New insights in the 2024 McDonald criteria: imaging biomarkers shaping MS diagnosis

In this keynote lecture at the Belgian MS Symposium 2025, Pietro Maggi discussed how advanced MRI biomarkers have been integrated into the upcoming 2024 revisions of the McDonald diagnostic criteria for Multiple Sclerosis.

Key Insights from the Webinar:

These revisions aim to improve diagnostic precision and reduce misdiagnosis, particularly in early or atypical cases. Among the most significant updates are:

• Optic nerve involvement — now recognized as a fifth anatomical location for demonstrating dissemination in space (DIS), supported by MRI, visual evoked potentials (VEP), and optical coherence tomography (OCT).
• The Central Vein Sign (CVS) — a highly specific imaging feature for MS lesions, detectable on advanced MRI sequences such as 3D-EPI and FLAIR*.
• Paramagnetic Rim Lesions (PRL) — markers of chronic active inflammation visible on T2*-weighted MRI, with a specificity of up to 99% for MS.

Together, these biomarkers enhance diagnostic confidence and may enable earlier identification of disease activity in clinically isolated (CIS) and radiologically isolated syndromes (RIS). Early data suggest that patients meeting the 2024 McDonald criteria show higher lesion loads and neurodegenerative changes than those classified under 2017 criteria.

“Updates in the 2024 McDonald criteria: inclusion of novel imaging biomarkers“.

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Find out about the speaker:

Pietro Maggi

Specialised in the diagnosis and treatment of multiple sclerosis (MS)

He is an Associate professor of clinical neurology at the Université Catholique de Louvain (UCLouvain) and a Neurologist at Cliniques Universitaires Saint-Luc.

Dr Maggi earned his MD from the University of Florence (Florence, Italy) and his PhD in neuroscience from the same university, in collaboration with the National Institutes of Health (Bethesda, US). His training includes a doctoral fellowship at the NIH in the lab of Dr Daniel Reich (director of the Translational Neuroradiology Section, NINDS), and a residency in neurology performed at the Erasme University Hospital in Brussels and at the Lausanne University Hospital in Lausanne (clinical-research ECTRIMS fellowship).

His clinical-research activity focuses on characterizing and modeling the pathogenesis of MS using advanced magnetic resonance imaging (MRI) methods. Thanks to several collaborations with other MS-research groups in EU and US, Dr Maggi’s lab at UCLouvain aims to combine advanced and more established imaging, laboratory and clinical data in order to improve MS diagnosis, prognosis and, ultimately, to improve our understanding of MS pathophysiology.

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