Thinking Inside the Box: Do You MRI Every Year?
An online MS buddy with whom I post in a private group recently asked us all about MRI results. She wanted to know why her scans showed no explanation for her new muscle spasms, and asked us all to chime in about our own MRI experiences. Something interesting happened—and couldn’t have felt more natural.
What happened to our attitudes over the years? Did we become less concerned because our MS hasn’t been particularly active? That was true of some of us, but not all. Whether we spent years without a relapse—or endured steroids, hospitalizations and physical rehab after relapsing once a year—didn’t seem to matter all that much. Did we lose interest in MRIs because we slid into depressive apathy—or something much healthier?
Those in our group who stopped having annual MRIs denied experiencing depressive lassitude or any other kind of ennui that bore a negative connotation. Quite the contrary, as a matter of fact. Some remarked that leaving it to the Fates—giving up looking at MRI scans-- is not defeatist or neglectful, nor is it a form of denial. One perfectly valid reason to stop is to eliminate the stress of the procedure itself, waiting for the results, and worrying over the final interpretation. It can also be born out of experience and rational thought in the form of practicality—which includes cost and whether it fits your life style—as well as intuition, deep religious faith or abandonment of old life narratives, whimsy and impulsiveness—all peppered with a strong appreciation of irony.
Irony is a good place to begin. That lack of correlation between MRI lesions and clinical symptoms is known as the “clinico-radiological paradox.” A strong example of this phenomenon is a study done at Center for Neurological Imaging at Brigham and Women’s Hospital in Boston, based on a time-series analysis of 24 brain magnetic resonance imaging scans taken in a man with relapsing-remitting multiple sclerosis (RRMS) over 12 months . . . The time-lapse photography showing appearing and disappearing lesions is described as follows:
“Numerous abnormal bright spots blossom and grow or shrink, as if the disease is waging a fierce territorial war in the brain... yet during this 12-month period of scans taken every week or two, the man’s clinical presentation was stable.”
Several explanations can cover the reasons why, not the least descriptive of which is location. Many MRI studies use experimental machines with magnet strengths of 9T--60T, but it wasn't made clear whether the magnets were weaker commercial strength or stronger. At the higher strengths, cortical gray matter atrophy will reveal itself. Our diagnostic MRI magnets are mostly 1.5T with some 3Ts in health systems that have run the risk/benefit analysis and can foot the expense. Although a weaker magnet is still deemed sufficient for diagnostic and treatment purposes, we patients all soon realize that the full extent of cell damage and its prognostic relevance will likely stay locked away inside the CNS for the rest of our lives.
Those of us who jumped on the MS express train to oblivion and at some point preferred to ride in the car that has no windows might be the same hipsters that learned a thing or two from the Las Vegas tourism slogan: “What happens in Vegas stays in Vegas.”
If we think of the CNS as an oblong box containing the brain and spinal cord within which immune attacks and cell damage hang their hats alongside our dreams--and an MRI as a special glass that lets us see it--then the mere act of embracing that metaphor might be the gateway to losing interest in gawking at all the white and gray scenery in a vain effort to find answers before we step off the train and onto a gurney to the autopsy table. If I'm going to be a voyeur, I'd rather watch the late afternoon sun dip below the horizon.
Whatever happens in the box stays in the box. Dig it.1-2
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