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My integrative doctor wants me to get an MRI on my brain and spine because she feels I have ms. I had no brain lesions in 2005, I had two in 2007, and I had several on both sides in 2014. I am not having symptoms like I was before, it is definitely much better. My doctor said we would decide at my appointment tomorrow about using contrast.

My questions are:
1) If we do the MRI now will it still show if I have ms but am not in a flareup?
2) Would it be better to do the MRI with or without contrast?
3) What is the difference between the MRI of a patient with ms during a flareup and during a relapse?

Thank you so much for your help.
God bless,
Michelle

heathertrent wrote:My integrative doctor wants me to get an MRI on my brain and spine because she feels I have ms. I had no brain lesions in 2005, I had two in 2007, and I had several on both sides in 2014. I am not having symptoms like I was before, it is definitely much better. My doctor said we would decide at my appointment tomorrow about using contrast.

My questions are:
1) If we do the MRI now will it still show if I have ms but am not in a flareup?
2) Would it be better to do the MRI with or without contrast?
3) What is the difference between the MRI of a patient with ms during a flareup and during a relapse?

Please note that all the following is from someone without medical training. I was diagnosed with MS using an MRI that did not use a contrast agent. Off the top of my head, I think the McDonald criteria does not specifically require enhancing lesions for a diagnosis. Even if you have Relapsing Remitting MS, I would say that after a few years, you should have lesions that will be evident on an MRI that does not use contrast.

For your questions, and from my understanding;
1. At least some old Lesions will still remain visible on an MRI without a current flareup. The fact that historically you have had some, would suggest that you will still have some today.
2. I personally have not been convinced by my Doctors to get contrast unless there is a specific purpose such as checking the effectiveness of a specific treatment or the suitability of another. Ask the question, why do you need to know if I am currently in a flareup? It may be that your doctor is trying to decide on the suitability of a treatment, and then it is beneficial. Some treatment options are only really effective on active disease.
3. Not sure if you are asking the difference between a relapse and a flare-up or if you understand they are basically the same. If the latter, the difference between the relapse and the remitting stages is that during the relapsing stage, your symptoms may get worse and you may develop new symptoms (my dr's imply that new symptoms only present during a relapse), whereas during the other stage (if you are RR) you will generally get better; as you appear to be saying.

My doctor has not said why she is thinking of ordering the MRI with contrast. She just said she wants me to come in tomorrow and get the order so I can have the MRI before seeing the neurologist in a couple of weeks.

If I agree to the contrast will it help them get a better image of my lesions?
Will that show more lesions than an MRI without contrast?

I didn't realize what I wrote on my third question, sorry about that. What I meant to ask was what the difference was between the MRI of a ms patient relapsing (having symptoms) and remitting (feeling better). Should I wait until I am having more symptoms again to get the MRI? The way I have been going the past year or so I doubt I would have to wait long.

Thank you for helping.

Hi Heather,

heathertrent wrote:If I agree to the contrast will it help them get a better image of my lesions?
Will that show more lesions than an MRI without contrast?

The gadolinium contrast agent will show which lesions are currently active. It shows where the blood brain barrier is leaky due to white blood cells actively crossing it.

I didn't realize what I wrote on my third question, sorry about that. What I meant to ask was what the difference was between the MRI of a ms patient relapsing (having symptoms) and remitting (feeling better). Should I wait until I am having more symptoms again to get the MRI? The way I have been going the past year or so I doubt I would have to wait long.

Lesions often don't correlate to symptoms, i.e., they can be subclinical. Patients in clinical trials receiving serial MRIs often have have lesions that come and go without the patient experiencing any new symptoms.

I don't think I will agree to the contrast then unless my doctor feels strongly about it since they will still be able to see all my lesions. Thank you for your help.

heathertrent wrote:I don't think I will agree to the contrast then unless my doctor feels strongly about it since they will still be able to see all my lesions. Thank you for your help.

As I implied, I try to avoid it personally, however, if cost is an issue, you may be best to get it done all at once, and it may also help your neuro decide on a treatment.