MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—establishing disease prognosis and monitoring patients
Open accessAbstract
In the second part of the MAGNIMS network's evidence-based guidelines, Wattjes and colleagues discuss the use of MRI in prognostication and follow-up in patients with multiple sclerosis. The group recommend several techniques that are useful for monitoring disease activity and treatment efficacy, and identify those techniques that require further study. The role of MRI in the assessment of multiple sclerosis (MS) goes far beyond the diagnostic process. MRI techniques can be used as regular monitoring to help stage patients with MS and measure disease progression. MRI can also be used to measure lesion burden, thus providing useful information for the prediction of long-term disability. With the introduction of a new generation of immunomodulatory and/or immunosuppressive drugs for the treatment of MS, MRI also makes an important contribution to the monitoring of treatment, and can be used to determine baseline tissue damage and detect subsequent repair. This use of MRI can help predict treatment response and assess the efficacy and safety of new therapies. In the second part of the MAGNIMS (Magnetic Resonance Imaging in MS) network's guidelines on the use of MRI in MS, we focus on the implementation of this technique in prognostic and monitoring tasks. We present recommendations on how and when to use MRI for disease monitoring, and discuss some promising MRI approaches that may be introduced into clinical practice in the near future.
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CSF findings atypical of MS (for example, markedly elevated protein >100 mg/dL; pleocytosis with >50 cells/mm 3 ; or presence of neutrophils, eosinophils, or atypical cells) suggest other diseases.
“Conversely, CSF findings atypical of MS (for example, markedly elevated protein >100 mg/dL; pleocytosis with >50 cells/mm 3 ; or presence of neutrophils, eosinophils, or atypical cells) suggest other diseases. 59”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [59]
The Prognostic value of baseline MRI and Detection of adverse effects sections discuss imaging findings, not CSF laboratory findings. Searches for elevated CSF protein, pleocytosis, and the listed cell types found no passage addressing whether those findings suggest another disease; page numbers were unavailable in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measuredThe sensitivity of OCB testing depends on the method used; agarose gel electrophoresis with isoelectric focusing and immunoblotting or immunofixation for IgG is the most sensitive at present.
“The sensitivity of OCB testing depends on the method used; agarose gel electrophoresis with isoelectric focusing and immunoblotting or immunofixation for IgG is the most sensitive at present. 58-60”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [59]
The Focal lesions and Detection of adverse effects sections discuss the sensitivity of MRI sequences, not oligoclonal band (OCB) testing. Searches for OCB methods, isoelectric focusing, immunoblotting, immunofixation, and cerebrospinal-fluid testing found no passage addressing the claimed comparison of methods. Page numbers are unavailable in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measuredThe qualitative demonstration of two or more CSF-specific oligoclonal bands (OCBs) more reliably indicates intrathecal antibody synthesis than other tests, such as IgG Index.
“The qualitative demonstration of two or more CSF-specific oligoclonal bands (OCBs) more reliably indicates intrathecal antibody synthesis than other tests, such as IgG Index. 58-60”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [59]
The cited paper’s Prognostic value of baseline MRI and Early prediction sections discuss MRI markers and treatment monitoring, not CSF oligoclonal bands. Searches of our full-text copy for “oligoclonal,” “intrathecal antibody synthesis,” and “IgG index” found no passage addressing the claimed comparison. (LLM, conf=0.76)
Experimental — accuracy not yet measuredNegative CSF OCBs does not rule out MS, particularly early in the condition and in children.
“While negative CSF OCBs does not rule out MS, particularly early in the condition and in children, 58,59 caution should be exercised in diagnosing MS when CSF OCBs are not detected and, certainly, in the presence of atypical clinical, imaging, or CSF findings.”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [59]
The Prognostic value of baseline MRI and Early prediction sections discuss MRI findings and treatment response, not CSF oligoclonal bands. Searches for negative OCBs, early MS, and children found no passage addressing whether negative CSF OCBs rule out MS. (LLM, conf=0.75)
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Polman, C. H., Reingold, S. C., Banwell, B., Clanet, M., Cohen, J. A., Filippi, M., Fujihara, K., Havrdova, E., Hutchinson, M., Kappos, L., et al. (2011) · Annals of Neurology · doi:10.1002/ana.22366 · Cited by 9,802 · see citing works
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Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., Correale, J., Fazekas, F., Filippi, M., Freedman, M. S., et al. (2018) · The Lancet Neurology · doi:10.1016/s1474-4422(17)30470-2 · Cited by 8,167 · see citing works
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- Authors
- on behalf of the MAGNIMS study group
- Corresponding author
- on behalf of the MAGNIMS study group
- Venue
- Nature Reviews Neurology
- Published
- 2015-09-15
- Volume
- 11
- Issue
- 10
- Pages
- 597-606
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- OpenAlex
- W2441939542
- Cited by
- 473
- References
- 1
- Citations by year
- 2026: 16 · 2025: 15 · 2024: 35 · 2023: 29 · 2022: 44 · 2021: 66 · 2020: 49 · 2019: 50 · 2018: 61 · 2017: 60 · 2016: 45 · 2015: 3
- FWCI
- 8.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Nature Reviews Neurology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Use Siena air (University of Siena) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0508-10058)
- 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 › Oncology › Polyomavirus and related diseases
- Keywords
- multiple sclerosis, magnetic resonance imaging, disease prognosis, disease surveillance, lesion burden, disability prediction, treatment response, immunomodulatory therapy, immunosuppressive therapy, tissue repair
- MeSH terms
- Brain, Humans, Immunotherapy, Magnetic Resonance Imaging, Multiple Sclerosis, Prognosis, Disease Progression, Evidence-Based Medicine, Consensus
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