Professor of radiology, associate member in neurology, and director, Multiple Sclerosis/MRI Research Group, University of British Columbia

David Li, MD, FRCPC

“The thing I love about CMSC is that its multi-themed and involves varying groups of people. As a radiologist, when I go to one of my own meetings, I’m always attending imaging related talks. Even when I go to ECTRIMS, I’m more focused on imaging things. Here at CMSC one of the things I love to do…is go and seek out something I know nothing about.”

The comprehensive care model is slowly becoming the standard of care for patients with neurologic diseases, such as multiple sclerosis (MS). This shift in the paradigm of how care is focused has been for good reason—many of these patients are affected by their disease in a multitude of ways that requires attention from more than just their neurologist. In MS alone, patients often benefit from having access to psychologists, physical therapists, nurse practitioners, and the like.

 is an organization that hones in on this focus—its 

, held this year October 25-28, 2021, includes lectures and presentations from clinicians from all facets of the comprehensive care team. One such individual is David Li, MD, FRCPC, professor of radiology, associate member in neurology, and director, Multiple Sclerosis/MRI Research Group, University of British Columbia, who, while holding some specialization in MS, is a radiologist in practice.

Li offered his perspective on the value of meetings such as CMSC 2021 with 

in this interview. He spoke to the importance of having access to other providers and being able to hear about disease management through the lens of their position on the care team.

Videos

With the CMSC 2021 annual meeting having wrapped up, the director of the Multiple Sclerosis/MRI Research Group at the University of British Columbia offered his perspective on this year’s conference. [WATCH TIME: 1 minute]

CMSC 2021 Annual Meeting Takeaways: David Li, MD, FRCPC

“Another aspect of imaging which there is a lot of excitement about are some of the advanced measures. Several of my colleagues at [University of British Columbia] have been working on myelin-related measures of MR, which will allow us to look at myelin content, but more importantly, see what happens with treatments.”

2021 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting

, October 25-28, David Li, MD, FRCPC, offered his insight into some of the ongoing efforts in MRI and neuroimaging advances that are being investigated in the clinical management of multiple sclerosis (MS). He specifically provided his perspective on some of the newer biomarkers, such as cortical lesions, the central vein sign, and 

Li, who is a professor of radiology, associate member in neurology, and director of the Multiple Sclerosis/MRI Research Group at the University of British Columbia (UBC), additionally spoke on the work being done at UBC by he and his colleagues to assess and implement some of the advanced MR measures focused on assessing myelin content. The goal, he noted, will be to continue to improve the utility of MR, and if successful, these measures would allow for better assessment of remyelination efforts in the clinical development side of the field.

One such effort that Li highlighted is the work that Shannon Kolind, PhD, assistant professor, UBC, has done with data from the OPERA trial of ocrelizumab (Ocrevus; Genentech), in which she and her group were able to observe distinct differences in myelin and white matter changes between treated and untreated patient groups.

At CMSC 2021, Li and colleagues have been undergoing an effort to help the adoption of the recently updated consensus MRI guidelines, which were published over the summer. This effort includes the sharing of a small, portable card that covers the need for scans to follow the new protocol—which Li and colleagues believe may potentially help improve the application of these new guidelines and inform patients and physicians about them.

The Standardized MRI Protocol card can be accessed 

, and the Spanish version can be accessed 

REFERENCE
Wattjes MP, Ciccarelli O, Reich DS, et al; 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. 

. 2021;20(8):653-670. doi:10.1016/S1474-4422(21)00095-8

The director of the Multiple Sclerosis/MRI Research Group at the University of British Columbia spoke to some of the newer biomarkers and measures being assessed in the clinical management of multiple sclerosis. [WATCH TIME: 3 minutes]

Promising Neuroimaging Biomarkers for Multiple Sclerosis: David Li, MD, FRCPC

“We think that this will be helpful for patients in that they can have it around and they can check with the people that are doing their scans; it’s going to be helpful for neurologists so that they can give it to their patient when they go to get MRI; and it’s going to be helpful for radiologists and the MR centers so they will have an idea of what is being asked for.”

