Modern neuroimaging criteria for diagnosing multiple sclerosis in children

Abstract

The article presents a clinical case of multiple sclerosis (MS) in a 10-year-old female patient, the use of one of the advanced magnetic resonance imaging (MRI) techniques, namely proton magnetic resonance spectroscopy (1H-MRS), in the diagnosis of MS. MRI is an integral part of the diagnostic algorithm for patients with multiple sclerosis according to the McDonald criteria, which were last updated in 2017. In addition, MRI allows assessing the course of the disease, serving as a criterion for confirming the aggravation of the pathological process. Although the McDonald criteria are applied in adults, they are also used to diagnose MS in children, and MS in children has its own particularities. The McDonald criteria include traditional (conventional) MRI sequences: T2-weighted images, T1-weighted images, post-contrast T1-weighted images. With the rapid development of MRI, cutting-edge (advanced) MRI techniques have emerged that allow for a better understanding of changes in the brain matter in MS: brain volumetry, magnetization transfer imaging, cortical imaging, diffusion tensor imaging, 1H-MRS, susceptibility-weighted imaging. In particular, 1H-MRS allows us to assess the degree of white matter integrity by detecting increased resonance of myelin breakdown metabolites. The studies have shown that changes in MS have their own specificity, but there is no consensus on this issue. Currently, there are no agreed guidelines that would include advanced MRI techniques, but we believe they will allow us to better understand the course of MS and to predict the development of the disease. This approach will improve the management of MS in both adults and children and quality of their life.