MRI is an important diagnostic tool for multiple sclerosis because it produces images of lesions in the brain and spinal cord. These lesions can appear as the condition progresses, and they may have a bearing on the symptoms that occur.

Also, MRI scans are useful in monitoring the status of the disease and how well a person is responding to treatment.

If someone has symptoms of multiple sclerosis (MS), their doctor may order an MRI scan, which is safe and painless.

The MRI scanner uses a strong magnetic field and radio waves to produce two- or three-dimensional images. Below, learn how these scans detect MS lesions, what these lesions are, what treatments are available, and how to prepare for an MRI scan.

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MRI scans provide a significant amount of information that doctors use to diagnose MS and assess the status of people with the condition.

These scans can detect damage in the central nervous system, which comprises the brain and spinal cord. MS-related lesions appear on MRI images as either bright or dark spots, depending on the type of MRI used.

This imaging technique is useful because it shows active inflammation and helps doctors determine the age of the lesions. Also, some specific types of lesion can indicate a flare-up of MS or damage in the brain.

It is a good idea for anyone with MS to have regular scans so that a doctor can assess the progression of the disease.

Below, we list some of the main MRI scanning techniques.

T1-weighted MRI scan

This provides information about the current status of MS. It reveals areas of active inflammation, which represent lesions that are either new or growing. This type of scan is particularly useful for the early diagnosis of MS.

In a T1-weighted MRI scan, areas of the brain that are permanently damaged appear as dark spots, or “black holes.”

The appearance of new or expanding lesions captured by a T1-weighted scan might indicate a progression of the condition.

T2-weighted MRI scan

This shows the number of old and new lesions in a specific part of the brain or spinal cord. It helps doctors determine the long-term impact of MS.

MS lesions appear as bright spots in a T2-weighted MRI scan. The appearance of more lesions on this type of scan may indicate higher levels of disability and a less favorable long-term outcome.

The way a lesion looks depends on the type of MRI scan. Lesions may look like bright spots or dark spots.

Some brain lesions have darker outer edges that appear to expand. Medical professionals refer to them as “smoldering spots,” and these tend to show up in research using specialized techniques.

The pictures below show what brain lesions may look like on an MRI scan.

The location of lesions determines the status of MS.

Symptoms also depend on the type and location of the lesions. Some lesions may appear in areas of the brain that do not produce symptoms.

Some lesion locations and the resulting MS symptoms include:

cerebellum — the back part of the brain

  • impaired balance and coordination

optic nerve behind the eye

  • problems with vision

spinal cord — from the brain stem to the lower back

  • muscle stiffness
  • numbness and tingling
  • pain in the arms, legs, or both
  • problems passing urine or having bowel movements

New research suggests that brain lesion atrophy, or shrinkage, could be a good indicator of how MS will progress.

Scientists typically evaluate new MS medications based on their ability to reduce the number of brain lesions. However, a 2018 study looked at whether a reduction in the number of lesions means that the condition is progressing rather than improving.

The researchers used MRI scans to observe brain lesion shrinkage in 192 people with MS. They found that people with relapsing-remitting MS, the most common type of MS, had the highest number of new lesions. However, the lesions atrophied at higher rates in people with more severe progressive forms of MS.

The researchers concluded that brain lesion shrinkage is a better predictor of disease progression than the appearance of new or growing lesions.

Nerve fibers in the brain are covered with myelin sheaths. Chronic inflammation from MS damages the myelin sheaths, which can result in brain lesions.

Currently, there is no cure for MS. Treatments can prevent or slow the progression of some types of MS and help manage symptoms. We explore some treatment options below.

Disease-modifying therapies

Disease-modifying therapies (DMTs) are an emerging type of medication that can help people with relapsing-remitting MS. They can reduce the number of relapses and help prevent or delay progression.

Current DMTs include:

  • interferon beta-1a (Avonex, Rebif)
  • interferon beta-1b (Betaseron, Extavia)
  • glatiramer acetate (Copaxone, Glatopa)
  • peginterferon beta-1a (Plegridy)
  • teriflunomide (Aubagio)
  • fingolimod (Gilenya)
  • dimethyl fumarate (Tecfidera)
  • cladribine (Mavenclad)
  • siponimod (Mayzent)
  • alemtuzumab (Lemtrada)
  • mitoxantrone (Novantrone)
  • ocrelizumab (Ocrevus)
  • natalizumab (Tysabri)

Some of these drugs are injected or administered in an infusion, while others are taken by mouth. A person takes them whether their symptoms are flaring up or not.

Treatments for flares

Other approaches can help with pain and other symptoms.

  • Corticosteroids: These reduce nerve inflammation. They are not a long-term solution, but they can relieve symptoms of severe relapses, including vision loss and severe weakness. Long-term use can cause side effects, including raised blood pressure, weight gain, and sleeping problems.
  • Treatments for symptoms and complications: Various treatments can manage a range of issues, including urinary problems, sexual health problems, itchiness, and fatigue.
  • Physical and other therapies: These can help a person stay mobile and active. In time, some people need help with daily tasks or benefit from using an assistive device, such as a wheelchair.

Plasma exchange

A plasma exchange, or plasmapheresis, involves removing and separating the liquid part of blood, called plasma, from the blood cells.

A machine then mixes the blood cells with a protein solution and returns this to the body.

A doctor may recommend a plasma exchange when symptoms are new, get worse, or do not improve after treatment with corticosteroids.

Before an MRI scan, a person should eat and take their usual medications, unless their doctor says otherwise. Inside the exam room, the person may need to change into a hospital gown.

It is important to remove any items that might affect the MRI machine, such as:

  • eyeglasses
  • hairpins
  • watches
  • jewelry
  • dentures
  • hearing aids
  • wigs
  • bras with underwires

Before the scan, a healthcare professional may inject a chemical contrast dye, called gadolinium, through an intravenous line into a vein in the person’s hand or arm. This improves the quality and accuracy of the images.

An MRI machine is a long, narrow tube. The person lies on a table that slides into the tube. A technician will monitor the examination process from a separate room.

During the scan, the inside of the machine makes loud, repetitive noises, such as tapping and thumping. The technician may provide earplugs or music to help block out the noise.

There is currently no cure for MS. People with the condition have a similar life expectancy to people without MS. The life expectancy for people with MS has increased, possibly due to improvements in treatment and diagnostic tools and lifestyle changes.

MS can significantly reduce the quality of life for some people. Treatment plans focus on managing the symptoms and speeding up recovery from flares.

The severity and symptoms of MS vary from person to person, and symptoms can be very unpredictable. A person can help manage their symptoms with stretching, light aerobic exercise, and dietary changes.

It is crucial to have a support network that understands what life with MS is like. Various organizations offer support groups and other resources.

In addition, MS Healthline is a free app that provides support through one-on-one conversations and live group discussions. A person can download the app for iPhone or Android.

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