What are the guidelines from the CMSC for imaging studies in the diagnosis and monitoring of clinically isolated syndrome (CIS) or suspected multiple sclerosis (MS)?

Updated: Oct 08, 2019
  • Author: Christopher Luzzio, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

CMSC revised guidelines recommend using higher-resolution three-dimensional (3D) imaging over two-dimensional (2D) imaging whenever possible. Recommended studies for patients with CIS or suspected MS include the following:

Brain MRI protocol with gadolinium at baseline

  • Spinal cord MRI if transverse myelitis, inconclusive brain MRI, or age older than 40 with non-specific brain MRI findings
  • Cervical cord MRI performed simultaneously with brain MRI is advantageous in patients with or without transverse myelitis
  • Orbital MRI if severe optic neuritis with poor recovery

Recommended schedules for follow-up brain MRI in patients with a CIS or suspected MS are as follows:

  • 6–12 months for high-risk CIS (≥2 ovoid lesions on first MRI)
  • 12–24 months for low-risk CIS (normal brain MRI findings) and/or uncertain clinical syndrome with suspicious brain MRI features (eg, radiologically isolated syndrome [RIS])

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