Linford Fernandes1, Christopher Martin Allen2, Thomas Williams3, Emma Tallantyre4, Nikos Evangelou5, Jeremy Chataway3, Helen L Ford6, Ala Abuown7, Michael Andrews8, Tarunya Arun9, Gavin Brittain10, William Brown11, Alasdair Coles11, Ibrahim Djoukhadar12, Anisha Doshi3, Amar Elsaddig13, Peter Fernandes14, Leonora Fisniku15, Shayna Franzetti16, Ian Galea17, Orla Gray18, Marc Hardwick19, Stella Hughes20, Gillian Ingram21, Seema Kalra22, Fiona Kennedy20, Emma Lammey18, Mazen Matar23, Gordon Mazibrada23, James McDonald24, Gavin McDonnell25, Ahmed Mubarak Mohamed10, David Paling10, Kate Petheram26, David Rog12, Klaus Schmierer27, Emma Spector26, Cord Spilker28, Anaïs Thouin29, Julie Webster30, Mark Willis4, Ray Wynford-Thomas31, Tadas Zuromskis32. 1. Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: linford.fernandes@nhs.net. 2. Queen's Medical Centre, Nottingham, UK. 3. Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK. 4. University Hospital of Wales, Cardiff, UK. 5. University of Nottingham, Nottingham, UK. 6. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 7. Imperial College Healthcare NHS Trust, UK. 8. Barts Health NHS Trust, UK. 9. University Hospitals of Coventry and Warwickshire, Coventry, UK. 10. Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 11. Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. 12. Manchester Centre for Clinical Neurosciences, Neuroradiology Department, Salford Royal NHS Foundation Trust, Salford, UK. 13. Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK. 14. University of Edinburgh, Edinburgh, UK. 15. University Hospitals Sussex NHS Foundation Trust, UK. 16. Sunderland Royal Hospital, UK. 17. Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. 18. Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK. 19. Wessex Neurosciences Centre, University Hospital Southampton, UK. 20. Department of Neurology, Belfast Health & Social Care Trust, Belfast, UK. 21. Swansea Bay University Health Board, Swansea, UK. 22. Royal Stoke MS Centre, University Hospital North Midlands NHS Trust, Stoke-on-Trent, UK. 23. University Hospitals Birmingham NHS Trust, Birmingham, UK. 24. Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK. 25. Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK. 26. South Tyneside and Sunderland NHS Foundation Trust, UK. 27. The Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, Barts and The London School of Medicine & Dentistry, London, UK. Electronic address: k.schmierer@qmul.ac.uk. 28. Bradford Teaching Hospitals NHS Trust, UK. 29. Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK. 30. Mid and South Essex NHS Foundation Trust, Essex, UK. 31. Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK. 32. Department of Neurology, Great Western Hospitals NHS Foundation Trust, UK.
Abstract
BACKGROUND: Compare the contemporary use of magnetic resonance imaging (MRI) in the monitoring and management of people with MS in the UK to current consensus guidelines. METHODS: This retrospective multicentre audit of clinical practice gathered data on 2567 patients with MS from 25 MS centres across the UK. RESULTS: Routine monitoring (44.7%), and recent clinical relapse (20.3%) were the most common scan indications. In routine monitoring, the addition of spinal imaging to brain showed no significant difference in disease modifying treatment (DMT) decision at subsequent clinical review. Approximately 1 in 5 gadolinium administered scans showed enhancement, and in 1 in 20 patients, gadolinium enhancement was the only evidence of radiological disease activity. Mean inter-scan intervals in relapsing-remitting MS for routine monitoring was 19.2 months (SD 20.7) with wide variation between centres. Only 53.8% of patients under progressive multifocal leukoencephalopathy (PML) surveillance met the recommended scanning frequency. MRI protocols demonstrated heterogeneity in the sequences used for diagnostic, monitoring and PML surveillance scans. CONCLUSIONS: MS centres across the UK demonstrate varied practice and protocols when using MRI to monitor people with MS. In this cohort, gadolinium use and spinal imaging demonstrates limited impact on subsequent DMT decisions.
BACKGROUND: Compare the contemporary use of magnetic resonance imaging (MRI) in the monitoring and management of people with MS in the UK to current consensus guidelines. METHODS: This retrospective multicentre audit of clinical practice gathered data on 2567 patients with MS from 25 MS centres across the UK. RESULTS: Routine monitoring (44.7%), and recent clinical relapse (20.3%) were the most common scan indications. In routine monitoring, the addition of spinal imaging to brain showed no significant difference in disease modifying treatment (DMT) decision at subsequent clinical review. Approximately 1 in 5 gadolinium administered scans showed enhancement, and in 1 in 20 patients, gadolinium enhancement was the only evidence of radiological disease activity. Mean inter-scan intervals in relapsing-remitting MS for routine monitoring was 19.2 months (SD 20.7) with wide variation between centres. Only 53.8% of patients under progressive multifocal leukoencephalopathy (PML) surveillance met the recommended scanning frequency. MRI protocols demonstrated heterogeneity in the sequences used for diagnostic, monitoring and PML surveillance scans. CONCLUSIONS: MS centres across the UK demonstrate varied practice and protocols when using MRI to monitor people with MS. In this cohort, gadolinium use and spinal imaging demonstrates limited impact on subsequent DMT decisions.
Authors: Kimberley Allen-Philbey; Stefania De Trane; Zhifeng Mao; Cesar Álvarez-González; Joela Mathews; Amy MacDougall; Andrea Stennett; Xia Zhou; Ozlem Yildiz; Ashok Adams; Lucia Bianchi; Camilla Blain; Christine Chapman; Karen Chung; Cris S Constantinescu; Catherine Dalton; Rachel A Farrell; Leonora Fisniku; Helen Ford; Bruno Gran; Jeremy Hobart; Zhaleh Khaleeli; Miriam Mattoscio; Sue Pavitt; Owen Pearson; Luca Peruzzotti-Jametti; Antonio Scalfari; Basil Sharrack; Eli Silber; Emma C Tallantyre; Stewart Webb; Benjamin P Turner; Monica Marta; Sharmilee Gnanapavan; Gunnar Juliusson; Gavin Giovannoni; David Baker; Klaus Schmierer Journal: Ther Adv Neurol Disord Date: 2021-11-25 Impact factor: 6.570