MS Diagnostics - The Neuroradiological Perspective

This lecture provides a detailed neuroradiological tour of the diagnosis and monitoring of Multiple Sclerosis using MRI. It focuses on the specific anatomical markers required to prove dissemination in space and time, including the upcoming 2025 diagnostic criteria. The session explains how radiologists identify MS-typical lesions, use contrast agents to pinpoint active inflammation, and apply newer imaging sequences, such as SWI, to distinguish MS from other neurological conditions.

Learning objectives

By the end of this lecture, students will be able to:

• Identify the five typical anatomical locations for MS lesions, including the periventricular, juxtacortical, infratentorial, spinal cord, and optic nerve areas.
• Explain the concept of Dawson’s fingers and their characteristic perpendicular orientation to the brain's ventricles.
• Differentiate between active and non-active lesions using contrast agents (Gadolinium) to establish dissemination in time during a single scan.
• Analyze the role of susceptibility-weighted imaging (SWI) in identifying the Central Vein Sign and paramagnetic rim lesions.
• Understand the technical requirements for optic nerve imaging, such as the need for thin-slice coronal sequences and fat suppression.
• Apply the 2025 revised McDonald Criteria to categorize lesion locations and determine diagnostic certainty in combination with clinical findings.