The contemporary role of MRI in the monitoring and management of people with multiple sclerosis in the UK

•Recent clinical relapse and routine monitoring are the most common indications for requesting an MRI scan in MS clinical practice.•In routine monitoring, the addition of spinal imaging to brain showed no significant difference in treatment decision at subsequent clinical review.•Approximately 1 in 5 gadolinium administered scans showed enhancement, and in 1 in 20 patients, gadolinium enhancement was the only evidence of radiological disease activity.•Mean inter-scan intervals in relapsing-remitting MS for routine monitoring was 19.2 months (SD 20.7) with wide variation between MS centres.•MRI protocols amongst MS centres demonstrated significant variation in the sequences used for diagnostic, monitoring and pharmacovigilance scans.