Table of ContentsView AllTable of ContentsWhat Is MS?Radiology for MS DiagnosisWhat to ExpectInterpreting ResultsOther MS Diagnostic TestsTreatmentLiving With MSHow to Know If You Have MSFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is MS?
Radiology for MS Diagnosis
What to Expect
Interpreting Results
Other MS Diagnostic Tests
Treatment
Living With MS
How to Know If You Have MS
Frequently Asked Questions
Diagnosing multiple sclerosis (MS)has traditionally been a challenging task because thesymptomsare often subtle and can mimic those of other health conditions. There’s also no single test that can confirm a diagnosis of MS. The emergence of advancedmagnetic resonance imaging (MRI)techniques, however, has revolutionized the detection of MS.
This article will review how different types of MRI scans can help support an MS diagnosis. It also will explore what it’s like to undergo an MRI and provides some basic information on the cause, types, diagnosis, and treatment of MS.
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What Is Multiple Sclerosis?
MS is an unpredictable disease in which a person’s immune system damages the protectivemyelincoating of nerves within the central nervous system (CNS). The CNS is made up of your brain, spinal cord, and the optic nerves of your eyes.
In MS, a person’s immune system mistakes myelin in the CNS for a foreign invader and launches attacks to damage and destroy it. During such attacks, fighter cells (called T cells) break through theblood-brain barrier (BBB).
What Is the Blood-Brain Barrier?Your blood-brain barrier is a tightly joined layer of cells intended to prevent foreign substances from entering the brain.
What Is the Blood-Brain Barrier?
Your blood-brain barrier is a tightly joined layer of cells intended to prevent foreign substances from entering the brain.
Once in the CNS, the T cells damage myelin (a process calleddemyelination), causinglesions(areas of inflammation) to form. Depending on their location, these lesions can lead to an array of MS symptoms.
What Causes Multiple Sclerosis?
Types
Experts have identified four types of MS, which are:
Magnetic resonance imaging (MRI)is a noninvasive imaging technology that creates three-dimensional images of the body’s soft tissues. Magnetic fields and radio waves (not radiation) are used to produce these images.
MRI is the most sensitive test for detecting MS-related inflammation and damage in the tissues of the central nervous system.
Different types of MRIs can be used, depending on whetherneurologists(specialists in conditions affecting the nervous system) are diagnosing or monitoring MS.
With some types of MRIs, a person is injected with a contrast dye calledgadolinium. As a large molecule, gadolinium cannot normally pass the blood-brain barrier. However, when a person’s MS is active, the blood-brain barrier is disrupted, allowing for it to enter and light up any inflamed areas.
Risks and Contraindications
MRI is rarely associated with any risks or adverse effects. Conditions or issues that may affect your safety and/or prevent you from undergoing the MRI include:
Types of MRIs
The different types of MRIs used to evaluate MS include:
T1, T2, and FLAIR are often done in sequence in a single examination.
Are CT Scans Helpful for Diagnosing MS?Acomputed tomography (CT) scanis not used to diagnose MS; although it can be helpful in ruling out alternative diagnoses. Overall, MRIs are significantly more sensitive in detecting abnormalities within the brain and spinal cord tissue.
Are CT Scans Helpful for Diagnosing MS?
Acomputed tomography (CT) scanis not used to diagnose MS; although it can be helpful in ruling out alternative diagnoses. Overall, MRIs are significantly more sensitive in detecting abnormalities within the brain and spinal cord tissue.
MRIs are performed in a hospital or freestanding imaging facility. Beforehand, discuss whether you will be able to drive after the procedure. If you are given a sedative, you will need someone else to drive you home.
Before the Test
Once you arrive for your MRI, you will fill out a healthcare form and be asked to remove anything with metal, including keys, jewelry, body piercings, and cell phones.
You may be asked to change into a hospital gown or be allowed to wear your own clothes, assuming they contain no metal (e.g., sweatpants with an elastic waist).
