While it's true that almost everyone with multiple sclerosis shows brain damage on an MRI, not everyone with brain injuries has multiple sclerosis. Magnetic resonance imaging plays a vital role in how we diagnose and manage MS. In fact, magnetic resonance imaging confirms the diagnosis of multiple sclerosis in more than 90% of people. Magnetic resonance imaging is particularly useful for detecting demyelination of the central nervous system, that is, damage to the myelin sheath of the nervous system.
This makes it a powerful tool for establishing the diagnosis of MS. There is no single test that diagnoses MS, including magnetic resonance imaging. Lesions detected with magnetic resonance imaging are pathologically nonspecific. The principles of MS diagnosis are based on showing the spread of white matter lesions in space and time.
Magnetic resonance imaging is the most sensitive method for revealing the asymptomatic spread of lesions in space and time. The pattern and evolution of magnetic resonance imaging lesions, in the right clinical setting, have made MRI abnormalities an invaluable criterion for the early diagnosis of MS. The first important function of MRI in the diagnosis of MS is to allow an early diagnosis of MS in patients with CIS using IP diagnostic criteria, including magnetic resonance imaging for the purpose of dissemination in space (DIS) and time (DIT). The sensitivity of diagnosing MS during the first year after a single attack is 94%, with a specificity of 83%.
The MRI tests needed to support the diagnosis vary depending on the strength of the clinical findings. Allowing a new MRI lesion to replace a clinical attack doubles the number of CIS patients who can be diagnosed with multiple sclerosis within one year of the onset of symptoms. Increasing the sensitivity of the test with more lenient criteria, as recommended by the AAN subcommittee, may result in a decrease in specificity. The second important function of magnetic resonance imaging in diagnosing patients with suspected multiple sclerosis is to rule out alternative diagnoses evident on magnetic resonance imaging, such as spinal stenosis and most brain tumors.
Characteristic lesions that favor multiple sclerosis include Dawson's fingers, ovoid lesions, corpus callosum injuries, and asymptomatic spinal cord injuries. However, other white matter diseases may look similar on MRI. The persistent increase in gadolinium for more than three months, mass-effect lesions, and increased meningeal pressure suggest other disorders. It is essential to have a standardized MRI protocol for the brain and spinal cord when comparing studies or centers.
T2W magnetic resonance imaging cannot distinguish between acute and chronic injuries. Gadolinium provides useful information about the activity of new lesions and helps rule out alternative diagnoses, such as neoplasms, vascular malformations and leptomeningeal disease. A single gadolinium-boosted MRI could provide evidence for its dissemination in space and time. Spinal cord imaging is equally valuable for ruling out stenosis or spinal tumor and for detecting asymptomatic lesions when brain imaging is not diagnostic in patients with suspected multiple sclerosis.
Precise criteria may suggest that MS can be diagnosed using magnetic resonance imaging, and a negative MRI at the time of CIS does not rule out MS. Magnetic resonance imaging evidence plays a supporting role in what is ultimately a clinical diagnosis of MS, in the appropriate clinical situation and always excluding alternative diagnoses. Multiple sclerosis lesions interrupt communication within the brain and between the brain and other parts of the body, causing vision problems and eye pain, double vision, muscle weakness, coordination problems, fatigue, dizziness, and problems with hearing and speech. However, multiple sclerosis isn't the only condition that can cause white spots to appear on an MRI.
The widespread use of magnetic resonance imaging (MRI) has revolutionized the ability to diagnose multiple sclerosis. Using advanced techniques to image the brain and eyes, along with new biomarkers, researchers in the Cedars-Sinai Department of Neurology are working to present a clearer picture of multiple sclerosis (MS).