In the summer of 2021, a combined effort from the Magnetic Resonance Imaging in Multiple Sclerosis study group, Consortium of Multiple Sclerosis Centers (CMSC), and North American Imaging in Multiple Sclerosis Cooperative resulted in the latest update in MRI guidelines for patients with multiple sclerosis (MS). The recommendations covered changes in MRI acquisition protocols, such as the emphasis on the value of 3D-fluid-attenuated inversion recovery as the core brain pulse sequence to improve diagnostic accuracy and ability to identify new lesions to monitor treatment effectiveness, as well as for the use of gadolinium-based contrast agents.

Additionally, the group extended the recommendations to the use of MRI for those in childhood, during pregnancy, and in the post-partum period. At the 

, October 25-28, one of the authors of the paper, David Li, MD, FRCPC, professor of radiology, associate member in neurology, and director, Multiple Sclerosis/MRI Research Group, University of British Columbia, spoke with 

Li specifically spoke to the use of a small, portable card that covers the needs for scans to follow the new protocol, its potential to help improve the application of these new guidelines, and how it might better inform patients and physicians about them.

The director of the Multiple Sclerosis/MRI Research Group at the University of British Columbia spoke to the portable Standardized MRI Protocol card that is being distributed in an effort to better inform the community to follow the newly published guidelines. [WATCH TIME: 2 minutes]

Multiple Sclerosis MRI Protocol Card: David Li, MD, FRCPC

“The recommendation is to use a subcallosal plane, which is something that we as radiologists use to prescribe the scans from, and the 3-D is particularly useful from that, because you can angle them any way that you want…that will make life so much easy for everybody because you can compare 1 scan with the other without having to do extra manipulation.”

Following the development of consensus guidelines for the use of MRI in patients with multiple sclerosis (MS), Scott D. Newsome, DO, president, Consortium of Multiple Sclerosis Centers (CMSC), director, Neurosciences Consultation and Infusion Center at Green Spring Station, and associate professor of neurology, Johns Hopkins Medicine; and David Li, MD, FRCPC, professor of radiology, associate member in neurology, and director, Multiple Sclerosis/MRI Research Group, University of British Columbia, spoke with 

on key points they feel fellow clinicians and neuroradiologists should focus on. 

Li discussed the importance of the protocol, namely the focus on the 3-D aspects, which many MRI scanners are now able to do, to compare scans and save time over the course of treatment. Additionally, Li commented on the recommendation to use the subcallosal plane when scanning, allowing for consistency when comparing scans. From a clinical perspective, Newsome stressed the importance of actually performing MRIs, particularly in the early stages during the course of MS. In terms of consistency, Newsome also spoke on how often MRIs should be performed, with emphasis on doing so at least 3 to 6 months after starting or switching drugs, as well as at the 1-year mark. 

Published and developed by the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) study group; the CMSC; and the North America Imaging in Multiple Sclerosis (NAIMS) MRI Guidelines working group, the guidelines represent international alignment on the use of MRI in patients with MS for the first time.  

Wattjes MP, Ciccarelli O, Reich DS, et al; 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. 

. Published online June 14, 2021. doi: 10.1016/S1474-4422(21)00095-8

In discussion regarding the new MRI consensus guidelines for patients with MS, Scott D. Newsome, DO, and David Li, MD, FRCPC, discuss key points for their peers and colleagues.

MRI in MS, Takeaways for Clinicians and Neuroradiologists: Scott D. Newsome, DO; David Li, MD, FRCPC

“When you come up with a standardized protocol, one of the first things people [ask] is, ‘Is it going to benefit me? Is it going to be faster? Will I be able to save time?’ And so, there’s a lot of education; we need to convince people that not only will this be good for them, in terms of how they’re reading the scans, but it’ll be good for their patients. But more importantly, it’s not going to cost them time.” 

