Structured Reporting in Multiple Sclerosis – Consensus-Based Reporting Templates for Magnetic Resonance Imaging of the Brain and Spinal Cord

Key words

structured reporting - multiple sclerosis - magnetic resonance imaging

Editorial/Consensus

Structured Reporting in Multiple Sclerosis – Consensus-Based Reporting Templates for Magnetic Resonance Imaging of the Brain and Spinal Cord

As a result of technical developments and greater availability of imaging equipment, the number of neuroradiological examinations is steadily increasing [1]. Due to improved image quality and sensitivity, more details can be detected making reporting more complex and time-intensive. At the same time, reliable algorithms increasingly allow quantitative image analysis that should be integrated in reports in a standardized manner. Moreover, increasing digitalization is resulting in a decrease in the personal exchange between neuroradiologists and referring disciplines, thereby making communication more difficult. The introduction of structured reporting tailored to the specific disease and medical issue [2] [3] and corresponding to at least the second reporting level as defined by the German Radiological Society (https://www.befundung.drg.de/de-DE/2908/strukturierte-befundung/) is therefore desirable to ensure that the quality standards of neuroradiological reports continue to be met.

The advantages of structured reporting include a reduced workload for neuroradiologists and an information gain for referring physicians. A complete and standardized list with relevant details for image reporting is provided to neuroradiologists in accordance with the current state of knowledge, thereby ensuring that important points are not forgotten [4]. A time savings and increase in efficiency during reporting were also seen [5]. Further advantages include report clarity and consistency and better comparability in follow-up examinations regardless of the neuroradiologist's particular reporting style. This results in better communication with the referring disciplines and makes clinical decision significantly easier [6] [7]. Although the advantages are significant, any potential disadvantages like the reduction of autonomy in reporting and inadequate coverage of all relevant details and any incidental findings not associated with the main pathology in complex cases or in rare diseases should be taken into consideration [4]. Therefore, studies examining the advantages of structured reporting, promoting the introduction of this system in the clinical routine, and increasing the acceptance among neuroradiologists are still needed.

Numerous specific templates for structured reporting, e. g., regarding diseases in cardiology and oncology, are already available on the website www.befundung.drg.de. Multiple sclerosis (MS) is an idiopathic chronic inflammatory and neurodegenerative disease of the central nervous system and is the most common non-trauma-based inflammatory neurological disease in young adults. Therefore, it has significant individual and socioeconomic relevance [8]. Magnetic resonance imaging (MRI) plays an important role in the diagnosis, prognosis evaluation, and follow-up of this disease. MRI is established as the central diagnostic method in the diagnostic criteria. Therefore, specific changes are seen on MRI in almost all patients with a verified MS diagnosis [9]. Reporting of MRI datasets regarding the brain and spinal cord of patients with MS includes examination of the images with respect to the relevant medical issue in order to determine whether the McDonald criteria, which were revised in 2017 [10] and define dissemination in time and space clinically as well as with respect to MRI based on the recommendations of the MAGNIMS groups [11] [12], are fulfilled. A more precise definition of lesion types and locations according to the recommendations of an international expert group [13] is discussed in the supplementary material. Spinal cord signal abnormalities are seen in up to 92 % of MS patients [14] [15] [16] and are primarily located in the cervical spine [15]. The recommendations of the MAGNIMS–CMSC–NAIMS working group published in 2021 [11] explicitly recommend the use of structured reporting for MS patients.

Therefore, a reporting template for evaluating MRI examinations of the brain and spinal cord of patients with MS was created as part of the BMBF-funded DIFUTURE consortium in consensus with neuroradiological and neurological experts in concordance with the recommendations mentioned above [11] and was made available for broad use (https://github.com/DRGagit/ak_befundung). The goal is to facilitate efficient and comprehensive evaluation of patients with MS in the primary diagnostic workup and follow-up imaging. These reporting templates are consensus-based recommendations and do not make any claim to general validity or completeness. The information technology working group (@GIT) of the German Radiological Society and the German Society for Neuroradiology strive to keep the reporting templates presented here up-to-date with respect to new research data and recommendations of the MAGNIMS-CMSC-NAIMS group [11].

Funding

Funding Acknowledgement: “BMBF – Future Medicine, DIFUTURE, Consortium, Germany”

JH is (partially) funded by the German Federal Ministry of Education and Research (Grant Numbers 01ZZ1603[A-D] and 01ZZ1804[A-H] (DIFUTURE)).

• References

• 1 European Society of R. The future role of radiology in healthcare. Insights Imaging 2010; 1 (01) 2-11
• 2 Kahn Jr CE, Langlotz CP, Burnside ES. et al. Toward best practices in radiology reporting. Radiology 2009; 252 (03) 852-856
• 3 European Society of R. ESR paper on structured reporting in radiology. Insights Imaging 2018; 9 (01) 1-7
• 4 Rocha DM, Brasil LM, Lamas JM. et al. Evidence of the benefits, advantages and potentialities of the structured radiological report: An integrative review. Artif Intell Med 2020; 102: 101770
• 5 Lee JK, Bermel R, Bullen J. et al. Structured Reporting in Multiple Sclerosis Reduces Interpretation Time. Acad Radiol 2020;
• 6 Schwartz LH, Panicek DM, Berk AR. et al. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011; 260 (01) 174-181
• 7 Alessandrino F, Pichiecchio A, Mallucci G. et al. Do MRI Structured Reports for Multiple Sclerosis Contain Adequate Information for Clinical Decision Making?. Am J Roentgenol American journal of roentgenology 2018; 210 (01) 24-29
• 8 Dobson R, Giovannoni G. Multiple sclerosis – a review. Eur J Neurol 2019; 26 (01) 27-40
• 9 Lovblad KO, Anzalone N, Dorfler A. et al. MR imaging in multiple sclerosis: review and recommendations for current practice. AJNR American journal of neuroradiology 2010; 31 (06) 983-989
• 10 Thompson AJ, Banwell BL, Barkhof F. et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet neurology 2018; 17 (02) 162-173
• 11 Wattjes MP, Ciccarelli O, Reich DS. et al. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. The Lancet Neurology 2021;
• 12 Filippi M, Rocca MA, Ciccarelli O. et al. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet neurology 2016; 15 (03) 292-303
• 13 Filippi M, Preziosa P, Banwell BL. et al. Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain: a journal of neurology 2019; 142 (07) 1858-1875
• 14 Bot JC, Barkhof F, Lycklama a Nijeholt G. et al. Differentiation of multiple sclerosis from other inflammatory disorders and cerebrovascular disease: value of spinal MR imaging. Radiology 2002; 223 (01) 46-56
• 15 Bot JC, Barkhof F, Polman CH. et al. Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology 2004; 62 (02) 226-233
• 16 Weier K, Mazraeh J, Naegelin Y. et al. Biplanar MRI for the assessment of the spinal cord in multiple sclerosis. Multiple sclerosis 2012; 18 (11) 1560-1569