“In previous times, it may have been that you only got one MRI scan at time of diagnosis, but now we’re increasingly using it to manage and monitor the disease too.”

Dr Martin Duddy, Consultant Neurologist

 

MS is sometimes compared to an iceberg. Whilst some symptoms of MS activity can be visible, this is just the tip of the iceberg. Other signs of disease progression occur beneath the surface and are detectable using MRI. These include the number of lesions on the brain, if any are increasing in size (enlarging lesions), and also overall brain volume loss (shrinkage).1

As progression of MS can cause damage to the nervous system that could become irreversible, the earlier it can be spotted the better. Regular MRI may therefore be an important part of your MS management.1

Image adapted from Giovannoni G, et al. Brain health: time matters in multiple sclerosis. 2016. Available at: www.msbrainhealth.org/report. Last accessed: April 2018.

1 Giovannoni G, et al. Brain health: time matters in multiple sclerosis. 2016. Available at: www.msbrainhealth.org/report. Last accessed: April 2018.

 

Scroll through the below videos to watch Consultant Neurologist Dr Martin Duddy explain more about the role of MRI in multiple sclerosis (MS):

What is MRI?

MRI stands for magnetic resonance imaging and it’s a way of getting very detailed pictures of structures inside the body. It works by using a magnetic field that makes the water in your brain show up and any changes in water content in parts of the brain means that we can see grey and white matter in the brain and the bones. We can see the lesions of MS which show up differently and we can also measure the size of the brain.

MRI scanners tend to be in big hospitals and scans are supervised by radiographers who are specially trained at the technique and all that’s involved in getting the best pictures we can.

The modern scanners are a little more open and a lot faster than the old ones used to be. We know that some people have had them in the past and found it quite uncomfortable with the noise and the length of time for the scans, but that has improved on the modern scanners now. It’s quite rare for people not to manage to go through with the scan if it needs to be done.

Dr Martin Duddy, Consultant Neurologist

How is MRI used in MS?

MRI has changed the way we diagnose MS and, while in the past it may have been that you only got one MRI scan at time of diagnosis, we’re increasingly using it to manage and monitor the disease.

If you’re not on treatment, we may do scans to make sure that the disease is quiet, even if you’re not having relapses. For people with relapsing remitting MS who are on a therapy, we’re also very much now using the MRI to monitor what’s happening. Although a lot of the treatment decisions are still determined on whether people have relapses or not, if you have MS you’ll know it’s sometimes quite hard to know what is a relapse and what isn’t, and the scan can often confirm whether activity that you report is actually due to new inflammation.

Sometimes people who are using a therapy think that everything’s going well, but when we scan them we can see that the disease is still active under the surface and maybe the first drug isn’t doing the job we want from it. MRI clearly shows us all that’s going on in the brain, and not just MS activity itself.

Dr Martin Duddy, Consultant Neurologist

Why are regular MRI scans important?

There are stages in MS where regular MRI scans are probably a lot more important than at other stages in the illness, we tend to be more proactive now with MS, in terms of trying to work out whether someone’s drug is working for them or not.

We may have previously waited for relapses to happen, but we now know that for every relapse there’s a lot of disease activity that’s under the surface, and if we can catch that, we can maybe change drugs or escalate therapy either before or quickly after there’s been that activity so that people aren’t left on a drug for a long time that isn’t working.

It may be that you’re at a stage of your MS where you’re not getting regular scans but it’s still important that you report new symptoms that come on as they may be treatable. It may be that a simple form of therapy, or drug, may be able to solve those, but the symptoms may be suggestive that the disease is progressing or relapsing which could change the decision not to scan or not to think about a change in therapy. So even if you’re not under a regular scanning review, we still need that regular clinical review to give us a picture of what’s happening.

Dr Martin Duddy, Consultant Neurologist

What will an MRI show?

MRI scans in MS are very useful because they show how active the disease is under the surface. We know that for every clinical relapse, there are at least 10 new lesions on average, and in some people a lot more.