Consensus guidelines for the use of MRI in patients with multiple sclerosis (MS) provide opportunities for unification in treatment practices, ultimately providing benefit to patients and providers alike. Scott D. Newsome, DO, president, CMSC, director, Neurosciences Consultation and Infusion Center at Green Spring Station, and associate professor of neurology, Johns Hopkins Medicine; and David Li, MD, FRCPC, professor of radiology, associate member in neurology, and director, Multiple Sclerosis/MRI Research Group, University of British Columbia, discussed some of the educational approaches that can be taken in the important processes of implementing standardization practices. 

, Newsome and Li spoke on distributing information to providers who may not be able to attend conferences, as well as familiarizing patients with the guidelines as an invaluable aspect of their treatment. Focus on special populations, namely pediatrics and pregnant patients, is another crucial aspect of the consensus recommendations, according to experts, in providing specified care guidance.

The new protocols were published and developed by the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) study group; the Consortium of Multiple Sclerosis Centers (CMSC); and the North America Imaging in Multiple Sclerosis (NAIMS) MRI Guidelines working group. Developed by experts in North America and Europe in response to technological advancements, new safety data, and numerous clinical updates, the guidelines establish a consensus for the use of MRI in patients with MS for the first time.

Wattjes MP, Ciccarelli O, Reich DS, et al; 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol. Published online June 14, 2021. doi: 10.1016/S1474-4422(21)00095-8

Implementing new recommendations for the use of MRI in patients with MS will be a challenge in terms of education and adherence; Scott D. Newsome, DO, and David Li, MD, FRCPC, discuss the next steps to increase awareness for both patients and providers.

Adopting Consensus Guidelines for MRI in MS: Scott D. Newsome, DO; David Li, MD, FRCPC 

“I applaud the last 20-plus years…this has not been an insignificant amount of work and number of people that have been involved, where we now finally have a consensus amongst experts, not just here in the Americas, but worldwide."

Experts in multiple sclerosis (MS) have established North American and European consensus recommendations for the use of MRI in patients MS for the first time, allowing for a more unified approach to diagnosis and treatment. The guidelines, published and developed by the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) study group; the Consortium of Multiple Sclerosis Centers (CMSC); and the North America Imaging in Multiple Sclerosis (NAIMS) MRI Guidelines working group, were developed and adopted by experts in response to technological advancements, new safety data, and numerous clinical updates. 

 discussed the updated guidelines with Scott D. Newsome, DO, president, CMSC, director, Neurosciences Consultation and Infusion Center at Green Spring Station, and associate professor of neurology, Johns Hopkins Medicine; and David Li, MD, FRCPC, professor of radiology, associate member in neurology, and director, Multiple Sclerosis/MRI Research Group, University of British Columbia. The pair offered unique commentary from the clinical and neuroradiology perspectives and further discussed the benefits of international adoption and adherence. 

New, uniform protocols are of further benefit when considering scanner manufacturers, who will now have standard, MS-type protocol to follow to foster international consistency. Additionally, patients have the comfort of knowing MS experts have reviewed evidence-based studies, collaborated, and decided on the best procedure for scheduling MRIs, as it relates to medication and treatment routes.

Wattjes MP, Ciccarelli O, Reich DS, et al. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol. Published online June 14, 2021. doi: 10.1016/S1474-4422(21)00095-8

Scott D. Newsome, DO, and David Li, MD, FRCPC, discuss the impact of new MRI consensus guidelines for patients with multiple sclerosis.

David Li, MD, FRCPC

Articles

CMSC 2021 Annual Meeting Takeaways: David Li, MD, FRCPC

Promising Neuroimaging Biomarkers for Multiple Sclerosis: David Li, MD, FRCPC

Multiple Sclerosis MRI Protocol Card: David Li, MD, FRCPC

MRI in MS, Takeaways for Clinicians and Neuroradiologists: Scott D. Newsome, DO; David Li, MD, FRCPC

Adopting Consensus Guidelines for MRI in MS: Scott D. Newsome, DO; David Li, MD, FRCPC

MRI in MS Consensus Guidelines: Scott D. Newsome, DO; David Li, MD, FRCPC

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