Magnetic Resonance Imaging (MRI) is a very important diagnostic tool in the care of MS patients. Used correctly, it provides a significant increase in information and is actually indispensable for meaningful and modern therapy control.
The clinical relapse is – as I have often explained here – only the tip of the iceberg of inflammatory activity in MS. With MRI, we are able to represent the “whole” extent of activity. The MRI helps to make a diagnosis quickly in the early phase of the disease. This is because the main characteristic of MS, namely the inflammation distributed in space and time, can be detected much earlier by MRI than by clinical observation. Therefore, MRI is essential for making a diagnosis.
If a therapy has been initiated, I can use MRI to estimate whether the therapy is achieving its goal. If I still see a change in the MRI after six months – even if the patient is doing well clinically – this is a warning to critically review the therapy and possibly consider changing the concept. Therefore, MRI is always useful before and after each therapy change. It also means that, especially in the early phases of the disease – until a stable therapeutic situation is reached – an image should be taken more often to guide the success of therapy. Once a stable phase is reached, there should be imaging approximately once a year to adequately monitor the disease. Of course, this approach can be relaxed somewhat with long-term stability.
In general, an MRI is always worthwhile when decisions need to be made – at this stage it is simply an additional source of information that can provide important clues.
Are MRI images still useful in the late stages of the disease? Although it is true that not much happens in the phase of SPMS (secondary chronic progressive MS) in the MRI images – sometimes one is still surprised that even in the late phases of MS there is still quite a lot of inflammatory activity visible in the MRI. These patients can certainly still benefit from therapeutic interventions.
What should be done – head or spinal cord? This can often only be answered individually. As a rule, both are very useful at the beginning, because one wants to assess the entire dynamics and the spinal cord is of course part of that. Later, when one wants to monitor a therapy, for example, the representative MRI image of the head is often sufficient. So, the decision is up to the individual case.
In summary, it can be noted: if there is no special occasion, an annual MRI check-up is desirable – and especially at the beginning, when it comes to assessing a therapy, one should not skimp on images, i.e. MRI scans.
