Magnetic Resonance Imaging (MRI) for Multiple Sclerosis

What to expect when undergoing this test

Magnetic resonance imaging (MRI) is a non-invasive procedure that plays a key role in diagnosing and monitoring multiple sclerosis (MS). In fact, researchers and medical professionals consider MRI to be one of the biggest breakthroughs in the field of multiple sclerosis, as it makes it possible to see lesions on the brain and spinal cord that indicate the disease that would otherwise require surgery to view.

If you are undergoing an MRI (a.k.a. nuclear magnetic resonance imaging, or NMRI) to find out if you have MS, or if you've been diagnosed and will be having the test to evaluate the progression of your disease, you may be nervous. Knowing what to expect from MRI testing from start to finish should can help.

What to expect during an MRI
Verywell / Emily Roberts

Purpose of Test

MRI is used in three ways for multiple sclerosis. As such, you may have several over the years for any one of these reasons.

Diagnosis

When a person is having symptoms that suggest MS, magnetic resonance testing is one of several procedures used to confirm if the disease is indeed the problem by revealing the presence of lesions—areas where the body has mistakenly attacked and damaged the protective myelin layer around nerves in the brain and/or spinal cord.

Disease Monitoring

Because multiple sclerosis is a progressive condition, regular MRIs can help track the development of new lesions. Regular MRIs also can provide an indication of how well you are responding to MS disease-modifying therapy. Many neurologists recommend MS patients have MRIs every year or so.

Relapse Detection

An MRI can determine if new neurological symptoms are being caused by a relapse. This is accomplished by using the contrast agent gadolinium, which causes new lesions to "light up," indicating active inflammation within the central nervous system.

Lesions that do not light up on an MRI with gadolinium likely are at least one to two months old.

Risks and Contraindications

For most people with MS, magnetic resonance imaging is safe.

However, according to the National Multiple Sclerosis Society (NMSS), there are two potential risks associated with the use of gadolinium-based contrast agents (GBCAs), even for people in otherwise good health.

  • Nephrogenic systemic fibrosis (NSF): This is a rare condition that has been known to occur in people with poor kidney function. It causes thickening of the skin and damage to internal organs.
  • Retention of GBCAs: Deposits of contrast material have been found in the brains and other body tissues of some people. Although it isn't known if these deposits are harmful, the U.S. Food and Drug Administration (FDA) has taken several safety measures, including issuing recommendations for the types of gadolinium that are less likely to be retained in the body.

Safety Considerations

Besides attracting metal objects outside of the body, such as jewelry, the powerful magnetic field in an MRI machine can affect objects inside the body. As such, the test may not be safe for people who have certain medical implants, medicine pumps, or aneurysm clips, for example.

Tattoos made from inks that contain metallic elements also may be a disqualifying factor for MRI.

Before the Test

Often scans of both the brain and the spinal cord are necessary, especially for an initial MRI for diagnosing MS. If your neurologist orders both, you may be asked if you want to do the scans in one session or in two separate appointments. Getting it done all at once is convenient, but time-consuming. Opting for two sessions means each will be shorter, but if gadolinium is being used, you'll receive it twice, which may be a consideration worth weighing.

Timing

The length of an MRI for multiple sclerosis will depend on the purpose of the test. For instance, it will take longer to do scans of both the brain and spinal cord than it will to scan one or the other structure.

Other factors that will impact the length of an MRI appointment include whether or not contrast material will be administered and if a sedative or anesthesia will be necessary. In general, an appointment for an MRI for any reason can take anywhere from 45 minutes to four hours.

Location

Magnetic resonance imaging typically takes place at freestanding imaging centers or at hospitals equipped with MRI equipment and technicians trained to perform scans.

In either case, the actual test is done in two conjoined rooms: In one is the actual scanner, in the other is the computer that will operate the machine and where the MRI technician will oversee the scan.

You will be able to communicate with each other while in separate rooms via an intercom system.

What to Wear

Because MRI relies on powerful magnets, anything that is metal or has metal parts—jewelry, watches, eyeglasses, hearing aids, dentures, body piercings, and even underwire bras—isn't allowed inside of scanners. Leave as many of these items at home as you can to reduce the risk of losing them since you'll have to remove them anyway.

Some MRI centers allow you to wear your own clothes instead of a hospital gown during the scan as long as there are no metal buttons, snaps, or zippers. If this is the case, wear soft, comfortable clothing. A T-shirt and elastic waist pants or shorts (plus a sports bra for women) are ideal. It can get hot in an MRI machine, so err on the side of choosing lightweight clothing; you can always ask for a blanket if you find the scanning room to be chilly.

Food and Drink

Typically, there are no restrictions as to what can be ingested before an MRI, including medications. One exception: If for any reason you will need to receive anesthesia or a sedative for your test—because you have claustrophobia that is severe enough to make it impossible to lie still and not panic, for example—you may receive instructions about what and when you can eat or drink the day before and the morning of your scan.

Tip

Take a ​cough suppressant if you think you'll need one. Coughing during an MRI may cause movements that require starting over. Just make sure your doctor says it's OK to do so.

Cost and Health Insurance

Magnetic resonance imaging can be expensive—anywhere from $400 to $3,500. If you have health insurance, your MRI likely will be covered, although you may be responsible for a co-pay and/or coinsurance. You also may need pre-authorization for an MRI; check with your insurance carrier to be on the safe side.

