Thomas Berger: Using MRI Wisely in Multiple Sclerosis – Practical Guidance for Everyday Clinical Practice

In this short video interview, Thomas Berger explains how MRI should be used pragmatically in the diagnosis and monitoring of multiple sclerosis.

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How should MRI be used pragmatically in the diagnosis and monitoring of multiple sclerosis in everyday clinical practice?

In the interview, Thomas Berger discusses how MRI should be applied pragmatically in the diagnosis and long-term monitoring of multiple sclerosis, particularly in routine, non-tertiary clinical settings.

Key points discussed include:

• The need for MRI protocols that are practical, efficient, and accessible for the majority of patients worldwide
• The central role of typical morphological changes on MRI (especially T2 lesion burden) in establishing diagnosis
• The importance of identifying inflammatory activity at baseline
• MRI as a complementary tool that supports, but does not replace, clinical assessment and CSF analysis
• Why standard sequences are sufficient for most patients in routine care
• Monitoring strategies focused on significant changes in lesion burden rather than exhaustive lesion counting
• Interpreting MRI findings longitudinally, in the context of MS as a lifelong disease
• When advanced imaging techniques or emerging markers (such as central vein sign or paramagnetic rim lesions) may be useful, and why they are not required in routine practice

Among the various MRI markers under discussion, which ones do you believe are the most relevant for clinicians to pay attention to today when diagnosing or monitoring multiple sclerosis?

* Please note that all the captions were generated automatically. If they do not appear, click on CC in the navigation.

Key messages from Thomas Berger

MRI is an essential but supportive tool in the management of multiple sclerosis. In the interview, Thomas Berger highlights that while advanced imaging techniques continue to evolve, routine MS care relies primarily on simple, robust MRI features that are widely available.

Diagnosis and monitoring should focus on identifying typical lesion patterns and meaningful changes over time, rather than minor fluctuations in lesion count. MRI findings must always be interpreted alongside clinical presentation and, when needed, CSF analysis.

Overall, the interview underscores a pragmatic, patient-centered approach: MRI should be lean, accessible, and clinically relevant, helping neurologists make informed decisions without turning everyday practice into a clinical trial.

Curious to learn more about the expert behind this interview?

Visit Thomas Berger’s full biography for more insights into his expertise.

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