When the MRI technician is ready, you will be asked to lie flat on a bed. You will be given earplugs or a headset to help reduce the noise of the MRI scanner. Patients who areclaustrophobicor unable to lie still may receive a sedative to help them relax during the test.
Once you are comfortable, the technician will electronically move the bed back into a magnetic tube-like structure.
During the Test
While the MRI is performed, your technician will oversee the images in an adjoining room. You will be able to talk with your technician via an intercom system throughout the test.
If you are receiving gadolinium, you may have an intravenous (IV) catheter placed in your arm before the MRI or halfway through the test.
The length of your test will depend on whether you are undergoing both a brain MRI and a spinal cord MRI and if contrast is being administered.
After the Test
When the MRI scan is complete, the technician will move the table out of the tubelike structure. They will remove your IV (if one was placed) and help you up from the table.
You will be able to get dressed and go home. If you received a sedative, you will not be allowed to drive and will need a family member or friend to drive you home.
After you undergo an MRI, a neuroradiologist (a doctor who specializes in interpreting imaging tests of the nervous system) will look for areas of myelin or nerve fiber damage within the tissues that were scanned.
For example, on a T1-weighted MRI with gadolinium, areas of active inflammation will show up as bright white spots. These enhancing lesions indicate that myelin damage and scarring are currently (or recently) occurring.
The neuroradiologist will then type up a formal report of their findings and relay that report to the ordering provider.
Keep in MindNot all enhancing lesions indicate MS. They may stem from normal aging, or another neurological condition, likemigraine.This is why multiple tools, in addition to a clinical exam, are used to diagnose MS.
Keep in Mind
Not all enhancing lesions indicate MS. They may stem from normal aging, or another neurological condition, likemigraine.This is why multiple tools, in addition to a clinical exam, are used to diagnose MS.
Neurologists use a formal set of guidelines called theMcDonald criteriato diagnose MS.
Fulfilling the McDonald criteria means that a person has evidence of MS-related damage to their CNS at different dates and to different parts (referred to as “dissemination in time and space”).
Besides asking you questions about your symptoms, performing aneurological exam, and using data from your MRI, a doctor will use the information gathered from one or more of these other tests is often used to help make a diagnosis of MS:
MS is an incurable disease. However, there aredisease-modifying therapies (DMTs)that can slow the disease down and reduce the number and severity of MS relapses.
There are numerous DMT options, and they vary in their delivery method (oral vs. injection vs. infusion), mode of action, level of effectiveness, and side effect profiles.
There are also medications, rehabilitation therapies, and/orcomplementary or alternative therapiesthat can ease MS symptoms and help you feel better on a day-to-day basis.
How Multiple Sclerosis Is Treated
No two people with MS experience the disease in the same way. As such, it’s best not to compare your symptoms, disease course, or treatment plan with others. Instead, focus on optimizing your quality of life through self-compassion and a take-charge attitude.
Consider the following strategies:
Living With Multiple Sclerosis
If you think you may have MS, the first medical professional to see is yourprimary care provider. Your provider will ask you questions about how you are feeling and perform an exam. Depending on their suspicions and clinical findings, they may also order various blood and imaging tests.
If you are referred to a neurologist, try to see anMS specialist(a physician with experience detecting and diagnosing MS).
Know that whether MS is ruled out or in, the diagnostic process can be time-consuming and nerve-racking. During this trying time, don’t hesitate to ask questions, communicate your concerns, and lean on family members and friends for comfort and emotional support.
When to See a Healthcare ProviderThe symptoms of MS, especially early on, can be subtle and resemble those of other medical conditions.While not an exhaustive list, possible MS symptoms include:Vision changes (e.g., blurry or double vision)Numbness and tinglingMuscle weakness or paralysisImbalanceHeadacheUnusual fatigueSee your healthcare provider if you are experiencing any of the above or if your symptoms are bothersome or interfering with your ability to function.
