A new test to diagnose multiple sclerosis (MS) using an MRI scan instead of a painful spinal tap, has been successfully rolled out in an NHS Trust in England.
Experts from the University of Nottingham previously found that by using a new type of MRI scan, they could successfully identify MS with only an extra six minutes in the scanner, which meant patients no longer had to undergo a painful lumbar puncture. This finding has now been implemented successfully in Nottingham and increasingly in other neurology departments across the world.
The findings of the roll out are published in Neurology: Clinical Practice.
MS is a neurological condition which affects around 150,000 people in the UK (according to the MS Society). It is notoriously difficult to diagnose as it has many symptoms but not all sufferers experience all of them and the disease can progress at different rates.
Previously many people suspected of having MS would have a standard MRI scan and then would undergo a lumbar puncture. These often cause headaches and back pain and could lead to unintended complications.
MS is characterised by multiple scars ('sclerosis') in the brain or spine. These scars, or lesions, form around little veins.
In the new test, the team use a clinical MRI scanner, of the type that all neuroscience centres have, to carry out a special type of scan called a T2*-weighted MRI. This lets doctors see MS lesions in close detail so they can tell if there are veins in the middle of lesions. This 'central vein sign' distinguishes MS from other conditions, which do not form around veins in the same way.
Here, the Nottingham team showed that the central vein sign can be successfully rolled out in the NHS.
The team introduced the new MRI test within their NHS MS diagnostic pathway. They arranged for the MRI to be before the first clinic appointment, to make the service more efficient. The average time to diagnosis was 2.9 months, compared with 5.6 months in the usual outpatient pathway, saving patients an average 83 days.
The team have also estimated cost savings of around £292 per patient in Nottingham by using the new test. Nottingham has a relatively low number of lumbar punctures and so this underestimates savings for other hospitals.
Spotting the central vein sign completely changes the MS diagnostic journey. By viewing lesions in far greater clarity, we can make an accurate diagnosis without invasive lumbar punctures - reducing unnecessary delays so people can start getting answers sooner."
Professor Evangelou (Professor of Clinical Neurology) has pioneered research on this test for the past twenty years, working from its initial recognition through to demonstrating its potential in clinical trials. He said: "This all began with a chance observation on the university's powerful 7 Tesla research scanner, and the early work was supported by a small grant from Nottingham University Hospitals. I am delighted that a test developed in Nottingham has been embraced by the rest of the world, and we have been lucky to see it become part of the international diagnostic criteria for MS. Seeing it make a difference for patients here in Nottingham, where the story started, is particularly rewarding. The team now encourages other hospitals across the UK to start using the new MRI test too."
Rachel Mellor, age 50, is from Nottingham. She was diagnosed with MS 19 years ago. She said: "I was very lucky when I was diagnosed, as because I had other symptoms, I only had to have an MRI scan. I would have been very stressed if I had to have lumbar puncture as you only hear about the negatives associated with them. From other people I've spoken to – it's so hard anyway having to be assessed for this lifelong condition and being stressed about that without adding in the prospect of a painful procedure.
"It's a petrifying thing when you consider about the side effects and how you feel afterwards and you don't want that on top of an already daunting diagnosis.
"That is why this development is an amazing thing. To have something non-invasive and quicker, eases the stress, and stress is a big thing for MS too."
