Beyond McDonald: updated perspectives on MRI diagnosis of multiple sclerosis

Introduction Magnetic resonance imaging (MRI) is an essential paraclinical test to establish an accurate and early diagnosis of multiple sclerosis (MS), which is based on the application of the McDonald criteria. Areas covered The objective of this article is to analyze, based on publicly available database since the publication of the 2017 McDonald diagnostic criteria, the clinical impact of these criteria, to discuss the potential inclusion within these criteria of the optic nerve to demonstrate dissemination in space, and to guide the acquisition and interpretation of MRI scans for diagnostic purposes. Finally, the authors will review emerging MRI features that could improve the specificity of MRI in the diagnosis of MS and consequently minimize the misdiagnosis of this disease. Expert opinion Although the optic nerve has not been included as one of the topographies required to demonstrate demyelinating lesion disseminated in space in the 2017 McDonald criteria, new studies seem to show some improvement in the sensitivity of these criteria when this topography is considered. New radiological findings such as the central vein sign and iron rims, should be considered within the typical MRI features of this disease with the objective of minimizing MRI-based diagnostic errors.

Automated summary

This article discusses the clinical impact of the McDonald criteria on the diagnosis of MS, the potential inclusion of the optic nerve within these criteria, and guidance on MRI acquisition and interpretation for diagnostic purposes. Additionally, emerging MRI features are reviewed to improve the specificity of MS diagnosis and minimize misdiagnosis.