When to See a Healthcare Provider
The symptoms of MS, especially early on, can be subtle and resemble those of other medical conditions.While not an exhaustive list, possible MS symptoms include:Vision changes (e.g., blurry or double vision)Numbness and tinglingMuscle weakness or paralysisImbalanceHeadacheUnusual fatigueSee your healthcare provider if you are experiencing any of the above or if your symptoms are bothersome or interfering with your ability to function.
The symptoms of MS, especially early on, can be subtle and resemble those of other medical conditions.
While not an exhaustive list, possible MS symptoms include:
See your healthcare provider if you are experiencing any of the above or if your symptoms are bothersome or interfering with your ability to function.
Summary
The diagnosis of MS requires a medical history, neurological exam, and blood/spinal fluid tests. An MRI is also essential for detecting MS-related abnormalities in the brain and spinal cord. There are different types of MRIs, depending on the purpose of the test (diagnosis versus monitoring), and whether injected contrast dye is being used.
If you or your primary healthcare provider believes you have the symptoms of MS, arrange to see a neurologist who specializes in MS care. This is because MS is a complex disease that affects people uniquely. It requires a thorough evaluation to avoid misdiagnosis and an individually tailored treatment plan.
A Word From Verywell
Frequently Asked QuestionsAvailable research suggests that radiation does not lead to the development of MS. However, radiation could possibly trigger a relapse in people with MS.An MRI is the most sensitive, noninvasive way of diagnosing MS-related damage in the brain, spinal cord, and eyes' optic nerves. Instead of radiation, MRIs use magnetic fields and radio waves to detect areas of active inflammation or nerve damage.A CT scan is not used to diagnose MS, with the exception of ruling out alternative diagnoses. That said, areas of demyelination (loss of the fatty myelin sheath covering nerve fibers) are sometimes seen on the CT scan of a person with MS.Nevertheless, MRI offers a much more sensitive means of detecting MS-related changes.Neuroradiologists interpret the findings of a patient’s MRI, which is the most sensitive test for detecting MS-related inflammation. However, neurologists formally diagnose MS. In addition to using data from a person’s MRI, they look at results from other studies (e.g., laboratory tests and spinal tap) when making the diagnosis.
Available research suggests that radiation does not lead to the development of MS. However, radiation could possibly trigger a relapse in people with MS.
An MRI is the most sensitive, noninvasive way of diagnosing MS-related damage in the brain, spinal cord, and eyes' optic nerves. Instead of radiation, MRIs use magnetic fields and radio waves to detect areas of active inflammation or nerve damage.
A CT scan is not used to diagnose MS, with the exception of ruling out alternative diagnoses. That said, areas of demyelination (loss of the fatty myelin sheath covering nerve fibers) are sometimes seen on the CT scan of a person with MS.Nevertheless, MRI offers a much more sensitive means of detecting MS-related changes.
Neuroradiologists interpret the findings of a patient’s MRI, which is the most sensitive test for detecting MS-related inflammation. However, neurologists formally diagnose MS. In addition to using data from a person’s MRI, they look at results from other studies (e.g., laboratory tests and spinal tap) when making the diagnosis.