If you don't have health insurance, you may be eligible for a discount. Talk to the business or accounting office at the hospital or imaging center to learn about their policies.

What to Bring

You shouldn't need to bring much to your scan, but do be sure to have:

  • A photo ID
  • Your insurance card (if you have one)
  • Printed information about any medical device or implant you have
  • Someone to drive you home after your MRI if you will be sedated or have anesthesia

During the Test

You will be interacting with a radiology technician during your MRI.

Pre-Test

Before you prepare for your scan, you may need to fill out a safety screening questionnaire and/or a consent form, go over your health history, and have your heart rate, temperature, and blood pressure checked. You'll remove your jewelry, glasses, and other such items.

You then will lie down on a moveable table that slides in and out of the MRI scanner, a large cylinder-shaped tube surrounded by a circular magnet. The technologist may use straps or bolsters to help you stay still comfortably. If you're having a brain MRI, a device may be used to keep your head still.

If you'll be having a T-1 weighted MRI with a gadolinium contrast agent, an IV will be placed in a vein in your hand or arm to administer the dye. The IV also may be used if you'll be receiving intravenous sedation.

Some people experience a cold feeling as contrast dye enters the bloodstream or get a metallic taste in their mouth. Both sensations are temporary and normal.

Very rarely, contrast dye causes an allergic reaction (mild hives and itchy eyes and/or skin). Tell the technician if this happens to you; note that the symptoms will probably go away within a few minutes after the dye is administered.

Throughout the Test

Once you're in position, the table will slide into the tube and the technologist will leave the room. The two-way intercom will allow you to tell him or her if you're experiencing claustrophobia, anxiety, or pain.

To get the best quality images, you'll be asked to hold as still as you can during the scan. This may be unpleasant, but it's the closest thing to discomfort you should experience. You may feel some warmth in the area of your body that's being scanned, but this is normal.

Post-Test

When the scan is complete, the technician will slide the table out of the machine, remove your IV (if you had one), and help you up.

At this point, you can get dressed, collect any valuables you removed, and go home. If you had anesthesia, you will be taken to a recovery room where you will be woken up and allowed to recover before you go home with a family member or friend.

After the Test

There's little you should need to do after having an MRI. Side effects are rare and are most likely to occur if contrast dye was used.

If you did receive a contrast dye, drink lots of water to help speed up the process of your kidneys flushing the agent out of your system.

Some people experience headache, nausea, and dizziness for a few hours after receiving contrast dye. The site of an IV may bruise and swell slightly, but this shouldn't last more than a day or two. If it doesn't get better, call your doctor.

Interpreting Results

It likely will take a few days for your neurologist to receive the results of your MRI, at which point he or she will contact you to discuss them and talk about any next steps that might be necessary.

What you will learn from your MRI will depend on which type was done and its intention.

Type of MRI What It Reveals
T-1 weighted MRI without gadolinium Diagnosis of MS based on presence of lesions
T-1 weighted MRI with gadolinium Active disease based on lesions that "light up"
T-2 weighted MRI without gadolinium Evaluation of MS based on old and new lesions
Spinal cord MRI MS diagnosis or evaluation lesions on spinal cord

Follow-Up

Likewise, what happens after you receive the results of an MRI for multiple sclerosis will depend on the specific findings.

If lesions that confirm you have multiple sclerosis are revealed, further testing may be needed to fine-tune your treatment. And even if your MRI doesn't show lesions but you have symptoms that seem to point to MS, your neurologist may have you undergo other types of MS diagnostic tests.

Around 5 percent of people with MS have normal results—no lesions—at the time they first are scanned, so other measures such as blood tests, spinal taps, and evoked potential tests may be needed to definitively confirm a diagnosis.

The results of an MRI scan to evaluate MS in someone who already is living with the disease will show how it's progressing (or not).

For example, according to the McDonald Criteria, which is used to determine if you have or don't have MS, MRI is one of the diagnostic methods typically used. (The others are a neurological exam, spinal fluid, and evoked potential testing.)

Use our Doctor Discussion Guide below to help start the conversation with your doctor about interpreting your results.

Multiple Sclerosis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

A Word From Verywell

The prospect of having magnetic resonance imaging to diagnose or evaluate MS can be as nerve-wracking as the fear of a diagnosis. Be reassured that the procedure is safe, and it is also one of the most powerful and important tools your neurologist has to make sure you receive the most effective treatment for you.

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Article Sources

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  2. National Multiple Sclerosis Society. Magnetic Resonance Imaging (MRI).

  3. MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-up of MS. Prepared By: Consortium of Multiple Sclerosis Centers. February 2018.

                  

  4. USS Food & Drug Administration. FDA Drug Safety Communication: FDA warns that gadolinium-based contrast agents (GBCAs) are retained in the body; requires new class warnings. Updated May 16, 2018.

  5. RadiologyInfo.org. Magnetic Resonance Imaging (MRI) - Spine. Reviewed June 04, 2019.

  6. Igra MS, Paling D, Wattjes MP, Connolly DJA, Hoggard N. Multiple sclerosis update: use of MRI for early diagnosis, disease monitoring and assessment of treatment related complications. Br J Radiol. 2017;90(1074):20160721. doi:10.1259/bjr.20160721

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