Magnetic Resonance Imaging (MRI) imaging of the brain and spinal cord is the most common diagnostic tool to confirm the diagnosis of Multiple Sclerosis (MS) and to monitor disease activity. MRI scans reveal abnormalities in the majority (90% to 95%) of people with MS. Although brain lesions are more common than spinal cord lesions, imaging of both brain and spinal cord are important in diagnosing and monitoring MS.
The radiologist and the neurologist look for evidence of new damage, mostly lesions, and evidence of chronic damage to the Central Nervous System (CNS). New or ongoing tissue damage may appear as areas of brightness where inflammation is causing damage to the myelin coating on nerve fibers. Gadolinium enhancement allows new active lesions to be distinguished from old ones as recently formed lesions or plaques will appear brighter on the MRI scan. Areas of past nerve damage or where axons (nerve fibers) have died, may appear as black holes.
While MRI imaging is a valuable tool in making an MS diagnosis, it cannot be used alone to make a diagnosis. Other diseases or even just natural aging, can cause similar lesions or plaques to those seen with MS. In addition, about 5% of people with MS have no visible lesions or brain tissue damage on their MRI scans (at least, initially).
Repeat MRI scans are useful in monitoring disease progression in MS. While MRI cannot reliably distinguish between types of MS, changes in the CNS as seen on repeat scans following diagnosis, especially early in the disease, may be useful in predicting long-term prognosis.
Repeat MRI scans can also be used to monitor the efficacy of disease-modifying treatments, such as glatiramer acetate, natalizumab, fingolimod, or beta interferon, in preventing new lesions from forming. New lesions may form without causing new symptoms, so monitoring changes in brain volume and lesion-load becomes important.
Capitol Imaging Services (CIS) offers physicians the ability to order MRI exams and specify MS protocols to be included. Commonly, these exams are best performed on our 3T ultra high field MRI systems at select CIS centers.