Multiple sclerosis ct scan
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D. Julinka Auta Fernandes
Overview
CT scan has a limited and nonspecific role in the evaluation of suspected multiple sclerosis (MS). Conventional CT is not the preferred imaging modality for diagnosing or routinely monitoring MS. The 2026 American College of Radiology (ACR) Appropriateness Criteria rate CT head examinations as Usually Not Appropriate for the initial evaluation of suspected central nervous system demyelinating disease because CT has limited soft-tissue characterization and poor sensitivity for demyelinating lesions.[1]
CT may demonstrate nonspecific abnormalities such as brain atrophy, white-matter hypoattenuation (lucencies), or occasional contrast enhancement. These findings are neither sufficiently sensitive nor specific to establish the diagnosis of MS.[2]
The 2024 McDonald diagnostic criteria do not use conventional CT findings to demonstrate dissemination in space or dissemination in time. Magnetic resonance imaging (MRI) remains the principal imaging modality for the diagnosis and imaging follow-up of MS.[3][4]
CT scan
CT findings that have historically been described in patients with MS include:
- Brain atrophy, which is nonspecific and may occur in established disease
- White-matter or periventricular hypoattenuation (lucencies)
- Occasional contrast enhancement reflecting disruption of the blood-brain barrier
These findings have low sensitivity and specificity. A conventional head CT may be normal despite demyelinating lesions being present, and any abnormality must be interpreted in the clinical context rather than as diagnostic evidence of MS.[2][5]
CT may be obtained in selected acute or emergency circumstances when the immediate purpose is to evaluate an alternative diagnosis or complication, such as intracranial hemorrhage, mass effect, or hydrocephalus, rather than to establish MS. CT may also be considered when MRI is unavailable, contraindicated, or cannot be performed promptly; however, a negative CT examination does not exclude MS.[1]
Routine CT is not recommended for monitoring MS disease activity because of its poor sensitivity for demyelinating lesions and its use of ionizing radiation. CT contrast enhancement should not be used as a substitute for MRI assessment of inflammatory disease activity.[1][4]
The previously described double delayed high-dose CT (DDHD CT) technique was historically used to increase detection of enhancing lesions. It is not included in current MS diagnostic criteria or contemporary imaging recommendations and should not be used to guide the current diagnosis or monitoring of MS.[6][7]
References
- ↑ 1.0 1.1 1.2 Kalnins A, Lewis LM, Soderlund KA, et al. (2026). "ACR Appropriateness Criteria® Demyelinating Diseases". J Am Coll Radiol. doi:10.1016/j.jacr.2026.02.003. PMID 41762178 Check
|pmid=value (help). - ↑ 2.0 2.1 Loizou LA, Rolfe EB, Hewazy H (October 1982). "Cranial computed tomography in the diagnosis of multiple sclerosis". J Neurol Neurosurg Psychiatry. 45 (10): 905–912. doi:10.1136/jnnp.45.10.905. PMC 491595. PMID 6292371.
- ↑ Montalban X, Lebrun-Frénay C, Oh J, et al. (October 2025). "Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria". Lancet Neurol. 24 (10): 850–865. doi:10.1016/S1474-4422(25)00270-4. PMID 40975101 Check
|pmid=value (help). - ↑ 4.0 4.1 Barkhof F, Reich DS, Oh J, et al. (October 2025). "2024 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI for the diagnosis of multiple sclerosis". Lancet Neurol. 24 (10): 866–879. doi:10.1016/S1474-4422(25)00304-7. PMID 40975102 Check
|pmid=value (help). - ↑ Weinstein MA, Lederman RJ, Rothner AD, Duchesneau PM, Norman D (December 1978). "Interval computed tomography in multiple sclerosis". Radiology. 129 (3): 689–694. doi:10.1148/129.3.689. PMID 725045.
- ↑ Hershey LA, Gado MH, Trotter JL (January 1979). "Computerized tomography in the diagnostic evaluation of multiple sclerosis". Ann Neurol. 5 (1): 32–39. doi:10.1002/ana.410050106. PMID 311613.
- ↑ Barrett L, Drayer B, Shin C (January 1985). "High-resolution computed tomography in multiple sclerosis is outdated". Ann Neurol. 17 (1): 33–38. doi:10.1002/ana.410170109. PMID 3985583.