Curley Michael, Josey Lawrence, Lucas Robyn, Dear Keith, Taylor Bruce V, Coulthard Alan, Chapman Caron, Coulthard Alan, Dear Keith, Dwyer Terry, Kilpatrick Trevor, Lucas Robyn, McMichael Tony, Pender Michael P, Ponsonby Anne-Louise, Taylor Bruce, Valery Patricia, van der Mei Ingrid, Williams David
Department of Medical Imaging, Royal Brisbane and Women's Hospital, Australia.
J Med Imaging Radiat Oncol. 2012 Dec;56(6):594-8. doi: 10.1111/1754-9485.12000.
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.
多发性硬化症（MS）是一种使人衰弱的疾病，在年轻人群中导致显著的发病率。MS的诊断指南不断发展，在过去二十年中，影像学在诊断中发挥着越来越重要的作用。为了使影像学以有意义的方式有助于诊断，其结果必须具有可重复性。MS的MRI共识指南旨在定义正确的序列类型和成像技术，但目前尚不清楚这些指南的遵循程度。本研究回顾了对首次临床诊断为中枢神经系统脱髓鞘（FCD）的澳大利亚人进行的MRI研究，以评估其对已发表指南的遵循情况，并根据最新更新讨论MS指南的实际应用。
Ausimmune研究是一项对2003年至2006年出现FCD的澳大利亚参与者进行的前瞻性病例对照研究。对来自澳大利亚四个不同地区的226例病例参与者的基线头颅和脊髓MRI研究进行了回顾。MRI序列根据解剖位置、切片平面、组织加权以及含钆造影剂的使用进行分类。将结果与2003年多发性硬化症中心联盟用于MS诊断的MRI方案进行比较。
在226次扫描中，所执行的核心头颅MRI序列的组成各不相同。在这些研究中，91%包括矢状位液体衰减反转恢复（FLAIR）序列。头颅轴位T2加权、轴位FLAIR和轴位质子密度加权序列分别在88%、60%和16%的扫描中进行。只有25%的研究包括T1加权对比增强序列。所有序列与指南的一致性都非常低（2）。
所进行的MRI检查中只有少数包括了共识指南规定的所有序列。这可能是由于影像学界对指南以及某些序列背后的原理认识不足。对神经放射学有亚专业兴趣的放射科医生应关注这个问题，并确保遵循推荐的成像指南。
