Suivi en imagerie par résonance magnétique des patients avec une sclérose en plaques : comment ?

Magnetic resonance imaging (MRI) has become a reference technique for multiple sclerosis patients because it enables positive (lesion dissemination in time and space) and differential (susceptibility imaging) diagnosis. The optimal monitoring protocol will ensure the difficult evaluation of brain atrophy and screening for disease-modifying therapies in terms of positive effects (non-evidence of disease activity) and negatives effects. MRI protocols must be harmonized to properly monitor patients. A national harmonization scheme is being developed at the French Observatory of Multiple sclerosis. With 3D imaging (T1/T2/FLAIR), sensitivity for detecting demyelinating lesions and progressive multifocal encephalopathy can be improved, with a better evaluation of atrophy, and the possibility of reconstructing MR images in various plans that can be compared in order to better characterize the evolution of active lesions. Risk stratification implies a narrower MRI protocol without gadolinium injection for the follow-up of patients taking natalizumab. High quality longitudinal MRI follow-up for all MS patients receiving care in the healthcare network requires compliance with these national guidelines.