Disparities in imaging and management of multiple sclerosis: a review

Despite advancements in multiple sclerosis (MS) imaging and treatment, there are sex-specific differences and disparities across sociodemographic factors (e.g., race, ethnicity, socioeconomic status, health literacy, and geography) that can result in disparate clinical presentation, diagnosis, management, and outcomes. These social determinants of health often intersect, limiting access to MRI or disease-modifying therapies. Financial and geographic barriers can delay diagnosis and treatment, particularly in rural or underserved areas. Patients with low health literacy may have difficulty navigating care, while provider-related factors, like implicit biases and varying practices in low-resource settings, contribute to unequal imaging and treatment utilization. Radiologists are uniquely positioned to help reduce these inequities. By collaborating with clinical teams, standardizing imaging protocols, and expanding access through extended service hours and patient navigation programs, radiology practices can address many barriers. Subspecialized neuroradiology expertise, delivered through teleradiology, can help mitigate diagnostic disparities in underserved regions. Radiologists can support health equity by engaging in community outreach to improve health literacy and by working to increase workforce diversity. This review examines the intersection of clinical and radiologic disparities in MS, identifies key barriers to imaging access and utilization, and highlights how radiology can promote equitable MS care to improve outcomes across all populations.