How can I interpret MRI results to guide management decisions in my patients?

Interpreting magnetic resonance imaging (MRI) results to guide management decisions requires understanding the clinical context, the specific MRI sequences used, and the pathology suspected. For patients with suspected spinal metastases or metastatic spinal cord compression (MSCC), MRI should be performed urgently—ideally within 24 hours for suspected MSCC or within one week for spinal metastases without cord compression symptoms—to guide treatment options effectively. The MRI protocol should include sagittal T1 and/or STIR sequences to identify metastases, sagittal T2-weighted sequences to assess cord or cauda equina compression, and supplementary axial imaging for detailed evaluation of abnormalities. Interpretation focuses on identifying the presence, location, and degree of spinal cord or nerve root compression, which directly informs immobilisation, referral to specialist teams, and potential surgical or radiotherapy interventions ¹.

In brain tumours such as gliomas or meningiomas, standard structural MRI sequences (T2 weighted, FLAIR, DWI, and T1 pre- and post-contrast) are essential for initial diagnosis and ongoing monitoring. Advanced MRI techniques like MR perfusion, diffusion tensor imaging, and MR spectroscopy can clarify ambiguous findings, particularly to detect tumour recurrence or high-grade transformation, which influences decisions on further treatment or surveillance intervals. Baseline MRI scans are recommended shortly after surgical resection and radiotherapy to establish a reference for future comparisons. Interpretation should consider tumour grade, molecular markers, and clinical symptoms to tailor follow-up schedules and therapeutic strategies ¹,².

In neurological diseases such as multiple sclerosis, MRI interpretation involves assessing lesion load, activity, and progression using specific sequences sensitive to demyelination and inflammation. This guides treatment decisions by indicating disease activity or response to therapy (Oreja-Guevara and ParadigMS Group, 2015). Clinicians should be aware that MRI findings can be complex and sometimes of uncertain significance, necessitating multidisciplinary discussion and patient communication to contextualise imaging results within the broader clinical picture ¹,² (Oreja-Guevara and ParadigMS Group, 2015).

In summary, effective interpretation of MRI results to guide management involves:

• Using appropriate MRI protocols tailored to the suspected pathology (spinal metastases, brain tumours, neurological diseases) ¹,².
• Assessing anatomical and pathological details such as lesion location, size, and impact on surrounding structures to inform urgency and type of intervention ¹.
• Incorporating advanced imaging techniques when standard MRI is inconclusive to refine diagnosis and prognosis ².
• Integrating MRI findings with clinical presentation, molecular markers, and multidisciplinary input to personalise patient management ¹,².
• Communicating clearly with patients about the implications and limitations of MRI findings to support shared decision-making ² (Oreja-Guevara and ParadigMS Group, 2015).