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Multiple Sclerosis MRI - How is MS Diagnosed?

Multiple sclerosis (MS) is a chronic condition that affects the central nervous system.

But accurately diagnosing the disease is extremely tricky. Both the symptoms and appearances on MRI results can mimic other conditions, such as migraines, stroke, and vitamin B-12 deficiency.

In a recent study, researchers found that nearly 1 in 5 people diagnosed with MS do not actually have the disease.

So what’s being done to prevent misdiagnosis? While there is no single test that can be used to confirm multiple sclerosis, MRI plays an important role in diagnosing and managing the disease.

From the benefits and limitations of a multiple sclerosis MRI to specific markers that help guide image interpretation - we spoke with expert neuroradiologist, Dr. Michael Rozenfeld, to find out what patients can do to ensure an accurate multiple sclerosis diagnosis.

[DocPanel] What are the benefits of using MRI to diagnose multiple sclerosis rather than CT?

[Dr. Rozenfeld]

When diagnosing multiple sclerosis, we are using various tests and physical exam findings to look for demyelination (damage to the protective layer that surrounds the nerve fibers in your brain).

Currently, MRI is one of the main tools we use, and it is invaluable to detect, diagnose, and monitor the progression of multiple sclerosis.

CT can play an important role in emergency settings. Because it is much quicker to perform than MRI - CT is useful in ruling out intracranial hemorrhage (bleeding that occurs inside the skull). But a dedicated multiple sclerosis protocol MRI is required to further investigate and make a diagnosis.

[DocPanel] What symptoms indicate the need for a multiple sclerosis MRI?

[Dr. Rozenfeld]

Multiple sclerosis can affect vision, cognition, and coordination, as well as cause pain, numbness, and paresthesias, among other symptoms. But it varies greatly from person to person, making the diagnosis difficult. In addition, symptoms in the early stages of MS can be quite subtle.

Since there is no definitive test for MS, a diagnosis takes time. It is a process that involves ruling out all other possible causes. If you are worried that you have symptoms of MS, it’s important to seek medical help right away.

[DocPanel] Are there any limitations in using MRI to diagnose MS? Should any other imaging tests be used in conjunction with MRI to diagnose the disease?

[Dr. Rozenfeld]

MRI has greater than 90% sensitivity in the diagnosis of MS; however, other white matter diseases can sometimes have a similar appearance on medical imaging. In older patients, age-related white matter changes and small vessel ischemia can also share similar features.

Because of this, multiple sclerosis MRI scans must always be looked at in conjunction with a patient’s history, physical exam performed by a neurologist, and any other diagnostic tests such as lumbar puncture and visual evoked potentials.

[DocPanel] What white matter patterns are indicative of MS?

[Dr. Rozenfeld]

The McDonald criteria is a tool utilized when interpreting suspected multiple sclerosis MRI scans. To be applied, it requires lesions in at least 3/4 of the following locations: periventricular, juxtacortical, infratentorial, and spinal cord.

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[DocPanel] Do all MS patients have brain lesions?

[Dr. Rozenfeld]

About 5% of patients with MS do not have brain lesions detected with current multiple sclerosis MRI techniques.

[DocPanel] What other specific markers help guide a multiple sclerosis MRI interpretation?

[Dr. Rozenfeld]

The role of imaging in the diagnosis of multiple sclerosis is to establish dissemination in space (lesions in different typical locations) and dissemination in time (lesions of different ages). Dissemination in space can be established with one MRI but dissemination in time requires an MRI with and without contrast and often a follow-up MRI.

[DocPanel] How can a patient ensure they are not misdiagnosed?

[Dr. Rozenfeld]

Any patient concerned about multiple sclerosis should seek the opinion of an experienced neurologist. Some neurologists sub-specialize in MS - they would be recommended for a second opinion.

A multiple sclerosis MRI is difficult to read. Imaging exams should be interpreted by a board-certified radiologist with a certificate of added qualification (CAQ) in neuroradiology. Often times the initial exams are interpreted by general radiologists, especially when performed in the emergency setting. A second opinion read by an experienced neuroradiologist can add immense value.

[DocPanel] What role does MRI play in the treatment and management of MS?

[Dr. Rozenfeld]

A multiple sclerosis MRI is utilized to follow up on the efficacy of treatment as well as to exclude other diseases when new symptoms present.

Just as with making a diagnosis, managing a disease also requires the expertise of an experienced physician. Getting a second opinion on your follow-up scans from a neuroradiologist can help ensure you’re on the best possible treatment plan.

[DocPanel] What advice do you have for patients who are navigating a potential MS diagnosis?

[Dr. Rozenfeld]

I would suggest finding an experienced neurologist whom you trust and enjoy working with because you will be seeing them for the rest of your life. Don’t be afraid to seek a second or third opinion until you feel that you have found the right doctor for you. Consider joining an MS support group, online or in person. And finally, don’t delay diagnosis and treatment.

[DocPanel] Is AI making an impact on the diagnosis of MS? If so, how?

[Dr. Rozenfeld]

In the future, artificial intelligence will have a large impact on all types of medicine, including the diagnosis, treatment, and follow up of diseases like multiple sclerosis. This may even include the interpretation of MRIs. This technology is, however, currently in the early research phase and will take many many years before it can be utilized clinically.

Multiple Sclerosis is a complex disease with varied presentations that are often misdiagnosed. It is important to seek a second, and sometimes third, opinion from a specialist if you are experiencing unexplained symptoms or are concerned that your diagnosis is incorrect.

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