Conflict of interest: None.
Adherence to MRI protocol consensus guidelines in multiple sclerosis: An Australian multi-centre study
Version of Record online: 5 NOV 2012
© 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists
Journal of Medical Imaging and Radiation Oncology
Volume 56, Issue 6, pages 594–598, December 2012
How to Cite
Curley, M., Josey, L., Lucas, R., Dear, K., Taylor, B. V., Coulthard, A., Ausimmune Investigator Group, Chapman, C., Coulthard, A., Dear, K., Dwyer, T., Kilpatrick, T., Lucas, R., McMichael, T., Pender, M. P., Ponsonby, A.-L., Taylor, B., Valery, P., van der Mei, I. and Williams, D. (2012), Adherence to MRI protocol consensus guidelines in multiple sclerosis: An Australian multi-centre study. Journal of Medical Imaging and Radiation Oncology, 56: 594–598. doi: 10.1111/1754-9485.12000
The Ausimmune Investigator Group includes Dr Caron Chapman, Professor Alan Coulthard, A/Professor Keith Dear, Professor Terry Dwyer, Professor Trevor Kilpatrick, A/Professor Robyn Lucas, Professor Tony McMichael, Professor Michael P Pender, Professor Anne-Louise Ponsonby, Professor Bruce Taylor, Dr Patricia Valery, Dr Ingrid van der Mei and Dr David Williams.
Funding sources: Funding for the Ausimmune Study was provided by the National Multiple Sclerosis Society of the United States of America, the National Health and Medical Research Council of Australia and Multiple Sclerosis Research Australia.
- Issue online: 5 DEC 2012
- Version of Record online: 5 NOV 2012
- Manuscript Accepted: 28 SEP 2012
- Manuscript Received: 12 MAR 2012
- National Multiple Sclerosis Society of the United States of America
- National Health and Medical Research Council of Australia
- Multiple Sclerosis Research Australia
- demyelinating disease;
- multiple sclerosis
Multiple sclerosis (MS) is a debilitating disease that causes significant morbidity within a young demographic. Diagnostic guidelines for MS have evolved, and imaging has played an increasingly important role in diagnosis over the last two decades. For imaging to contribute to diagnosis in a meaningful way, it must be reproducible. Consensus guidelines for MRI in MS exist to define correct sequence type and imaging technique, but it is not clear to what extent they are followed. This study reviewed MRI studies performed on Australian individuals presenting with a first clinical diagnosis of central nervous system demyelination (FCD) for adherence to published guidelines and discussed practical implementation of MS guidelines in light of recent updates.
The Ausimmune study was a prospective case control study of Australian participants presenting with FCD from 2003 to 2006. Baseline cranial and spinal cord MRI studies of 226 case participants from four separate Australian regions were reviewed. MRI sequences were classified according to anatomical location, slice plane, tissue weighting and use of gadolinium-containing contrast media. Results were compared with the 2003 Consortium of Multiple Sclerosis Centres MRI protocol for the diagnosis of MS.
The composition of core cranial MRI sequences performed varied across the 226 scans. Of the studies, 91% included sagittal fluid attenuated inversion recovery (FLAIR) sequences. Cranial axial T2-weighted, axial FLAIR and axial proton density-weighted sequences were performed in 88%, 60% and 16% (respectively) of scans. Only 25% of the studies included a T1-weighted contrast-enhanced sequence. Concordance with the guidelines in all sequences was very low (2).
Only a small number of MRI investigations performed included all of the sequences stipulated by consensus guidelines. This is likely due to poor awareness in the imaging community of the guidelines and the rationale behind certain sequences. Radiologists with a sub-speciality interest in neuroradiology should take ownership of this issue and ensure that recommended imaging guidelines are followed.