Multiple Sclerosis
Multiple Sclerosis
This extensive lecture covers the evolution of Multiple Sclerosis (MS) from a disease of "types" to a biological continuum of inflammation and neurodegeneration. It provides a deep dive into the 2024/2025 McDonald Criteria revisions, which incorporate new topographic locations and advanced MRI biomarkers. The session emphasizes the role of the radiologist and researcher in identifying specific lesion patterns and utilizing advanced sequences to distinguish MS from its primary clinical mimics.
At the end of this lecture, students will be able to:
- Summarize the 2024/2025 revisions to the McDonald Criteria, including the addition of the optic nerve as a site for dissemination in space.
- Identify the hallmarks of typical MS lesions, such as Dawson’s fingers and juxtacortical U-fiber involvement.
- Differentiate between Dissemination in Space (DIS) and Dissemination in Time (DIT) using both structural MRI and CSF markers, such as Kappa free light chains.
- Explain the significance of advanced biomarkers: the Central Vein Sign (CVS) for diagnostic specificity and Paramagnetic Rim Lesions (PRL) for tracking chronic active inflammation.
- Distinguish MS from other demyelinating disorders, specifically NMOSD and MOGAD, based on lesion morphology and location.
Topics covered in this lesson
- The role of T and B cell infiltration, blood-brain barrier breakdown, and the energy failure of demyelinated axons.
- Detailed scenarios for establishing DIS and DIT, and the new role of Radiologically Isolated Syndrome (RIS) in early diagnosis.
- Recommended 3D FLAIR and T2 sequences versus optional sequences like Double Inversion Recovery (DIR).
- Utilizing SWI/T2* to visualize the Central Vein Sign and iron-laden macrophages in chronic active lesions.
- Comparing "short-segment" MS lesions with the "long-segment" transverse myelitis seen in NMOSD.
- A review of MAGNIMS and CMSC consensus recommendations for standardized reporting and pregnancy-related considerations.
External links