What Are the Different Types of MRIs Used for Multiple Sclerosis?

Magnetic resonance imaging (MRI) is one of the most important and most commonly used tools for diagnosing and monitoring multiple sclerosis (MS). It is non-invasive and uses magnetic fields and radio waves to get sensitive images of the brain, spinal cord, and other areas of the body.¹

A person with MS will likely have many different types of MRIs over the course of the disease. During the diagnosis phase of MS, a doctor may order an MRI of the brain, cervical spine, and thoracic spine, both with and without contrast. Follow-up MRIs can be any combination of these and other types of MRIs. It can be hard to keep track of what they all mean and why your doctor may be ordering a certain type of MRI.¹

What is a contrast MRI and why is it used?

In a contrast MRI, an agent called gadolinium is injected in the vein. The contrast MRI is used to look for areas of active inflammation. These areas will show up as bright on the MRI when contrast is used. An MRI without contrast will show dark areas that may be areas of permanent damage.²

Doctors use contrast and non-contrast MRIs initially to confirm a diagnosis of MS. It is especially important for people who may be experiencing their first attack. Early diagnosis and treatment may delay progression and produce better long-term results. During the course of the disease, both contrast and non-contrast MRIs are used to track disease progression and monitor whether treatments are working.³

There are some risks associated with contrast agents, so you should discuss any safety concerns with your doctor.

What is a c-spine or t-spine MRI?

A cervical spine MRI, also known as c-spine MRI, shows an image of the cervical spine. This area starts at the base of the neck and connects to the thoracic area. A thoracic spine MRI, or t-spine MRI, shows an image of the thoracic spine. This area extends from the bottom of the neck down to the chest area. About 50 to 90 percent of people with MS have lesions present on the spinal cord.¹

When should I be getting MRIs?

Although each case of MS is unique, there are some guidelines and best practices for doctors to follow on when to order MRIs.^1,3

Initial diagnosis

An MRI is needed to establish diagnosis of MS as a baseline for treatment. This MRI includes the brain, c-spine, and t-spine, with and without contrast.

On disease-modifying treatment (DMT)

A baseline MRI is needed before treatment, and follow-up MRIs are needed to ensure treatment is still effective. When switching to a new DMT, this process should be repeated.

• Before starting DMT: Brain, c-spine, and t-spine, with and without contrast
• 3-6 months after starting DMT treatment: Brain MRI, with and without contrast; spine MRI, if person has initial spine activity
• Every 6-12 months while on DMT: Brain MRI, with and without contrast; spine MRI, if person has spinal activity

Stable disease

MRIs are used to monitor disease activity and progression.

• Every year: Brain MRI, with and without contrast; spine MRI, if person has spinal activity
• Every 2 years: Brain MRI, contrast optional; spine MRI, regardless of initial spinal activity

These are not all of the times or reasons that your doctor may order an MRI during your treatment for MS. If you have a question about why a certain MRI has been ordered, your doctor will be your best source of information.