Optimized Susceptibility MRI Sequences for Novel Diagnostic Biomarkers of Multiple SclerosisSreekanth Madhusoodhanan Nair, Ph.D.; Nader Binesh, Ph.D.; Marcel Maya, M.D.; Pascal Sati, Ph.D.

The 2024 revisions of the international diagnostic criteria for multiple sclerosis introduce an expanded role for MRI by incorporating two novel imaging biomarkers: the central vein sign (CVS) and paramagnetic rim lesions (PRL). Recent MRI guidelines developed by the MAGNIMS-CMSC-NAIMS consortia provide practical recommendations for implementing the MRI sequences required for accurate biomarker detection and reliable identification of MS.

Given the need for rapid clinical adoption of these newly integrated imaging biomarkers, the article outlines practical strategies to support the integration of appropriate susceptibility MRI sequences into routine diagnostic workflows. The use of an optimized susceptibility-weighted imaging (SWI) protocol is recommended to ensure sensitive detection of CVS, while filtered phase images are suggested for improved detection of PRL. When available, advanced 3D echo planar imaging (EPI) sequences are recommended to acquire submillimeter isotropic images, enabling multiplanar evaluation of T2*-weighted and filtered phase images and increasing diagnostic confidence in the assessment of CVS and PRL.