When is follow-up brain MRI with gadolinium indicated in established multiple sclerosis (MS), according to CMSC guidelines?

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

Follow-up brain MRI with gadolinium is recommended for patients with an established diagnosis of MS in the following circumstances:

  • No recent prior imaging available (eg, patient with MS transferring to a new clinic)
  • Postpartum, to establish a new baseline
  • Prior to starting or switching disease-modifying therapy
  • Approximately 6 months after switching disease-modifying therapy, to establish a new baseline on the new therapy
  • Every 1–2 years while on disease-modifying therapy, to assess subclinical disease activity
  • In the event of unexpected clinical deterioration or reassessment of original diagnosis

In addition, brain MRI is recommended to monitor for progressive multifocal leukoencephalopathy (PML) at the following intervals:

  • Every 12 months for patients negative for serum JC virus antibody
  • Every 3–6 months for patients positive for serum JC virus antibody treatment and treatment duration with natalizumab ≥18 months

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