1st Dec, 2002
Karen J Zielinski
Real Living with Multiple Sclerosis
I have a wonderful primary care clinician and a good neurologist. I see my primary care clinician regularly, and he handles blood work, Pap tests, and so on. I see my neurologist regularly every 6 months, whether I feel a need to see him or not.
This past visit, my neurologist ordered another magnetic resonance imaging (MRI) test. I have an MRI every year even when I don't have any new symptoms. I hate the test-the noise it makes and the feeling of being enclosed. I'd rather get a root canal without a painkiller than receive another MRI.
Is my strong dislike for this test typical? It seems that every year my neurologist says "no change" about my test. If the MRI only helps diagnose MS-a disease I already know I have-- why keep repeating it? It sure would save me the trouble. Am I missing something important?
"Nervous Nellie" Flagstaff, AZ
Dear Nervous Nellie
An MRI is a painless diagnostic test often used for persons diagnosed with MS. I hate them too. But I know they're important tests that neurologists use to monitor our disease.
I know only the bare minimum about MRIs. Sometimes an individual with many MS symptoms has a normal MRI. Then again, a person might have multiple brain lesions and still not have much disability.
Because my clinical expertise has its limits, I asked my neurologist (who, by the way, ordered an MRI for me next month) a few basic questions.
Q: What does a physician look for in an MRI if the patient is currently on one of the ABC (Avonex, Betaseron, Copaxone) MS drug therapies?
A: I look for new lesions in white matter, enhancing fresh lesions, global atrophy (shrinkage), or atrophy of the corpus callosum.
Q: If your patient's MRI shows little difference from year to year, why do one?
A: Serial studies of brain MRIs have shown new lesions despite the patient or the physician seeing no new signs or symptoms. The MRI is the only real "window" to disease activity.
Q: Does MRI activity (plaque, lesions) always mean new disability?
A: T1-weighted lesions correlate best with clinical disability. T2 lesions are nonspecific. Enhancing lesions, after injection of contrast material, correlate best with new disease.
I truly try to keep up and read about T cells, MRI, and disability. But all I know from what I've read (at my level of neurologic understanding) is that MRI is an objective record of what is happening in our bodies. I let my neurologist interpret the data and try to give him my accurate clinical information. He uses all of this information to help me decide how to take care of my disease.
It reminds me of teaching piano. Sometimes I ask students questions about musical terms: What does presto mean? (Play fast.) How many sharps or flats does the key of G have? (One, F#.) But that's only part of their lesson; my evaluation of their progress is just as important. Each week they come, I test them. By having them play, I figure out how well they're doing as a whole.
This might be a simplistic comparison, but it holds true. Just like my piano students don't enjoy being tested, I similarly hate the MRI test. But I have one every time it's requested because MRI is a critical part of seeing the whole picture and managing MS. I might not understand MRI, but I trust that it offers neurologists a better understanding of MS. We need both objective data (MRI) and subjective data (a patient's feedback of their MS).
So, if your physician suggests an MRI, you might ask her or him to explain why it's necessary. Down the road, we'll be tested with more advanced diagnostic tests that will show how medications work in our bodies, as well as provide other important clinical information. Good luck!
Editor's note: Yearly MRIs to monitor disease activity is a controversial
issue, and standards are not yet set. There are some preferences among
practitioners, but these are not yet formally endorsed.
© 2002, Real Living with Multiple Sclerosis