Early detection of brain lesions through magnetic resonance imaging (MRI) is critical in ALD. This allows for timely treatment, which can prevent severe disability and death. However, there was no consensus on which MRI sequences should be used for screening and monitoring ALD lesions in clinical practice. To address this issue, 30 ALD imaging experts from nine countries employed a modified Delphi procedure, a structured approach involving iterative questionnaires and expert discussions, to reach a consensus. This is the second time our group has successfully used this approach to establish international guidelines. [Click to read more ▼]
The Results: The experts agreed on a core screening protocol for both adults and children that includes: ✅ 3D T1-weighted imaging, ✅ spin-echo T2-weighted imaging, ✅ 3D fluid-attenuated inversion recovery (FLAIR), and ✅ diffusion-weighted imaging (DWI).
Post-contrast T1-weighted imaging should be added in specific clinical scenarios. For monitoring lesion progression, the experts recommended using DWI alongside the Loes score and post-contrast imaging.
Why this matters: This harmonized protocol provides clinicians worldwide with a practical framework for screening and monitoring brain lesions in ALD, thereby improving clinical decision-making. It also identifies priority MRI sequences for future research, including diffusion tensor imaging, MR perfusion, and quantitative volumetric analyses. International collaboration through structured consensus-building is advancing standardized, evidence-based care for ALD patients.