Medico legal consideration about the follow-up in multiple sclerosis: enhanced or non enhanced MRI?

Background: Scientific literature supports that, in cases of multiple sclerosis, follow-up for clinically stable patients can be performed with an non-enhanced magnetic resonance examination (MRI). One of the reasons for applying the contrast medium protocol, even in cronic patients, is the fear of legal disputes.

Objectives: Our objective is to to analyze the risks of performing a non-enhanced MRI control test. In multiple sclerosis (MS) cronic patients, the control test monitors the evolution of the disease. The MRI show the evolution of the disease represented by the appearance of new lesions or the extension in size of already known lesions.

Results: The only situation where the use of contrast medium can provide further information not deducible from the baseline examination is the reactivation of one or more lesions already present without the appearance of new lesions. This situation is extremely rare. Furthermore, the interval between one check-up to the next is time that isn't significant with respect to the evolution of a chronic disease even if a therapy is modified or started late.

Conclusion: The fear of incurring legal disputes related to the failure to administer contrast medium has no reason to influence the professional choices of radiologists.