Research by Dr Poneh Adib-Samii

All of our attendees carry out a piece of research in an area of MS clinical practice or treatment that interests them.

This snapshot, which won ‘runner up’ in the MS Academy MasterClass 5 Project Award 2019, gives you a quick idea of what they found and why. If you want to learn more, just click through to the full research report, or follow the links within the snapshot.

If you would like to contact Dr Thouin, drop us a line and we’ll put you in touch where possible.

 

Aim

To carry out an audit comparing MRI scanning in both suspected multiple sclerosis (MS) and clinically isolated syndrome (CIS) to the Consortium of MS Centers (CMSC) guidelines.

Headlines

  • Magnetic resonance imaging (MRI) is a cornerstone in the diagnosis and treatment monitoring of MS.
  • Imaging guidelines in MS have been proposed by MRI in MS (MAGNIMS, 2015) & Consortium of MS Centers (CMSC) (2016) which proposed four standard protocols (brain, orbits, spine and PML).
  • The Barnet MS service has over 600 patients mostly on disease modifying therapies (DMT) and MRI departments which are both extremely busy and have no neuro-specialist available.
  • The audit looked at retrospective data across one year:
    • 22 new patients (5 males: 17 females) with a mean age of 33.5 (range 19 to 51).
    • Scanned on 5 different scanners (all 1.5T) across 4 sites.
    • Requesting imaging as: 3 brain, 12 brain with cervical spine, and 7 brain with whole spine.
    • Post contrast imaging was acquired in 11(50%) brain and 5 (25%) spinal scans.

Key findings

  • MRI at Barnet is non-standardised with variation in hardware, software and protocols.
  • Imaging is acquired across multiple sites within set time slots.
  • All imaging fell short of recommended guidelines with large slice thicknesses and/or gaps resulting in partial volume effects.
  • Radiographers fed back that the minimum delay of 5 minutes post contrast was not adhered to, potentially reducing enhancement detection rate.

Specific areas where imaging fell short included:

  • Brain sagittal and axial FLAIR (only 14%) is recommended for better detection of juxtacortical & peri-ventricular lesions compared with T2.
    • Most FLAIR was coronal (86%) making axial T2 lesion corroboration difficult.
    • Adequate axial T2 or PD is recommended for better detection of posterior fossa lesions compared to FLAIR.
    • The most common T2 protocol was BLADE, optimized for motion artifact but with poor resolution.
    • There were no 3D volumetric T1, however, time & suboptimal images at 1.5T may preclude its clinical use.
    • For spine imaging, 80% had T2 and STIR but no PD.

Core recommendations

  • PD may be better than STIR for cord signal and can be acquired with T2 using a long repetition time (dual echo).
  • Any future protocol must consider the findings of this study, meet all clinical needs, and be agreed with third party private providers.

 

More information

  • Read the full report from Dr Poneh Adib-Samii on this project.
  • Find a helpful list of all the medical abbreviations used in this Snapshot.