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hemond CC, Bakshi R.Magnetic Resonance Imaging in Multiple Sclerosis.Cold Spring Harb Perspect Med.2018 May 1;8(5):a028969. doi:10.1101/cshperspect.a028969van Langelaar J, Rijvers L, Smolders J, van Luijn MM.B and T cells driving multiple sclerosis: Identity, mechanisms and potential triggers.Front Immunol.2020;11:760. doi:10.3389/fimmu.2020.00760Ömerhoca S, Akkaş SY, and İçen NK.Multiple sclerosis; diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1–S9. doi:10.29399/npa.23418Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.National MS Society.Magnetic resonance imaging (MRI)Chernoff D.Principles of magnetic resonance imaging. Elmore JG, Muller NK, eds. UpToDate. Waltham, MA: UpToDate.Klawiter EC.Current and new directions in MRI in multiple sclerosis.Continuum (Minneap Minn). 2013;19(4 Multiple Sclerosis):1058–1073. doi:10.1212/01.CON.0000433283.00221.37National MS Society.Momentum: 7 tips for getting through an MRIWharton SB, Simpson JE, Brayne C, Ince PG.Age‐associated white matter lesions: the MRC Cognitive Function and Ageing Study.Brain Pathol. 2015;25(1):35-43. doi:10.1111/bpa.12219McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: A review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858Bejargafshe MJ, Hedayati M, Zahabiasli S, Tahmasbpour E, Rahmanzadeh S, Nejad-Moghaddam A.Safety and efficacy of stem cell therapy for treatment of neural damage in patients with multiple sclerosis.Stem Cell Investig.2019;6:44. doi:10.21037/sci.2019.10.06Guillemin F, Biau J, Conde S, Clavelou P, Dupic G.Multiple sclerosis as differential diagnosis of radionecrosis for post-irradiation brain lesions: A case report.Clin Transl Radiat Oncol.2020;21:44-48. doi:10.1016/j.ctro.2020.01.001Kim DS, Na DG, Kim KH, et al.Distinguishing tumefactive demyelinating lesions from glioma or central nervous system lymphoma: added value of unenhanced CT compared with conventional contrast-enhanced MR imaging.Radiology.2009;251(2):467-75. doi:10.1148/radiol.2512072071
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hemond CC, Bakshi R.Magnetic Resonance Imaging in Multiple Sclerosis.Cold Spring Harb Perspect Med.2018 May 1;8(5):a028969. doi:10.1101/cshperspect.a028969van Langelaar J, Rijvers L, Smolders J, van Luijn MM.B and T cells driving multiple sclerosis: Identity, mechanisms and potential triggers.Front Immunol.2020;11:760. doi:10.3389/fimmu.2020.00760Ömerhoca S, Akkaş SY, and İçen NK.Multiple sclerosis; diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1–S9. doi:10.29399/npa.23418Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.National MS Society.Magnetic resonance imaging (MRI)Chernoff D.Principles of magnetic resonance imaging. Elmore JG, Muller NK, eds. UpToDate. Waltham, MA: UpToDate.Klawiter EC.Current and new directions in MRI in multiple sclerosis.Continuum (Minneap Minn). 2013;19(4 Multiple Sclerosis):1058–1073. doi:10.1212/01.CON.0000433283.00221.37National MS Society.Momentum: 7 tips for getting through an MRIWharton SB, Simpson JE, Brayne C, Ince PG.Age‐associated white matter lesions: the MRC Cognitive Function and Ageing Study.Brain Pathol. 2015;25(1):35-43. doi:10.1111/bpa.12219McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: A review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858Bejargafshe MJ, Hedayati M, Zahabiasli S, Tahmasbpour E, Rahmanzadeh S, Nejad-Moghaddam A.Safety and efficacy of stem cell therapy for treatment of neural damage in patients with multiple sclerosis.Stem Cell Investig.2019;6:44. doi:10.21037/sci.2019.10.06Guillemin F, Biau J, Conde S, Clavelou P, Dupic G.Multiple sclerosis as differential diagnosis of radionecrosis for post-irradiation brain lesions: A case report.Clin Transl Radiat Oncol.2020;21:44-48. doi:10.1016/j.ctro.2020.01.001Kim DS, Na DG, Kim KH, et al.Distinguishing tumefactive demyelinating lesions from glioma or central nervous system lymphoma: added value of unenhanced CT compared with conventional contrast-enhanced MR imaging.Radiology.2009;251(2):467-75. doi:10.1148/radiol.2512072071