We get a lot of information when we scan people sequentially, because what we can see is how the scan has changed since last time, so we’ll see if new lesions have appeared. Sometimes, but not every time, we’ll give an injection, and that will show whether there are any active lesions actually at the time of the scan. Putting those two together – whether there are lesions, whether there are active lesions – is a good measure of whether the MS is active and importantly, if you’re on a drug, we really don’t want to see very much by way of activity if we think the drug is working.

As well as looking at the inflammatory part of MS – which is whether lesions are getting bigger or whether there’s enhancement – we can also look at the effect on the brain itself. We know that if there’s a lot of inflammation in MS, and you have the disease for a long time, that we can see a little bit of shrinkage of the brain and spinal cord. That correlates with the disability that people get long term, and it can give us an idea of how the disease is progressing over time. So we’re keen to try and stop both the relapses that we see and the attacks under the surface. Knowing how active the disease is clinically and sub-clinically on the MRI is really what gives us the complete picture of the disease.

Dr Martin Duddy, Consultant Neurologist

Will I be worried about having an MRI and its findings?

I think it’s reasonable to be a little bit apprehensive if you’re going for your first MRI scan, we’re always a little bit scared of things we don’t know. What you’ll find however is that the radiographers are very used to dealing with people who are worried about the scan, and will talk you through what’s involved.

The current scanners are better, and different, to what you might have been used to in the past if your last scan was a long time ago. The sequences tend to be faster so you don’t have to lie still for as long, they’re a little bit less noisy and less enclosed. Some people do get worried when they have an MRI scan, wondering what we’re going to do with that information. When you go for a test you don’t know what the result is going to be, and it may be that it shows that the disease is more active than anyone had suspected - either you or the doctor. In some ways that might be unwanted information, but it’s useful information because it does tell us that, whatever the current strategy is, the disease is still active.

In the past, we didn’t have a lot of choices, so we may not have been able to do very much with that information, but with the range of treatments we have now, if you’re on a therapy, or not on a therapy, and your disease is active, there are probably things that we can offer. So I don’t think there is anything to be particularly scared about in finding that the disease has been more active than you thought.

Dr Martin Duddy, Consultant Neurologist

What are the common misconceptions relating to MRI?

There are a lot of stories that go around about things you need to worry about with an MRI – some of them are true, and some of them aren’t.

It is a powerful magnet, so you do need to be careful that you’re not wearing any metal, but the radiographers will be very careful when you go in to make sure that you’re not wearing anything or not carrying anything that’s going to be attracted to the magnet. For most things however, such as implants that you have, fillings and jewellery, it’s not going to be an issue. Although most people go through the scanner with no problems whatsoever, we do see some people present with a little bit of dizziness afterwards, particularly with some of the stronger MRI scans. It’s rare and usually only a transient thing.

Long term, however, we have scanned many people for many years, sometimes 10s and 100s of times, and we don’t see long term side effects, so we’re not worried about using MRI repeatedly in people.

Dr Martin Duddy, Consultant Neurologist

Watch Anne Marie, who has had MS for 17 years, explain why she uses MRI to help manage her MS:

Anne Marie – My MS Story

My first experience with MRI was, like most people, at diagnosis. At this time, I was given very little information about MRI – no one really explained what it showed, what that meant and what would come next, and I didn’t ask any questions, because I was scared of the answers.

Once the initial shock of diagnosis passed, and after learning more about the condition and how it can be managed, I became more hopeful and decided that I wasn’t going to live with my head buried in the sand. I wanted to face MS head on and be proactive about managing my condition, alongside my MS team.

My MS team and I meet regularly to monitor how I’m doing, not only discussing my symptoms and how I’m feeling today, but also using the MRI to monitor for any new or enlarging lesions, which may go completely unnoticed if not for the MRI.

Anne Marie

The 1MSg campaign is initiated and funded by Biogen

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BI-PAN-0437l
April 2018