Recommendations for the management of contrast media in diagnostic MRI in multiple sclerosis/DMSG

MRI scans are still of great importance for the treatment of MS – Commentary by Mark Pawlitzki and Sven J.

Diagnostic MRI continues to have high diagnostic value, but also therapeutic value for the care of patients with multiple sclerosis. Diagnostic criteria alone have recently reinforced the importance of MRI. Already after the first clinical episode, MS can be diagnosed by the appropriate distribution of demyelinating foci typical of MS on initial cranial and spinal MRI. However, there must also be evidence of a contrast-enhancing lesion as a criterion for temporal dynamics. Although this criterion can be replaced by finding an appropriate cerebrospinal fluid (detection of so-called oligoclonal bands), this should not lead to the dispensation of a contrast medium. Current data from the DMSG’s MS record show a generally interesting development. Because the immediate implementation of current international recommendations leads to an improvement in previous MRI examinations and thus to a reduction in unnecessary contrast agent administration. In detail, administration of contrast media is no longer reasonable, especially for regular MRI scans, but current recommendations continue to stress the basic requirements for optimal monitoring with MRI:

1. Standardized MRI imaging protocols, which thus allow good comparison with previous images and

2. MRI scans of the skull, especially to detect malignant disease activity.

Caution should be taken if one wants to assess the success of immunotherapy by follow-up MRI. Here, three to six months after the start of treatment, an MRI scan should be considered as the primary finding (the so-called baseline restatement), which is then conclusive as a comparison with additional MRI controls. The fact that administration of contrast medium is usually dispensed with disease progression is consistent with previous experience from studies showing an age-related decrease in contrast medium-enhanced lesions in MSĀ². However, administration of a contrast agent may be considered, particularly if secondary chronic development is suspected, to determine (still) current inflammatory activity.

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