Using Radiology to Diagnose Multiple Sclerosis

Medically reviewed by Deborah Weatherspoon, PhD, RN, CRNA, COI on September 26, 2016Written by Ann Pietrangelo on September 26, 2016

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS). It’s thought to be the result of an immune system attack. MS damages myelin, the protective layer that surrounds nerve fibers. This is known as demyelination. As scar tissue, or lesions, form, it interferes with nerve signals within the CNS.

People with relapsing-remitting MS experience periods of increased disease activity followed by remissions. Progressive forms of MS cause symptoms that steadily worsen.

There are many symptoms associated with MS, depending on the location of the lesions. Severity of symptoms varies significantly from person to person. Some common symptoms include:

  • fatigue or weakness
  • numbness, tingling, or strange sensations
  • dizziness or vertigo
  • balance and coordination problems, or unsteady gait
  • visual disturbances
  • cognitive changes
  • bladder dysfunction

Types of radiology

Magnetic resonance imaging (MRI) has made it easier to diagnose MS and monitor disease progression. MRI can provide different information, depending on how it’s done.

T1-weighted brain MRI uses contrast dye to detect active inflammation. This scan highlights new lesions or lesions that are growing. It can also show dark areas or “black holes” that indicate possible permanent damage.

T2-weighted brain MRI detects all old and new lesions. It helps gauge total disease progression.

Fluid attenuated inversion recovery (FLAIR) is a more sensitive scan and can help identify brain lesions.

Spinal cord MRI can detect lesions within the spinal cord.

Computed tomography (CT or CAT scan) can also detect areas of demyelination, but with less detail than MRI.

CT scans involve radiation, while MRI does not.

What to expect during a radiology test

There’s not much preparation for MRI, but there are some important considerations. Due to the strong magnetic field, some conditions may make it unsafe or require special preparation. Let your doctor and MRI technician know if you have any diagnosed medical conditions or:

  • are claustrophobic
  • are pregnant
  • have an implanted medical device, such as a pacemaker, drug infusion device, cochlear implant, or aneurysm clips
  • have tattoos or metal fragments

If you’re claustrophobic or anxious about the procedure, tell your doctor in advance. A mild prescription sedative may help.

For MRI of the spine, wear clothing that’s easy to change. Even if you’re only having MRI of the brain, you’ll still need to choose clothes with no metal, such as zippers or snaps. You may be required to wear a hospital gown.

You’ll be asked to remove jewelry and other metal objects. You may need to leave your valuables in another room. Most hospitals provide a locker for safekeeping.

Your doctor or facility should provide you with instructions before the day of your scheduled test.

Preparation for a CT scan is similar to that of MRI. If your test will be done with contrast dye, you may be asked not to eat solid foods for a few hours before the test.


Your MRI may be performed with or without contrast. Contrast dye is given intravenously in your arm. You’ll lie on a table that slides into the tube-shaped MRI machine.

Earphones help you communicate with the technician, who will monitor from another room. MRI is noisy. You’ll hear loud banging sounds. Some facilities offer music via the earphones to help drown out the noise. You’ll also have a call button in case you feel claustrophobic or anxious.

You must remain perfectly still during scanning. Any movement could ruin the scans. The procedure is painless and you won’t feel anything from the scanning.

Length of the procedure depends on how many scans are being done and if they’re done both with and without contrast. It generally takes at least one hour, but could take much longer.

Like MRI, the CT scanner doesn’t touch you and you won’t feel anything. You’ll be required to remain still. The scanner makes some noise as it moves and captures images.


You’ll be able to dress and go home as soon as scanning is complete. If you were given an IV it will be removed.

If you took a sedative, you’ll need someone to drive you home.

Understanding your results

MS was a lot more difficult to diagnose before MRI was available. The detailed images are an excellent way to detect MS lesions, which appear as white spots in the brain or spinal column.

But other things can also cause white spots. They don’t necessarily mean you have MS.

A single lesion, when accompanied by symptoms of MS, is usually diagnosed as clinically isolated syndrome (CIS). CIS can sometimes develop into MS.

Multiple lesions may indicate MS. The diagnosis usually requires at least two lesions of the CNS that occurred at separate points in time.

A radiologist will study the MRI or CT scans and prepare a report for your doctor to share with you.

Diagnosing multiple sclerosis

There’s no single test for MS. To make the diagnosis, your doctor will consider your clinical evaluation, symptom history, and other test results. Other diagnostic tests may include:

lumbar puncture (spinal tap): to check for antibodies that are sometimes found in people with MS, and also help rule out similar conditions

sensory and visual evoked potentials: to study how well electrical signals in your CNS work

blood tests: although no blood test can diagnose MS, they can help rule out quite a few other conditions with similar symptoms

What is the treatment for multiple sclerosis?

There are a variety of treatments for MS:

Disease-modifying drugs are designed to slow progression and lower the relapse rate. Most are self-injectable, meaning you can inject them yourself. A few are given intravenously and some newer drugs are available in pill form.

Corticosteroids are generally used to reduce inflammation during relapses.

Individual symptoms can also be treated. Options may include:

  • physical therapy and exercise
  • pain relievers
  • medication to treat fatigue, muscle spasms, or other symptoms
  • complementary therapies such as meditation, relaxation techniques, or massage

Living with multiple sclerosis

Your individual outlook depends on the type and severity of the disease, as well other health factors. While there’s no cure for MS, there are a variety of treatments and ways of managing your MS.

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Life expectancy is close to normal, averaging about seven years less than the general population. This is mainly due to complications or other health problems. It’s rare, but MS can be fatal.

Good lifestyle habits not only help you feel better, but they help prevent additional health problems. That’s why you should strive for a well-balanced diet, regular exercise, and maintaining a healthy weight.

If you use a disease-modifying drug, it must be taken exactly as directed. Follow up with your doctor regularly.

Most people with MS continue to lead active, fulfilling lives.

Do I have multiple sclerosis?

Having some symptoms isn’t enough to conclude you have MS. These symptoms can be caused by a variety of conditions. That’s why it’s important to investigate the cause.

Start with your family physician. If necessary, you’ll be referred to a neurologist.

Symptoms of MS can come and go, so diagnosis can take time. That’s why it’s a good idea to keep a symptom diary. Keep track of your symptoms, when they started, and when they stopped. That information will help your doctor decide on the next steps.

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