The precision of magnetic resonance imaging (MRI) measurement has improved over the years, and now scans can identify brain damage before symptoms begin showing. Whether the presence of new or expanding lesions predict disease progression is, however, still controversial, and clinicians have no guidance when making treatment decisions about the management of potential high-risk patients.
Discussions have gone back and forth for years about using conventional and unconventional MRI techniques for both predicting disease progression and monitoring treatment response. The argument continued March 18 at the 10th World Congress on Controversies in Neurology (CONy) in Lisbon, Portugal, where Uroš Rot, from the University Medical Centre in Ljubljana, Slovenia, and Mark S. Freedman, from the University of Ottawa in Ontario, Canada, presented opposing views on the topic.
The debate at CONy, “My MRI worsened but I didn’t. Should I change my disease-modifying treatment?” was hosted by Prof. Xavier Montalban, chairman of the Department of Neurology-Neuroimmunology and director of the Multiple Sclerosis Centre of Catalonia at the Vall d’Hebron University Hospital in Barcelona, Spain.
Rot, holding a critical position, noted that studies exploring a connection between asymptomatic lesions and both early and late disease progression pointed in different directions, with some studies showing negative results.
He argued that most of the studies showing an association between MRI findings and disease progression looked at patients receiving treatment with interferon-beta, which limited their use for patients receiving other treatments.
Freedman argued the opposite, claiming it is not possible to ignore the power of MRI and that findings from imaging that are not paralleled by symptoms are still relevant enough to be included in all current interpretations of the diagnostic criteria for multiple sclerosis (MS), revised in 2010.
These criteria are based on the need to demonstrate the presence of lesions, disseminated in both space and time.
He supported his arguments by citing a recent publication by the Magnetic Resonance Imaging in MS (MAGNIMS) network that proposed an even more simplified and less ambiguous definition of the diagnostic criteria. This publication also provided clinical guidelines for how to use MRI findings in making treatment decisions.
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