MRIs for Diagnosing Multiple Sclerosis

Uses of MRIs in MS

central nervous system demyelination — that is, damage of the myelin sheath in the nervous system. This makes it a powerful tool in establishing an MS diagnosis.

You may not always see a direct correlation between the MRI scan and your symptoms. Lesions seen on MRI may be small or have caused little damage. Your brain may have developed a workaround.
Lesions in smaller areas, such as the brainstem, the spinal cord or the optic nerve are more likely to produce signs and symptoms of MS.
People over age 50 may have small areas on their MRIs that resemble those seen in MS but are related to the aging process. A similar thing happens with people who experience migraine headaches.

MRIs for Assessing Risk After Clinically Isolated Syndrome (CIS) Diagnosis

MRI is particularly helpful for people who have had a single demyelinating attack that is suggestive of MS, also called clinically isolated syndrome (CIS).

The number of lesions on an initial MRI of the brain (or spinal cord) can help assess your risk of developing a second attack in the future and being diagnosed with MS.
The MRI can also identify a second neurological event in a person who has no additional symptoms. This helps confirm an MS diagnosis as early as possible.

MRIs for Tracking Disease Progress

After an MS diagnosis, MRI scans help healthcare providers track the progress of the disease and help you make the best treatment decisions.In 2021, MS experts from North America and Europe developed guidelines on the use of MRI to diagnose and monitor the MS disease course. Learn more about these guidelines through the Ask an MS Expert webinar below." c-nmssatomrichtext_nmssatomrichtext-host="">

MRIs for Detecting Demyelination and Diagnosing MS

MRI is particularly useful in detecting central nervous system demyelination — that is, damage of the myelin sheath in the nervous system. This makes it a powerful tool in establishing an MS diagnosis.

You may not always see a direct correlation between the MRI scan and your symptoms. Lesions seen on MRI may be small or have caused little damage. Your brain may have developed a workaround.
Lesions in smaller areas, such as the brainstem, the spinal cord or the optic nerve are more likely to produce signs and symptoms of MS.
People over age 50 may have small areas on their MRIs that resemble those seen in MS but are related to the aging process. A similar thing happens with people who experience migraine headaches.

MRIs for Assessing Risk After Clinically Isolated Syndrome (CIS) Diagnosis

MRI is particularly helpful for people who have had a single demyelinating attack that is suggestive of MS, also called clinically isolated syndrome (CIS).

The number of lesions on an initial MRI of the brain (or spinal cord) can help assess your risk of developing a second attack in the future and being diagnosed with MS.
The MRI can also identify a second neurological event in a person who has no additional symptoms. This helps confirm an MS diagnosis as early as possible.

MRIs for Tracking Disease Progress

central nervous system demyelination — that is, damage of the myelin sheath in the nervous system. This makes it a powerful tool in establishing an MS diagnosis.

You may not always see a direct correlation between the MRI scan and your symptoms. Lesions seen on MRI may be small or have caused little damage. Your brain may have developed a workaround.
Lesions in smaller areas, such as the brainstem, the spinal cord or the optic nerve are more likely to produce signs and symptoms of MS.
People over age 50 may have small areas on their MRIs that resemble those seen in MS but are related to the aging process. A similar thing happens with people who experience migraine headaches.

MRIs for Assessing Risk After Clinically Isolated Syndrome (CIS) Diagnosis

MRI is particularly helpful for people who have had a single demyelinating attack that is suggestive of MS, also called clinically isolated syndrome (CIS).

The number of lesions on an initial MRI of the brain (or spinal cord) can help assess your risk of developing a second attack in the future and being diagnosed with MS.
The MRI can also identify a second neurological event in a person who has no additional symptoms. This helps confirm an MS diagnosis as early as possible.

MRIs for Tracking Disease Progress

MRIs for Detecting Demyelination and Diagnosing MS

You may not always see a direct correlation between the MRI scan and your symptoms. Lesions seen on MRI may be small or have caused little damage. Your brain may have developed a workaround.
Lesions in smaller areas, such as the brainstem, the spinal cord or the optic nerve are more likely to produce signs and symptoms of MS.
People over age 50 may have small areas on their MRIs that resemble those seen in MS but are related to the aging process. A similar thing happens with people who experience migraine headaches.

