, Ripellino P, Pravatà E, Sacco R, et al. Recurrence and Prognostic Value of Asymptomatic Spinal Cord Lesions in Multiple Sclerosis. J Clin Med. 2021 Jan 26;10(3):463.
  81. [89]89. Maggi P, Sati P, Nair G, Cortese ICM, Jacobson S, Smith BR, et al. Paramagnetic Rim Lesions are Specific to Multiple Sclerosis: An International Multicenter 3T MRI Study. Ann Neurol. 2020 Nov;88(5):1034 -42.
  82. [90]90. Altokhis AI, Hibbert AM, Allen CM, Mougin O, Alotaibi A, Lim SY, et al. Longitudinal clinical study of patients with iron rim lesions in multiple sclerosis. Mult Scler Houndmills Basingstoke Engl. 2022 Dec;28(14):2202 -11.
  83. [91]91. Arrambide G, Rovira A, Sastre-Garriga J, Tur C, Castilló J, Río J, et al. Spinal cord lesions: A modest contributor to diagnosis in clinically isolated syndromes but a relevant prognostic factor. Mult Scler Houndmills Basingstoke Engl. 2018 Mar;24(3):301 -12.
  84. [92]92. Brownlee WJ, Altmann DR, Prados F, Miszkiel KA, Eshaghi A, Gandini WheelerKingshott CAM, et al. Early imaging predictors of long-term outcomes in relapse-onset multiple sclerosis. Brain J Neurol. 2019 Aug 1;142(8):2276 -87.
  85. [93]93. Mallucci G, Ferraro OE, Trojano M, Amato MP, Scalfari A, Zaffaroni M, et al. Early prediction of unfavorable evolution after a first clinical episode suggestive of multiple sclerosis: the EUMUS score. J Neurol. 2024 Jun;271(6):3496 -505.
  86. [95]95. Eshaghi A, Prados F, Brownlee WJ, Altmann DR, Tur C, Cardoso MJ, et al. Deep - gray matter volume loss drives disability worsening in multiple sclerosis. Ann Neurol. 2018 Feb;83(2):210 -22.
  87. [96]96. Uher T, Krasensky J, Malpas C, Bergsland N, Dwyer MG, Kubala Havrdova E, et al. Evolution of Brain Volume Loss Rates in Early Stages of Multiple Sclerosis. Neurol Neuroimmunol Neuroinflammation. 2021 May;8(3):e979.
  88. [97]97. Azevedo CJ, Overton E, Khadka S, Buckley J, Liu S, Sampat M, et al. Early CNS neurodegeneration in radiologically isolated syndrome. Neurol Neuroimmunol Neuroinflammation. 2015 Jun;2(3):e102.
  89. [98]98. Ruggieri S, Prosperini L, Al-Araji S, Annovazzi PO, Bisecco A, Ciccarelli O, et al. Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study. J Neurol Neurosurg Psychiatry. 2024 Jan 11;95(2):142 -50.
  90. [99]99. Kunchok A, Lechner-Scott J, Granella F, Trojano M, Alroughani R, Sola P, et al. Prediction of on-treatment disability worsening in RRMS with the MAGNIMS score. Mult Scler Houndmills Basingstoke Engl. 2021 Apr;27(5):695 -705.
  91. [100]100. Ruggieri S, Prosperini L, Petracca M, Logoteta A, Tinelli E, De Giglio L, et al. The added value of spinal cord lesions to disability accrual in multiple sclerosis. J Neurol. 2023 Oct;270(10):4995 -5003.
  92. [101]101. Dickerson E, Davenport MS, Syed F, Stuve O, Cohen JA, Rinker JR, et al. Effect of Template Reporting of Brain MRIs for Multiple Sclerosis on Report Thoroughness and Neurologist-Rated Quality: Results of a Prospective Quality Improvement Project. J Am Coll Radiol JACR. 2017 Mar;14(3):371-379.e1.
  93. [102]102. Lee JK, Bermel R, Bullen J, Ruggieri P, Jones SE. Structured Reporting in Multiple Sclerosis Reduces Interpretation Time. Acad Radiol. 2021 Dec;28(12):1733 -8.
  94. [103]103. Mendelsohn Z, Pemberton HG, Gray J, Goodkin O, Carrasco FP, Scheel M, et al. Commercial volumetric MRI reporting tools in multiple sclerosis: a systematic review of the evidence. Neuroradiology. 2023 Jan;65(1):5 -24.

Cited by

Sorted by citations

Authors
Barkhof, F., Reich, D. S., Oh, J., Rocca, M. A., Li, D. K. B., Sati, P., Azevedo, C. J., Bagnato, F., Calabresi, P. A., Ciccarelli, O., Dwyer, M. G., DeLuca, G. C., De Stefano, N., Enzinger, C., Filippi, M., Granziera, C., Halper, J., Henry, R. G., Gasperini, C., Gauthier, S., Kappos, L., Laule, C., Newsome, S. D., Montalban, X., Morrow, S. A., Schoonheim, M. M., Sicotte, N., Toosy, A., Wilken, J., Yousry, T., Sastre-Garriga, J., Traboulsee, A., Ontaneda, D., & Rovira, À.
Affiliations
  • Amsterdam Neuroscience (NL)
  • National Institutes of Health (US)
  • St. Michael's Hospital (CA)
  • Vita-Salute San Raffaele University (IT)
  • University of British Columbia (CA)
  • Cedars-Sinai Medical Center (US)
  • University of Southern California (US)
  • Nashville VA Medical Center (US)
  • Johns Hopkins University (US)
  • National Institute for Health and Care Research (GB)
  • University at Buffalo, State University of New York (US)
  • University of Oxford (GB)
  • Medical University of Graz (AT)
  • University of Basel (CH)
  • University of California, San Francisco (US)
  • Azienda Ospedaliera San Camillo-Forlanini (IT)
  • Weill Cornell Medicine (US)
  • University of Calgary (CA)
  • National Hospital for Neurology and Neurosurgery (GB)
  • Georgetown University (US)
  • University College London Hospitals NHS Foundation Trust (GB)
  • Cleveland Clinic Lerner College of Medicine (US)
  • Universitat Autònoma de Barcelona (ES)
Corresponding author
Barkhof, Frederik
ORCID
Venue
The Lancet Neurology
Publisher
Elsevier BV
Published
2025-10
Volume
24
Issue
10
Pages
866-879
ISSN
1474-4422 (ISSN-L)
DOI
10.1016/s1474-4422(25)00304-7
OpenAlex
W4414273415
Cited by
113
References
6
Citations by year
2026: 95 · 2025: 18
FWCI
75.14
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • Use Siena air (University of Siena) (submittedVersion)
Funders
  • National Institutes of Health
  • U.S. Department of Health and Human Services
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
Keywords
multiple sclerosis, MRI diagnosis, dissemination in space, optic nerve lesions, central vein sign, paramagnetic rim lesions, radiologically isolated syndrome, image interpretation, misdiagnosis, older adults, children, migraine, vascular comorbidities, early diagnosis
MeSH terms
Brain, Humans, Magnetic Resonance Imaging, Multiple Sclerosis, Consensus

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review