How MRI can Help Diagnose and Track Multiple Sclerosis
If you have symptoms of MS, your doctor may want you to get an MRI (magnetic resonance imaging) of your brain and spine. Currently, there is no single test to diagnose MS, so a diagnosis is based on symptoms, clinical evaluation and a series of diagnostic tests. Typically before you are sent for those tests, your doctor will have you get an MRI. The National MS Society calls MRI the preferred imaging method to establish a diagnosis because the exam is sensitive and non-invasive.
“If the pictures on the MRI are suggestive of MS, then they'll do the biochemical testing to make a diagnosis,” explains Dr. Steven Pollei, a CDI Neuroradiologist.
MRI is also a powerful tool for monitoring MS because it gives a visual of changes in your brain so your doctor can monitor the course of the disease.
What shows up on a brain MRI?
Patients who have shown signs of MS like clumsiness, loss of balance, tingling, numbness, blurred vision or weakness in an arm or leg, are often sent for a brain MRI. The radiologist who interprets the pictures of your brain will be looking for scars called lesions. MS is a process that predominately affects the white matter of your brain. Dr. Pollei describes the white matter as the connecting fibers of the brain and MS interferes with how those fibers work. MRI can reveal tell-tale lesions says Dr. Pollei because the abnormal brain lesions show up as a different color on the MR scan.
The number of lesions doesn’t always tell your doctor the severity of symptoms and not all people with MS have lesions. In fact, researchers have found that MRI shows no lesions in five percent of patients with “clinically definite MS” at time of diagnosis. Though there is no perfect test, Dr. Pollei says, “For someone who's worried they have MS, getting an MR study is a great thing. It gives you very high-negative predicted values. So if you get a negative response from the MR, that’s a really good thing.”
How does brain imaging work for MS patients?
In addition to lesions, the volume of the gray matter of your brain can give your doctor important information as the disease progresses. To translate the pictures of your brain into quantitative information, radiologists at CDI use 3D brain volume data software. When a radiologist is examining the pictures of your brain, this software helps take volume measurements and compare them to other brain scans.
Dr. Murray Solomon, a CDI Neuroradiologist who has interpreted more than 300,000 scans in his career, diagnoses and tracks MS for patients in the Los Gatos, CA area. He has been using brain volume measuring software since it was first released in 2009. Initially, the technology was used to track brain volume loss in pre-Alzheimer’s patients. But it is very valuable in helping track MS patients through the course of treatment. Brain volume drops in MS patients often go hand-in-hand with cognitive impairment. “You cannot predict cognitive decline from the number of white matter lesions. It's not sufficient,” says Dr. Solomon. “Gray matter volume is a better predictor of future disability.”
How MS monitoring is improving
In addition to monitoring patients, MR has also been key to understanding Multiple Sclerosis. “Technological advances of MR in recent years have dramatically improved our understanding of MS disease,” according to the American Journal of Neuroradiology. To see how MRI has made it possible for researchers to better understand the underlying pathology of the disease, watch this video:
Can MRI tell an MS patient what’s coming?
According to Dr. Solomon, doctors are now using MRI to try to predict future disability by monitoring a patient’s brain volume. While there is no way to predict cognitive decline, quick drops in brain volume may suggest cognitive impairment for an MS patient. There’s no way to tell an MS patient exactly what’s coming, but an MRI can help give you and your doctor probability. Dr. Solomon says with brain images, he can tell a doctor if it’s time to be more aggressive with treatment or to get the patient working toward a better diet or more exercise. Those suggestions, along with rapid advancements in drugs to treat the disease, offer hope for patients living with MS.
About Dr. Pollei
Steven Pollei, M.D. is a board certified neuroradiologist and the medical director of Center for Diagnostic Imaging’s (CDI) Bellingham, Federal Way, Lakewood and Puyallup outpatient centers. He offers additional expertise in diagnostic injections and pain management procedures, and is considered one of the pioneers of pain management in the country. Read his full bio here.
About Dr. Solomon
Murray Solomon, M.D. was the first radiologist between the city limits of San Francisco and Los Angeles to open an outpatient radiology facility. Since 1983, Dr. Solomon has read more than 100,000 MRI scans, making him one of the most experienced readers of magnetic resonance images in the United States. He has given lectures on MRI throughout the world. Dr. Solomon has special expertise in reading MRI scans of the brain, spine and musculoskeletal system. Dr. Solomon helped bring the first outpatient 3T MRI Unit to Northern California. Read his full bio here.
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