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Imaging in Pediatric Multiple Sclerosis

An Iconographic Review

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Abstract

Pediatric-onset multiple sclerosis (POMS) is defined by a first multiple sclerosis (MS) attack occurring before 18 years old and is diagnosed by demonstration of dissemination in time (DIT) and space (DIS). Although guidelines evolved over the years, they always recognized the importance of magnetic resonance imaging (MRI) for diagnosis. The 2017 McDonald criteria are increasingly used and have been validated in several cohorts. The use of MRI is the most important tool for the early diagnosis, monitoring, and assessment of treatment response of MS and standard protocols include precontrast and postcontrast T1, T2, fluid attenuation inversion recovery (FLAIR) and diffusion sequences. A distinctive MS lesion compromises white matter and it is well-demarcated and confluent, showing demyelination, inflammation, gliosis, and relative axonal preservation. Considering the growing recognition of pediatric MS as a differential diagnosis for children presenting with a clinical central nervous system event, we present a POMS lesions guide (periventricular, juxtacortical, infratentorial, spinal cord, cortical, tumefactive, black hole, contrast-enhanced). Owing to its rareness, POMS is a diagnosis by exclusion and MRI plays a fundamental role in distinguishing POMS from other demyelinating and non-demyelinating conditions. Three main groups of disorders can mimic POMS: inflammatory, metabolic and tumoral; however, imaging patterns earlier described lower the possibilities of alternative diagnoses and strongly suggest POMS when likely.

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Authors and Affiliations

  1. Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP—HP, 94270, Le Kremlin-Bicêtre, France

    Gonzalo Barraza, Béatrice Husson & Catherine Adamsbaum

  2. Pediatric Neurology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP—HP, 94270, Le Kremlin-Bicêtre, France

    Kumaran Deiva

  3. Inserm UMR1184 “Immunology of viral infections and autoimmune diseases”, CEA, IDMIT, Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France

    Kumaran Deiva

  4. Pediatric stroke National Reference Center, Hôpitaux Universitaires Paris-Sud, Bicêtre AP—HP, 94270, Le Kremlin-Bicêtre, France

    Béatrice Husson

  5. Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France

    Catherine Adamsbaum

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  1. Gonzalo Barraza
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Catherine Adamsbaum had the idea for the article. Gonzalo Barraza performed the literature search, data analysis, and drafted the work. Kumaran Deiva, Béatrice Husson and Catherine Adamsbaum critically revised the work.

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Correspondence to Gonzalo Barraza.

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G. Barraza, K. Deiva, B. Husson and C. Adamsbaum declare that they have no competing interests.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Barraza, G., Deiva, K., Husson, B. et al. Imaging in Pediatric Multiple Sclerosis. Clin Neuroradiol 31, 61–71 (2021). https://doi.org/10.1007/s00062-020-00929-8

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