User:Julinka Auta Fernandes/sandbox MS CT
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D. Julinka Auta Fernandes
Overview
CT scan has a limited and nonspecific role in the evaluation of suspected multiple sclerosis (MS). Conventional CT is not the preferred imaging modality for the diagnosis or routine monitoring of MS. Current American College of Radiology (ACR) Appropriateness Criteria support magnetic resonance imaging (MRI) rather than CT for initial imaging when central nervous system demyelinating disease is suspected.[1]
CT may demonstrate nonspecific abnormalities such as brain atrophy, white-matter hypoattenuation, or, less commonly, areas of contrast enhancement. These findings are not specific for MS and cannot establish the diagnosis.[1]
The 2024 McDonald criteria and the 2024 MAGNIMS-CMSC-NAIMS consensus recommendations emphasize MRI as the principal imaging modality for the diagnosis and evaluation of MS.[2][3]
CT scan
CT scan is not recommended as the primary imaging test for the diagnosis of MS when MRI is available. In the current ACR Appropriateness Criteria for suspected central nervous system demyelinating disease, CT examinations are generally rated Usually Not Appropriate for initial evaluation, whereas MRI is the preferred imaging modality.[1]
Findings that may be seen on CT in patients with MS include:
- Brain atrophy, which is nonspecific and may occur in established MS
- Areas of white-matter hypoattenuation or other nonspecific abnormalities
- Occasional contrast enhancement associated with disruption of the blood brain barrier
These CT findings are neither sufficiently sensitive nor specific to diagnose MS. Contrast enhancement on CT is nonspecific and should not be regarded as a substitute for MRI assessment of inflammatory disease activity or for application of the current MS diagnostic criteria.[1][2]
The 2024 McDonald criteria incorporate clinical and paraclinical evidence and recognize five anatomical regions relevant to dissemination in space: periventricular, cortical or juxtacortical, infratentorial, spinal cord, and optic nerve. These diagnostic concepts are principally evaluated using MRI and cannot be adequately assessed with conventional CT.[2]
The 2024 MAGNIMS-CMSC-NAIMS consensus recommendations describe the expanded role of MRI in the diagnosis of MS, including standardized MRI acquisition and interpretation and the use of additional MRI markers such as the central vein sign and paramagnetic rim lesions when appropriate.[3]
CT may still be appropriate in selected clinical circumstances when the purpose of imaging is to evaluate an alternative diagnosis or an acute complication rather than to establish or monitor MS. This may include selected emergency presentations or situations in which MRI is unavailable, contraindicated, or cannot be performed promptly. The indication for CT should be based on the specific clinical question.[1]
Routine CT is not recommended for monitoring MS disease activity. MRI is the preferred modality for follow-up assessment of MS and for detection of new or enlarging lesions and other imaging evidence of disease activity.[1][3]
The previously described double delayed high dose CT (DDHD CT) technique is not included in current MS diagnostic criteria or contemporary American or European recommendations for MS imaging. The historical use of DDHD CT to demonstrate enhancing lesions or assess changes following steroid therapy should therefore not be used to guide current diagnosis or management of MS.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 "ACR Appropriateness Criteria®: Demyelinating Diseases". American College of Radiology.
- ↑ 2.0 2.1 2.2 Montalban X, Oh J, Stangel M, et al. (October 2025). "Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria". Lancet Neurology. 24 (10): 850–865. doi:10.1016/S1474-4422(25)00270-4. PMID 40975101 Check
|pmid=value (help). - ↑ 3.0 3.1 3.2 Barkhof F, Reich DS, Oh J, et al. (October 2025). "2024 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI for the diagnosis of multiple sclerosis". Lancet Neurology. 24 (10): 866–879. doi:10.1016/S1474-4422(25)00304-7. PMID 40975102 Check
|pmid=value (help).