Diagnosis & MS

Diagnosing MS

It may have taken your health care provider a while to diagnose you with definite MS. It can be frustrating, but a proper diagnosis takes time. MS is known as a "diagnosis of exclusion." That's because the symptoms of MS can seem like symptoms of other diseases. So, MS is usually diagnosed after a health care provider has thoroughly tested for other medical conditions and diseases. There is no single test or symptom that can determine whether a person has MS.

Your health care provider may be able to make a diagnosis based on different findings, such as:

• Complete health history
• Symptoms that occur at different times and last for at least 24 hours in the absence of a fever
• Signs of damage in different areas of the CNS
• Testing for balance, reflexes, coordination, vision, and areas of numbness
• Spinal fluid test
• Magnetic resonance imaging (MRI): to check for disease in the brain and spinal cord

Magnetic Resonance Imaging (MRI)

MRI is a safe and painless way for a doctor to see what's going on inside your body.

In MS, an MRI is used to take detailed pictures of the brain and spinal cord. MRI scans show the amount of water in tissues. MS lesions have higher-than-normal water content. MRI uses a very large and very strong magnet to find these lesions. It takes detailed pictures of the central nervous system (CNS). These pictures show the areas of damage.

MRI is an important tool that doctors use to help confirm an MS diagnosis. MRI allows your doctor to see a picture of what's happening to your brain and spinal cord. MRI scans can also help your doctor manage your MS.

The exact correlation between MRI findings and the current or future clinical status of patients, including disability progression, is unknown.

Often, MS can be active in areas that are not causing obvious symptoms. For this reason, your health care provider may want you to have a routine MRI from time to time. He or she will then compare your new MRI scan with your old one. Your doctor can see if you have lasting lesions. And, he or she can see if you have new ones. However, it is important to note that MRI results and a patients' symptoms or disability status may or may not match. Either way, your doctor may want to try a new treatment. Be sure to ask what he or she thinks about your MRI scan results. The more you know about what is happening, the better you can take care of yourself. And the better you can manage your MS.

Types of MRI and how they work

Two types of MRI scans are commonly used for MS.

A Gadolinium-enhanced T1-weighted scan reveals only new lesions

These are areas where the disease is currently active. Before the MRI, you will receive an injection of Gadolinium(Gd). Gd is like a dye that can help your health care provider separate the active lesions from the normal parts of the brain. When MS is active, Gd will cross the blood-brain barrier (BBB) and reveal areas of inflammation by "lighting up." Health care providers call these "enhancing lesions" because they are able to see them.

Over time, lesions on Gd-enhancing MRI may grow or shrink, depending on how active your MS is. This type of MRI does not show older, inactive lesions.

T2-weighted scans show both the number and size of new lesions

But they do not pick up new lesions as well as T1 scans. They do show older, inactive lesions. Regular T2 MRIs can be important for tracking long-term disease progression.

If you are having trouble getting your insurance company to cover an MRI scan:

Contact the MRI Institute * at the Multiple Sclerosis Association of America Website. This program is designed for patients who have no or inadequate insurance, and/or no or inadequate financial means to pay for the test themselves. Patients needing an MRI exam specifically to determine a diagnosis of MS are not eligible for this program.