Objective:

To establish the variation between original reports and those elucidated at neuroinflammatory
MDT review and determine the impact on diagnostic confirmation and treatment strategies.

Background:

Accurate MRI interpretation is crucial for diagnosis and monitoring of multiple sclerosis (MS).
Since June 2018, the Belfast MS Clinic has had a monthly neuroinflammatory multidisciplinary
team (MDT) meeting involving neuroradiologists and neurologists, providing second opinions
on complex cases.

Design/Methods:

All cases discussed in 17 monthly meetings between January 2023 and May 2024 were
reviewed. Data collected included patient demographics, grade or subspecialty of the initial
report author (neuroradiologist vs general radiologist), nature and frequency of revisions, and
changes to management and DMT strategies. Reasons for amendments were categorised as: (1)
newly identified lesions not reported initially, (2) lesions initially described as new but
subsequently determined to be pre-existing, (3) other interpretative modification.

Results:

Of 391 MRI reports discussed, 139 (35.5%) were amended. Among these, 64 (46.0%) were
revised due to identification of lesions not reported originally, 61 (43.9%) because lesions
described as new were actually pre-existing, 14 (10.1%) involving other interpretative
refinements. Of these 139, 37 (26.6%) were performed for diagnostic purposes, and in 14
(10.1%) a previously uncertain MS diagnosis was confirmed. The remaining 102 (73.4%) were
undertaken in established MS patients for surveillance or investigation of relapse.
Neuroradiologists had authored the reports of 41 (29.5%) and general radiologists, 98 (70.5%).
Following MDT review, 40 patients (28.7%) with a changed report and 10.2% of all cases had
DMT escalation.

Conclusions:

This neuroinflammatory imaging MDT has substantially enhanced MRI diagnostic accuracy and
influenced clinical decision-making in MS. Over 1/3 of reports required amendment, ~ 1/2 of
these revealing previously unidentified lesions, 1/6 resulting in treatment modification. Several
previously uncertain MS diagnoses were confirmed, reinforcing diagnostic confidence and
delivering higher quality care.