Àlex Rovira, introduction by Carlos Torres

Magnetic Resonance Imaging (MRI) plays a pivotal role in the diagnosis of multiple sclerosis (MS), particularly with the updated 2024 McDonald criteria. Recent advances have introduced new MRI features, such as the central vein sign (CVS) and paramagnetic rims, which have significantly enhanced diagnostic accuracy for MS by providing more specific biomarkers for lesion identification. The central vein sign, characterized by small perivenular lesions visible on T2*-weighted sequences, has emerged as a distinguishing feature, helping to differentiate MS lesions from mimics such as small vessel disease. Paramagnetic rim lesions, detected using susceptibility-based sequences, are associated with chronic active demyelinating plaques, reflecting ongoing inflammation and axonal damage. This presentation will explore the clinical utility of these emerging MRI markers, their pathophysiological significance, and their integration into the 2024 McDonald criteria. By incorporating CVS and paramagnetic rims into diagnostic workflows, clinicians can more effectively distinguish MS from other white matter diseases, thereby improving early and accurate diagnosis and guiding timely treatment decisions. In conclusion, the inclusion of advanced MRI features such as the central vein sign and paramagnetic rims in the 2024 McDonald criteria represents a significant advancement in neuroimaging for MS, enhancing diagnostic precision and providing valuable insights into disease activity. Although the 2024 revisions introduce a slightly more complex diagnostic algorithm, these innovations are expected to increase the criteria's applicability and utility in clinical practice.

At the end of this session, participants will be able to:  

• Analyze the role of emerging MRI features in Multiple Sclerosis (MS) diagnosis.
• Describe the pathophysiological significance of the central vein sign and paramagnetic rim lesions in MS.
• Apply the 2024 McDonald criteria for early and accurate MS diagnosis.

Target Audience:

• Radiologist
• Resident

CanMEDS:

• Medical Expert

The speaker discloses the following relationships:

• Receipt of financial payments from Bayer, Sanofi, Merck-Serono, Teva Pharmaceutical Industries Ltd, Novartis, Roche, Bristol-Myers, and Biogen.
• Service on advisory boards or bureaus for Novartis, Sanofi-Genzyme, Synthetic MR, TensorMedical, Roche, and Biogen, with payments received personally or on behalf of their institution.
• Recipient of funded grants for research projects PI19/00950 and PI22/01589 from the Fondo de Investigación en Salud at Instituto de Salud Carlos III, Spain.
• Service as Chief Medical Officer (CMO) and co-founder of TensorMedical.