Current and future role of MRI in the diagnosis and prognosis of multiple sclerosis

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Europe Pub Date : 2024-09-01 DOI:10.1016/j.lanepe.2024.100978
Maria A. Rocca , Paolo Preziosa , Frederik Barkhof , Wallace Brownlee , Massimiliano Calabrese , Nicola De Stefano , Cristina Granziera , Stefan Ropele , Ahmed T. Toosy , Àngela Vidal-Jordana , Massimiliano Di Filippo , Massimo Filippi
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Abstract

In the majority of cases, multiple sclerosis (MS) is characterized by reversible episodes of neurological dysfunction, often followed by irreversible clinical disability. Accurate diagnostic criteria and prognostic markers are critical to enable early diagnosis and correctly identify patients with MS at increased risk of disease progression. The 2017 McDonald diagnostic criteria, which include magnetic resonance imaging (MRI) as a fundamental paraclinical tool, show high sensitivity and accuracy for the diagnosis of MS allowing early diagnosis and treatment. However, their inappropriate application, especially in the context of atypical clinical presentations, may increase the risk of misdiagnosis. To further improve the diagnostic process, novel imaging markers are emerging, but rigorous validation and standardization is still needed before they can be incorporated into clinical practice. This Series article discusses the current role of MRI in the diagnosis and prognosis of MS, while examining promising MRI markers, which could serve as reliable predictors of subsequent disease progression, helping to optimize the management of individual patients with MS. We also explore the potential of new technologies, such as artificial intelligence and automated quantification tools, to support clinicians in the management of patients. Yet, to ensure consistency and improvement in the use of MRI in MS diagnosis and patient follow-up, it is essential that standardized brain and spinal cord MRI protocols are applied, and that interpretation of results is performed by qualified (neuro)radiologists in all countries.

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磁共振成像在多发性硬化症诊断和预后中的当前和未来作用
在大多数病例中,多发性硬化症(MS)的特征是神经功能障碍的可逆性发作,随后往往出现不可逆转的临床残疾。准确的诊断标准和预后标志物对于早期诊断和正确识别疾病进展风险增加的多发性硬化症患者至关重要。2017 年麦克唐纳诊断标准将磁共振成像(MRI)作为基本的临床辅助工具,显示出对多发性硬化症诊断的高灵敏度和准确性,可实现早期诊断和治疗。然而,如果应用不当,尤其是在临床表现不典型的情况下,可能会增加误诊的风险。为了进一步改善诊断过程,新型成像标记物不断涌现,但在将其应用于临床实践之前仍需要严格的验证和标准化。本系列文章讨论了磁共振成像目前在多发性硬化症的诊断和预后中的作用,同时研究了有前景的磁共振成像标记物,这些标记物可作为后续疾病进展的可靠预测指标,有助于优化多发性硬化症患者的个体化管理。我们还探索了人工智能和自动量化工具等新技术在支持临床医生管理患者方面的潜力。然而,为了确保核磁共振成像在多发性硬化症诊断和患者随访中的一致性并提高其应用水平,各国必须采用标准化的脑和脊髓核磁共振成像方案,并由合格的(神经)放射科医生对结果进行解读。
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来源期刊
CiteScore
19.90
自引率
1.40%
发文量
260
审稿时长
9 weeks
期刊介绍: The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.
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