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Can brain scans replace painful lumbar punctures in diagnosing multiple sclerosis?

Dr Christopher Allen is a Clinical Research Fellow based at the University of Nottingham and Nottingham University Hospitals NHS Trust. To mark multiple sclerosis (MS) awareness week, he talks about research taking place at the John Radcliffe Hospital, Oxford, into diagnosing MS using brain scans.

There is currently no agreement on the best way to diagnose MS, an incurable lifelong condition affecting the brain and spinal cord. Doctors need to be sure about the correct diagnosis quickly to start treatment so many people undergo lumbar punctures, where a thin needle is inserted between the bones in the lower spine, resulting in discomfort and additional costs to the NHS. Patients often report they find the lumbar puncture painful and it can cause unintended complications requiring hospitalisations or time off work to recover.

Misdiagnosis can also occur through lumbar puncture diagnosis as we do not find abnormalities in everyone with MS and some people with other conditions have similar abnormalities.

The aim of the DiagnosE using the Central veIn SIgn v1.0 (DECISIve) study is to modernise diagnosis with a new type of MRI scan which allows us to see small veins that run through damaged areas of the brain only in MS patients. It is not painful and carries few risks.

Patients suspected of having MS are being recruited from hospitals across the UK and invited to have the new eight-minute MRI scan. We will find out what diagnosis is eventually reached and compare this to the new scan to establish if lumbar punctures can be replaced by a slightly longer, pain-free MRI scan.

This research could provide the NHS with a scientific approach to diagnosing MS which is safer, cost effective and more acceptable to patients. Thanks to our amazing study participants and the NIHR, we are well on the way to completing the study.

This study is funded by the National Institute for Health and Care Research (NIHR) Research for Patient Benefit.