Diagnostic, Monitoring, and Safety MRI Protocols for Multiple Sclerosis 
Based on the 2021 and 2024 MAGNIMS Consensus Recommendations and the McDonald Criteria

Manuela Vaněčková, Ph.D., MBA 
General University Hospital in Prague, Department of Magnetic Resonance (MRI) of the Radiodiagnostic Clinic at the Neurological Clinic, Prague, Czech Republic

In multiple sclerosis (MS), care relies on magnetic resonance imaging (MRI) for diagnosis and longitudinal management. Standardized, cross-institutional MRI protocols maximize clinical utility by aligning with contemporary criteria. They enable early, accurate diagnosis and capture prognostic markers, flagging subclinical activity that may signal therapeutic ineffectiveness or safety concerns, and support equitable access to high-quality, innovative treatment.

General University Hospital in Prague presents optimized therapeutic MS imaging protocols for 1.5T and 3T systems from Siemens Healthineers. The suite of protocols — diagnostic, monitoring, and safety — covers the brain, spinal cord, and optic nerves to provide a comprehensive assessment of central nervous system disease activity, including dissemination in space and time, negative prognostic markers, and treatment-relevant activity.

For brain MRI, 3D FLAIR, high-resolution 3D MPRAGE, 3D DIR, 3D EPI, and 2D T2WI and DWI delineate lesions in white and gray matter. Contrast-enhanced imaging is performed immediately following gadolinium administration to highlight new or active lesions. Spinal cord evaluation employs sagittal T2 STIR — in line with guidance from the Magnetic Resonance in MS (MAGNIMS) network — and proton density sequences, followed by post-contrast T1 to detect inflammation and structural damage. Optic nerve assessment includes coronal and transverse T2WI with fat suppression (FS) and, after contrast administration, T1WI with FS to visualize inflammation and demyelination associated with optic neuritis.

These harmonized protocols provide a reliable framework to detect, localize, and monitor MS lesions across the central nervous system in accordance with the 2021 and 2024 MAGNIMS international consensus recommendations and the diagnostic McDonald criteria.