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hemond CC, Bakshi R.Magnetic Resonance Imaging in Multiple Sclerosis.Cold Spring Harb Perspect Med.2018 May 1;8(5):a028969. doi:10.1101/cshperspect.a028969van Langelaar J, Rijvers L, Smolders J, van Luijn MM.B and T cells driving multiple sclerosis: Identity, mechanisms and potential triggers.Front Immunol.2020;11:760. doi:10.3389/fimmu.2020.00760Ömerhoca S, Akkaş SY, and İçen NK.Multiple sclerosis; diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1–S9. doi:10.29399/npa.23418Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.National MS Society.Magnetic resonance imaging (MRI)Chernoff D.Principles of magnetic resonance imaging. Elmore JG, Muller NK, eds. UpToDate. Waltham, MA: UpToDate.Klawiter EC.Current and new directions in MRI in multiple sclerosis.Continuum (Minneap Minn). 2013;19(4 Multiple Sclerosis):1058–1073. doi:10.1212/01.CON.0000433283.00221.37National MS Society.Momentum: 7 tips for getting through an MRIWharton SB, Simpson JE, Brayne C, Ince PG.Age‐associated white matter lesions: the MRC Cognitive Function and Ageing Study.Brain Pathol. 2015;25(1):35-43. doi:10.1111/bpa.12219McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: A review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858Bejargafshe MJ, Hedayati M, Zahabiasli S, Tahmasbpour E, Rahmanzadeh S, Nejad-Moghaddam A.Safety and efficacy of stem cell therapy for treatment of neural damage in patients with multiple sclerosis.Stem Cell Investig.2019;6:44. doi:10.21037/sci.2019.10.06Guillemin F, Biau J, Conde S, Clavelou P, Dupic G.Multiple sclerosis as differential diagnosis of radionecrosis for post-irradiation brain lesions: A case report.Clin Transl Radiat Oncol.2020;21:44-48. doi:10.1016/j.ctro.2020.01.001Kim DS, Na DG, Kim KH, et al.Distinguishing tumefactive demyelinating lesions from glioma or central nervous system lymphoma: added value of unenhanced CT compared with conventional contrast-enhanced MR imaging.Radiology.2009;251(2):467-75. doi:10.1148/radiol.2512072071
Hemond CC, Bakshi R.Magnetic Resonance Imaging in Multiple Sclerosis.Cold Spring Harb Perspect Med.2018 May 1;8(5):a028969. doi:10.1101/cshperspect.a028969
van Langelaar J, Rijvers L, Smolders J, van Luijn MM.B and T cells driving multiple sclerosis: Identity, mechanisms and potential triggers.Front Immunol.2020;11:760. doi:10.3389/fimmu.2020.00760
Ömerhoca S, Akkaş SY, and İçen NK.Multiple sclerosis; diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1–S9. doi:10.29399/npa.23418
Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.
National MS Society.Magnetic resonance imaging (MRI)
Chernoff D.Principles of magnetic resonance imaging. Elmore JG, Muller NK, eds. UpToDate. Waltham, MA: UpToDate.
Klawiter EC.Current and new directions in MRI in multiple sclerosis.Continuum (Minneap Minn). 2013;19(4 Multiple Sclerosis):1058–1073. doi:10.1212/01.CON.0000433283.00221.37
National MS Society.Momentum: 7 tips for getting through an MRI
Wharton SB, Simpson JE, Brayne C, Ince PG.Age‐associated white matter lesions: the MRC Cognitive Function and Ageing Study.Brain Pathol. 2015;25(1):35-43. doi:10.1111/bpa.12219
McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: A review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858
Bejargafshe MJ, Hedayati M, Zahabiasli S, Tahmasbpour E, Rahmanzadeh S, Nejad-Moghaddam A.Safety and efficacy of stem cell therapy for treatment of neural damage in patients with multiple sclerosis.Stem Cell Investig.2019;6:44. doi:10.21037/sci.2019.10.06
Guillemin F, Biau J, Conde S, Clavelou P, Dupic G.Multiple sclerosis as differential diagnosis of radionecrosis for post-irradiation brain lesions: A case report.Clin Transl Radiat Oncol.2020;21:44-48. doi:10.1016/j.ctro.2020.01.001
Kim DS, Na DG, Kim KH, et al.Distinguishing tumefactive demyelinating lesions from glioma or central nervous system lymphoma: added value of unenhanced CT compared with conventional contrast-enhanced MR imaging.Radiology.2009;251(2):467-75. doi:10.1148/radiol.2512072071
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