Background

Recent changes in the understanding and management of multiple sclerosis (MS) have increased the role of MRI in supporting diagnosis and disease monitoring. However, published guidelines on the use of MRI in MS do not translate easily into different clinical settings and considerable variation in practice remains. Here, informed by published guidelines for the use of MRI in MS, we identified a clinically informative MRI protocol applicable in a variety of clinical settings, from district general hospitals to tertiary centres.

Methods

MS specialists geographically representing the UK National Health Service and with expertise in MRI examined existing guidelines on the use of MRI in MS and identification of challenges in their applications in various clinical settings informed the formulation of a feasible MRI protocol.

Results

We identified a minimum set of MRI information, based on clinical relevance, as well as on applicability to various clinical settings. This informed the selection of MRI acquisitions for scanning protocols, differentiated on the basis of their purpose and stage of the disease, and indication of timing for scans. Advice on standardisation of MRI requests and reporting, and proposed timing and frequency of MRI scans were generated.

Conclusions

The proposed MRI protocol can adapt to a range of clinical settings, aiding the impetus towards standardisation of practice and offering an example of research-informed service improvement to support optimisation of resources. Other neurological conditions, where a gap still exists between published guidelines and their clinical implementation, may benefit from this same approach.

中文翻译：

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多发性硬化的诊断和管理：临床实践中的MRI。

背景

多发性硬化症（MS）的理解和管理方面的最新变化增加了MRI在支持诊断和疾病监测中的作用。然而，已发表的有关在MRI中使用MRI的指南不能轻易转化为不同的临床环境，并且实践中仍存在很大差异。在此，根据已发布的有关在MS中使用MRI的指南，我们确定了从地区综合医院到三级中心均适用于多种临床环境的临床信息MRI协议。

方法

MS专家在地理上代表了英国国家卫生服务局（National National Service Service），并具有MRI方面的专业知识，研究了有关在MRI中使用MRI的现有指南，并确定了在各种临床环境中应用MRI所面临的挑战，为制定可行的MRI方案提供了依据。

结果

我们根据临床相关性以及对各种临床环境的适用性，确定了一套最少的MRI信息。这就为扫描方案选择了MRI采集，根据其目的和疾病阶段以及扫描时间的指示来区分。产生了有关MRI请求和报告标准化的建议，并提出了MRI扫描的建议时间和频率。

结论

所提出的MRI协议可以适应各种临床环境，有助于实现实践的标准化，并提供一个以研究为依据的服务改进实例，以支持资源优化。其他神经系统疾病，如果已发布的指南与其临床实施之间仍然存在差距，则可以从这种方法中受益。