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Sunday, June 19, 2016

MRI and MS - by Scott L. Gold, MD - a digest of the Ask the MS Clinician series


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MRI and MS

by Scott L. Gold, MD

The topic of this discussion is MRI - Magnetic Resonance Imaging - what is
it, how does it work, and how does it help in the diagnosis and
management of multiple sclerosis.

MRI is an unique technique for imaging or viewing the human body, looking
for evidence of disease. The history dates back to 1882, when Nikola Tesla
made basic discoveries in physics that enabled us to understand the basic
principles upon which MRI were developed. Our understanding was
advanced in 1937 by Isidor Rabi - professor at Columbia University. In the
early 1970’s, Dr. Raymond Damadian at Downstate Medical Center, built
the first MRI device and used it to differentiate cancer from normal tissue.
His patent in 1974 started an explosion of MRI machines built throughout
the world - 12 machines in the 1980’s and currently 36,000 (45% in the
US). By 1982, MS plaques were first imaged and MRI was on its way to
revolutionizing the way we view and treat MS.

MRI works by placing the person in a large, powerful magnetic field, which
safely aligns our protons, acting like tiny magnets. Radio waves - not
damaging X-rays - are used to knock these protons slightly out of
alignment. The protons then realign, producing signals that a computer
puts together into a detailed image of our body. The signals coming from
abnormal tissue (MS plaques, strokes, trauma, cancers, infections) are
different from signals coming from normal tissue, enhancing our ability to
make a diagnosis.

Over the years, MRI hardware and software have advanced significantly,
helping physicians to more accurately detect diseases earlier in their
course. In the case of multiple sclerosis, this has had a dramatic impact on
the diagnosis and treatment of our patients. We now have a technique that
more accurately confirms our clinical suspicion of MS even after the first
attack, provides a way to better predict the course of the disease, allows us
to start disease modifying therapies earlier in the course of the disease,
and enables us to more quickly determine when that therapy is ineffective,
even before a person develops symptoms or disability.

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