What Does Ms Look Like On Mri – Magnetic resonance imaging (MRI) is a non-invasive technique used to take detailed pictures of the internal structures and tissues of the body. MRI is the imaging tool required to assess damage to the brain and spinal cord as a result of multiple sclerosis (MS). It can also help diagnose neurological diseases and monitor their progress.
Unlike an X-ray or a computed tomography (CT) scan, an MRI does not rely on radiation. Instead, the technique uses a very powerful magnetic field to image water molecules in the body’s tissues.
What Does Ms Look Like On Mri
An important part of the human body is made up of water, and each water molecule is made up of two hydrogen atoms attached to one oxygen atom – H2O.
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Simply put, MRIs work by using a powerful magnetic field to temporarily change the direction of subatomic particles (protons in hydrogen atoms) in water molecules inside the body. Radio waves are then used to force these particles out of this direction and return them to their original alignment. As they readjust, the protons emit a resonance signal that is sent to a computer, which eventually uses the signal to create an image.
MS is caused by the body’s immune system accidentally attacking the myelin sheath, the fatty covering of nerves that helps them transmit electrical signals.
Because myelin contains fat and fat does not mix with water, healthy myelin sheaths generally repel water. However, when the myelin sheath is damaged in MS, there is less fat—and therefore, more water—accumulating in that area. Water-rich areas of damage, called lesions, are visible on MRI scans as spots that are lighter or darker (depending on the type of scan) than the surrounding area.
To receive an official MS diagnosis, a person must show evidence of MS-like damage that affects more than one region of the central nervous system, consisting of the brain and spinal cord, and that it occurs at more than one point in time—hence, the “multiple” in “multiple sclerosis.”
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MRI is the gold standard for identifying and monitoring this damage in the brain and spinal cord, so it is often an important part of the diagnostic workup for those who suspect MS.
The scan can be used to help diagnose MS and assess disease activity in all types of MS — including relapsing-remitting MS, secondary progressive MS, and primary progressive MS. MRI may help identify early stages of MS-like disease.
When a person is diagnosed with MS, regular MRI scans help in monitoring the progress of the disease, which can help in making MS treatment decisions such as whether to continue the current treatment or switch to a new one.
Follow-up MRIs are generally recommended every six months to two years. If possible, follow-up scans should be obtained on the same scanner, so that it is easy to compare from one scan to the next.
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In addition to monitoring the development of new lesions, MRIs are used to assess brain atrophy – the gradual loss of brain volume over time. In MS patients, brain shrinkage can occur at a rate of more than 1% per year, exceeding the normal rate. Assessment of brain atrophy can be used to predict an individual’s risk of future physical and cognitive disability, and inform decisions about treatment and care.
MS lesions are usually visible on MRI scans from the early stages of the disease, and they may be evident before a person develops MS symptoms.
Individuals who experience the first attack of MS-like symptoms and brain inflammation – as detected via MRI – are said to have an isolated syndrome, called CIS. MRI scans can be used to monitor CIS patients for the development of additional inflammatory damage, even if the patient has no new symptoms. Therefore, MRI may help facilitate the early diagnosis of MS.
Sometimes, patients who get MRIs for other health reasons are found to have MS-like lesions in the brain or spine, even though they don’t have any MS symptoms. This is called radiation isolated syndrome (RIS). Some people with RIS will develop MS, but others will not. MRI may be used to further examine brain damage in people with RIS to help establish the diagnosis.
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The main difference between a normal MRI scan and a scan of someone with MS is the presence of brain lesions. These lesions represent areas where inflammation has caused damage to the myelin sheath, and they can be seen on an MRI scan as points of obvious color change (usually bright or white spots, although in some types of scans, the lesions are instead darker than the surrounding). .
Below is an abnormal brain MRI from a young person with MS. In this scan, many lesions are visible as bright white spots. In brain scans of people without MS, the brain appears very gray, with no bright spots.
Accurately interpreting MRI scans requires training and expertise, so patients should discuss the results of MRI scans with a qualified medical professional.
Shown is an image from a brain MRI of a young sclerosis patient. White spots correspond to demyelinating lesions. (Credit: ISM/SOVEREIGN)
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MS is defined by the presence of lesions – areas of inflammatory myelin loss, a process called demyelination – that develop in various parts of the central nervous system at various points in time. To be diagnosed with MS, a person must show clear evidence of these lesions.
MRI is the gold standard for diagnosing MS, although some lesions do not show up on an MRI scan – for example, some may be too small to be seen clearly through this technique. Symptoms that indicate a lesion in any part of the nervous system may be used as evidence for a lesion even if an MRI does not show it. However, in such cases, it is important to rule out other possible causes of MS symptoms and mimics.
There are several types of MRI scans that can be useful for detecting different types of MS lesions. The most commonly used in clinical practice include:
Active and inactive lesions can be distinguished on MRIs using a technique called gadolinium enhancement. Before the scan, a contrast agent called gadolinium is injected into the patient’s vein. Normally, a protective wall called the blood-brain barrier stops any of this contrast material from entering the brain and spinal cord, so no contrast material is visible on an MRI scan. However, active inflammation in the lesion causes this barrier to become leaky, causing a bright spot at the lesion as the contrast agent leaks through the barrier. These areas of active inflammation can be called enhancing lesions.
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The terms T1 and T2 refer to the time between the magnetic pulse and when the image is taken. Gadolinium-enhancing lesions are usually imaged specifically through T1-weighted scans, while T2-weighted scans are generally used to image the overall lesion load, both old (inactive) and new (active).
A T1-weighted scan without gadolinium can reveal persistent lesions, which can appear as dark areas. These “black holes” or hypointense lesions are thought to indicate areas of permanent nerve damage.
T2-weighted FLAIR is a technique used to improve the detection of lesions by suppressing the signal (or interference) from the cerebrospinal fluid (CSF) — the liquid that surrounds the brain and spinal cord.
MRI scanners rely on powerful magnets. In general, the more powerful the magnet, the better the resolution of the image produced by the MRI scan.
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The strength of the MRI magnet is measured in units called Tesla (T). One Tesla is equal to about 20,000 times the strength of the Earth’s magnetic field on its surface. Most MRI scanners used in the clinic have magnets of 1.5 or 3 T, although more powerful magnets – 7 T, or more than 10 T – are being explored in research.
MRI is generally considered a very safe procedure. The scan itself is painless. Some people may feel claustrophobic during an MRI scan; Anti-anxiety medication can help if this is a problem.
Because MRI uses powerful magnets, it can affect metals in or on the body. To ensure safety, it is important to remove metal wear (jewelry, glasses, etc.) before scanning. People with certain types of metal implants should not undergo an MRI scan – doctors usually perform a thorough screening process to determine if a person has implants or other conditions that may cause safety issues during an MRI.
Gadolinium-based contrast agents, sometimes called GBCAs, can be injected into the body before certain MRI scans to help detect areas of active inflammation. These agents are generally considered safe.
Figure 1 From Optimized T1 Mprage Sequence For Better Visualization Of Spinal Cord Multiple Sclerosis Lesions At 3t
In rare cases – especially in people with impaired kidney or liver function – GBCAs can increase the risk of nephrogenic systemic fibrosis (NSF), a serious condition marked by fibrosis (scarring) throughout the body.
Recent research has shown that GBCAs can be stored in deposits in the brain and other body tissues; These deposits are not linked to any health problems, but they
