Camilla Blains' advice re imaging surveillance obtained 30.11.20

Please note; Leonora Fisniku and Neuroradiology may take a different view

Contrast imaging is not required very often

 * Gadolinium will accumulate
 * MS patients if young and disease is active, will have many repeated scans over their lifetimes
 * Consider at diagnosis, especially if no prior neurological symptoms
 * Imaging with contrast then helps determine if dissemination in time and space is present
 * Can help rule out mimics such as neurosarcoid (meningeal enhancement)
 * New lesions can be judged by their size and diffusion sequence characteristics
 * The same applies for imaging during relapse symptoms

If patient is well with RRMS and on injectable DMTs rescan every 2 years

 * If older and has been stable for a long time 2-3 years is OK
 * young at MS diagnosis disease likely to be inflammatory
 * older (40-50s+) less inflammatory but more likely to progress
 * She would recommend brain and cervical/thoracic cord rather than brain alone
 * Chance of silent lesions developing is higher in brain than cord but helpful to have cord imaging every few years so that comparison can be made if disease activity changes

Progressive patients rescan every 3 years, especially if eligibility for DMT is being considered

 * brain, cervical and thoracic cord with gadolinium

Some DMTs require baseline imaging at start of DMT especially highly active DMTs and tecfidera

 * Frequency of surveillance if patient is stable depends on the disease activity of the scan.
 * 6/12 if active. Can consider 12/12 if less active.
 * Re-scan if clinical relapse/symptom progression of course