Table 2. Suggested MRI protocol for the diagnosis and monitoring of MS and NMOSD.
| Sequence | MS | NMOSD | |||
|---|---|---|---|---|---|
| Diagnosis | Monitoring | Diagnosis | Monitoring | ||
| Brain | |||||
| T2-w | Yes | Yes | Yes | If cerebral attack | |
| FLAIR (preferably 3D) | Yes | Yes | Yes | If cerebral attack | |
| Pre-contrast T1-w (2D) | Yes | Optional | Yes | Optional | |
| Post-contrast T1-w (2D) | Yes | Optional | Yes | If cerebral attack | |
| DIR or PSIR* | Yes | Optional | Optional | No | |
| High-resolution T1-w (3D)† | Optional | Optional | Optional | Optional | |
| SWI‡ | Optional | Optional | Optional | No | |
| DTI | Optional | Optional | Optional | Optional | |
| Optic nerve | |||||
| Fat-Sat T2-w/FLAIR/STIR§ | Optional | If optic neuritis | Yes | If optic neuritis | |
| Fat-Sat post-contrast T1-w | Optional | If optic neuritis | Optional | If optic neuritis | |
| Spinal cord | |||||
| ≥ 2 Sagittal T2-w | Yes | Yes | Yes | If myelitis | |
| Axial T2-w | Yes | Yes | Yes | If myelitis | |
| Sagittal pre-contrast T1-w | Optional | No | Optional | No | |
| Sagittal post-contrast T1-w | Yes | If myelitis | Yes | If myelitis | |
| Axial post-contrast T1-w | Optional | Optional | Optional | Optional | |
| High-resolution T1-w (3D)† | Optional | Optional | Optional | Optional | |
Modified from Wattjes et al. [10], Lancet Neurol 2021;20:653-670, 2021 MAGNIMS-CMSC-NAIMS consensus recommendations according to authors’ personal experience.
*Sequences for cortical lesion detection may be particularly useful at the time of diagnosis given the lack of cortical lesions in NMOSD patients, †This sequence should be included if clinicians/researchers are interested in measuring atrophy, ‡Useful for the detection of the central vein sign (more common in MS) and for the identification of the paramagnetic rim, §Optional in patients with MS, unless suspected with optic neuritis. At the time of diagnosis, evidence of long lesions extending over 50% of the optic nerve or involving the optic chiasm, even if not active, may provide clues towards NMOSD diagnosis.
MRI = magnetic resonance imaging, MS = multiple sclerosis, NMOSD = neuromyelitis optica spectrum disorders, MAGNIMS = Magnetic Resonance Imaging in Multiple Sclerosis, CMSC = Consortium of Multiple Sclerosis Centres, NAIMS = North American Imaging in Multiple Sclerosis, T2-w = T2-weighted sequence, FLAIR = fluid-attenuated inversion recovery, 3D = three dimensional, T1-w = T1-weighted sequence, 2D = two dimensional, DIR = double inversion recovery, PSIR = phase-sensitive inversion recovery, SWI = susceptibility-weighted imaging, DTI = diffusion-tensor imaging, Fat-Sat = fat suppressed, STIR = short tau inversion recovery