MRIs for Assessing Risk After Clinically Isolated Syndrome (CIS) Diagnosis

MRI is particularly helpful for people who have had a single demyelinating attack that is suggestive of MS, also called clinically isolated syndrome (CIS).

The number of lesions on an initial MRI of the brain (or spinal cord) can help assess your risk of developing a second attack in the future and being diagnosed with MS.
The MRI can also identify a second neurological event in a person who has no additional symptoms. This helps confirm an MS diagnosis as early as possible.

MRIs for Tracking Disease Progress

Types and Purposes of MRI Scans

FDA has updated their recommendations.What you should know about these risks:

The FDA issued a safety communication on the use of GBCAs and recommended types of gadolinium less likely to be retained in the body.
The FDA also required that the makers of gadolinium contrast agents do research to determine if GBCA deposits are harmful.

What you can do:

Ask your doctor if you need to receive GBCA for your next MRI scan. It is not needed for all MRIs.
Have your doctor check your kidney function with a blood test prior to receiving GBCA. This will reduce the risk of developing NSF. Ask the center doing your MRI what type of GBCA they use. Current macrocyclic agents are Dotarem (gadoterate meglumine), Gadavist (gadobutrol), ProHance (gadoteridol) and Elucirem/Vueway (gadopiclenol). Macrocyclic agents are less likely to be retained in the body.

Different Magnets Provide Different Information

The strength of the magnet used in the MRI machine affects the quality of the images. Magnet strength is measured in Tesla (T).

Most conventional MRI machines are 1.5T or 3T.
Open MRIs are usually less than 1.5T and do not provide the best images for detecting MS activity. But they may be used when someone has difficulty tolerating a closed MRI machine.

When possible, follow-up MRIs should be obtained on the same scanner, as this will help the radiologist and your healthcare provider make a comparison from one MRI to the next." c-nmssatomrichtext_nmssatomrichtext-host="">

Various types of MRI scans are used to test for and track MS. Sometimes gadolinium, a contrast agent, is injected into the vein during an MRI to help detect areas of new inflammation. Because gadolinium is a large molecule, it normally cannot pass through the blood-brain barrier, which prevents substances from passing from the bloodstream into the central nervous system. However, active inflammation can disrupt the blood-brain barrier. Then gadolinium can enter and highlight the inflamed areas.

Common MRI sequences used in MS include:

T-1 weighted without gadolinium — may show dark areas (hypointensities) thought to indicate areas of permanent nerve damage
T-1 weighted with gadolinium — may show bright areas (enhancing lesions) that indicate areas of active inflammation
T-2 weighted — shows overall disease burden or lesion load (meaning the total number of lesions, both old and new)
Fluid attenuated inversion recovery (FLAIR) — shows MS activity by reducing interference from the spinal fluid

Possible Risks Associated With Gadolinium-Based Contrast Agents (GBCAs)

Although gadolinium-based contrast agents (GBCAs) can be helpful, you might consider these safety concerns:

People with poor kidney function have increased risk of developing nephrogenic systemic fibrosis (NSF) if they are given GBCAs. This rare and serious disease causes thickening of the skin and damage to internal organs.
Small amounts of the GBCAs can stay in your body for several months to years. It is not yet known if this retention of GBCA is harmful.
Pregnant people should only receive a GBCA MRI during their pregnancy if it is considered essential. If possible, delay imaging if you are pregnant. The FDA has updated their recommendations.

What you should know about these risks:

The FDA issued a safety communication on the use of GBCAs and recommended types of gadolinium less likely to be retained in the body.
The FDA also required that the makers of gadolinium contrast agents do research to determine if GBCA deposits are harmful.

What you can do:

Ask your doctor if you need to receive GBCA for your next MRI scan. It is not needed for all MRIs.
Have your doctor check your kidney function with a blood test prior to receiving GBCA. This will reduce the risk of developing NSF. Ask the center doing your MRI what type of GBCA they use. Current macrocyclic agents are Dotarem (gadoterate meglumine), Gadavist (gadobutrol), ProHance (gadoteridol) and Elucirem/Vueway (gadopiclenol). Macrocyclic agents are less likely to be retained in the body.

