I was waiting for more symptoms to prove that I had multiple sclerosis. It wasn’t until five years later that I finally could no longer deny the MS that I learned symptoms are just the tip of the iceberg.
MS causes damage to the myelin, the protective coating of the nerves. This damage creates lesions or “scars” that can be seen on the brain and spinal cord in a process is called demyelination.
MS activity in the brain happens before the symptoms are being experienced and can be seen as white spots on the MRI images.
MRI or magnetic resonance imaging is a way to see inside the brain and spinal column. MRI scanners use strong magnetic fields and radio waves to form images of the body. The technique is widely used in hospitals for medical diagnosis, staging of disease and for follow-up without exposure to ionizing radiation.
MRI images can show old damage and new inflammation. The pictures that are taken of the brain include information on past and ongoing disease and possible prediction of the future.
Five key MRI changes can show:
1. T2 and flair lesions: Standout at Bright Spots called Hyperintensities, ventricles or spinal fluid spaces, old damage and new inflammation, having T2 or flair lesions may be an increased risk for disability. Without MS usually no T2 spots are found in the brain until age 50. Other causes of white spots need to be considered also when diagnosing MS.
2. T1 with contrast lesions: MS lesions, bright with contrast when contrast is given in the vein, the contrast goes through your blood and seeps out of leaky blood vessels at sites with active MS inflammation. Typical MS lesions remain active for only one or two months. The spots may go away, or leave a flair scar.
3. T1 black holes cells also known ‘T1Hypo-dense lesions: These dark spots on T1 scans are damage on the myelin coating and the nerve, higher risk for physical disability
4. Atrophy: As all of us age, our brain shrinks naturally, with MS the brain shrinks more quickly.
5. Cortisol lesions: Cortex or surface of the brain contains the nerve cells and new MRI research techniques make these spots more visible. Cortisol lesions are more common in progressive MS
Good News is medications prevent over 70% of new lesions from forming or existing lesions from becoming larger and flair or T2 images contrast T1 lesions can decrease more than 80% with treatment. Medications have been proven to slow down atrophy and prevent new T1 black holes.
MRI scans are the central tool to diagnose and monitor treatment options. Significant changes are seen on the MRI, the doctor might consider a change in treatment. An unchanged MRI is one indicator that the MS is in check.
Also, exciting research is focusing on repairing the myelin heal the damage of multiple sclerosis.
If I would have understood the MRI results, agreed to another scan, maybe I would have gotten on medication earlier. There is no way of knowing if that would have changed things. I’m just grateful my MS seems under control, at least for now.