Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer
Question: How often is an MRI recommended, and is it still needed when symptoms have not worsened?
Answer: Although there is a wide variation in the use and frequency of magnetic resonance imaging (MRI) testing in neurological practices, it may be helpful to begin by considering why we get MRI scans for people with MS.
MRIs have been very important in confirming or excluding the diagnosis of MS in people in whom the diagnosis of MS has been raised as a consideration. Generally that means that the MRI scan will be done for the brain as well as for cervical and thoracic spine, with and without gadolinium (contrast agent).
For follow-up MRIs, we are asking a different question, since the diagnosis has already been accomplished. For follow-up MRIs, we are asking whether multiple sclerosis has been progressing and whether there are new brain lesions or spinal cord lesions despite current therapies. Here, MRIs are particularly important because of their sensitivity for “silent lesions,” which might be unrecognized by people who are feeling well and by people who are non-symptomatic. Approximately 80% of brain lesions are silent and are not associated with any symptoms!
In my practice, we generally get an MRI scan approximately six months after starting any new medication to see if it is effectively controlling inflammation. The finding of acute gadolinium-enhancing lesions suggests that the new therapy is suboptimally controlling inflammation and leads to a discussion about changing one’s medication.
If the MRI scans are stable and show no new or enhancing lesions, we will generally get repeat MRI scans on a yearly basis. Since multiple sclerosis tends to decrease its inflammatory intensity with aging, scheduling of yearly MRI scans may become less frequent as our patients age. So the answer to this question is that we do schedule regular MRI scans whether or not our patients are experiencing relapses or new symptoms, to check on our success in controlling inflammation and new lesions, including silent lesions.
We are asking new and more complex questions today regarding MRI results and findings. MRI scanners and techniques have become more sophisticated. So, the answers today may be changing in the future. Stay tuned!
About Dr. Hendin
Barry A. Hendin, MD, is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School.