Different Magnets Provide Different Information

The strength of the magnet used in the MRI machine affects the quality of the images. Magnet strength is measured in Tesla (T).

Most conventional MRI machines are 1.5T or 3T.
Open MRIs are usually less than 1.5T and do not provide the best images for detecting MS activity. But they may be used when someone has difficulty tolerating a closed MRI machine.

When possible, follow-up MRIs should be obtained on the same scanner, as this will help the radiologist and your healthcare provider make a comparison from one MRI to the next.

FDA has updated their recommendations.What you should know about these risks:

The FDA issued a safety communication on the use of GBCAs and recommended types of gadolinium less likely to be retained in the body.
The FDA also required that the makers of gadolinium contrast agents do research to determine if GBCA deposits are harmful.

What you can do:

Ask your doctor if you need to receive GBCA for your next MRI scan. It is not needed for all MRIs.
Have your doctor check your kidney function with a blood test prior to receiving GBCA. This will reduce the risk of developing NSF. Ask the center doing your MRI what type of GBCA they use. Current macrocyclic agents are Dotarem (gadoterate meglumine), Gadavist (gadobutrol), ProHance (gadoteridol) and Elucirem/Vueway (gadopiclenol). Macrocyclic agents are less likely to be retained in the body.

Different Magnets Provide Different Information

The strength of the magnet used in the MRI machine affects the quality of the images. Magnet strength is measured in Tesla (T).

Most conventional MRI machines are 1.5T or 3T.
Open MRIs are usually less than 1.5T and do not provide the best images for detecting MS activity. But they may be used when someone has difficulty tolerating a closed MRI machine.

T-1 weighted without gadolinium — may show dark areas (hypointensities) thought to indicate areas of permanent nerve damage
T-1 weighted with gadolinium — may show bright areas (enhancing lesions) that indicate areas of active inflammation
T-2 weighted — shows overall disease burden or lesion load (meaning the total number of lesions, both old and new)
Fluid attenuated inversion recovery (FLAIR) — shows MS activity by reducing interference from the spinal fluid

Possible Risks Associated With Gadolinium-Based Contrast Agents (GBCAs)

Although gadolinium-based contrast agents (GBCAs) can be helpful, you might consider these safety concerns:

People with poor kidney function have increased risk of developing nephrogenic systemic fibrosis (NSF) if they are given GBCAs. This rare and serious disease causes thickening of the skin and damage to internal organs.
Small amounts of the GBCAs can stay in your body for several months to years. It is not yet known if this retention of GBCA is harmful.
Pregnant people should only receive a GBCA MRI during their pregnancy if it is considered essential. If possible, delay imaging if you are pregnant. The FDA has updated their recommendations.

What you should know about these risks:

The FDA issued a safety communication on the use of GBCAs and recommended types of gadolinium less likely to be retained in the body.
The FDA also required that the makers of gadolinium contrast agents do research to determine if GBCA deposits are harmful.

What you can do:

Ask your doctor if you need to receive GBCA for your next MRI scan. It is not needed for all MRIs.
Have your doctor check your kidney function with a blood test prior to receiving GBCA. This will reduce the risk of developing NSF. Ask the center doing your MRI what type of GBCA they use. Current macrocyclic agents are Dotarem (gadoterate meglumine), Gadavist (gadobutrol), ProHance (gadoteridol) and Elucirem/Vueway (gadopiclenol). Macrocyclic agents are less likely to be retained in the body.

Different Magnets Provide Different Information

The strength of the magnet used in the MRI machine affects the quality of the images. Magnet strength is measured in Tesla (T).

Most conventional MRI machines are 1.5T or 3T.
Open MRIs are usually less than 1.5T and do not provide the best images for detecting MS activity. But they may be used when someone has difficulty tolerating a closed MRI machine.

When possible, follow-up MRIs should be obtained on the same scanner, as this will help the radiologist and your healthcare provider make a comparison from one MRI to the next.

Magnetic Resonance Imaging (MRI) for Diagnosing Multiple Sclerosis

Uses of MRIs in MS

Types and Purposes of MRI Scans