Thinking Inside the Box: Do You MRI Every Year?

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.

Those of us who responded had all stopped getting MRIs some time ago. We discovered that our scans generally did not correlate with our MS symptoms.

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

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. More Than Meets the Eye: The promises and pitfalls of MRI imaging in multiple sclerosis, by Ingfei Chen, 3 April 2012, Multiple Sclerosis Discover Forum. www.msdiscovery.org/
  2. Can we overcome the 'clinico-radiological paradox' in multiple sclerosis? By Hackmack K, Weygandt M, Wuerfel J, Pfueller CF, Bellmann-Strobl J, Paul F, Haynes JD. J Neurol. 2012 Oct; Epub 2012 Mar 24. www.ncbi.nlm.nih.gov/pubmed/22446893

Comments

View Comments (5)
  • Carol
    2 years ago

    My neurologist used to have me do MRI once a year, but now I get one every six months, yuck. I asked him if I was worse or more lesions, no comment, sigh. Sometimes, neurologist will talk to me at other times he is very distant.

  • Sue
    2 years ago

    My brain scans never show enhancing lesions or much damage in the last 15 years. I just had numbness and today I need assistance to walk15 feet with a walker. But, always a qualifier, the scans of the cervical spine show continuing demyelination..

  • swampdoctor dave
    2 years ago

    another excellent analysis of the conundrum of what does an MRI really do for us? Do we really need one or do we just want to have one to see what is going on. Kim, thank you for your excellent writing and all the research you put into you articles (or are you just making all this stuff up?!)

  • FIGHTBACK
    2 years ago

    I gave up on MRIs many years ago because they did not correlate with my symptoms. In the past few years I have seen a couple of members of my self help group have their neurologists order changes to their disease modifying therapy because of one new lesion but no new symptoms. For one of these people the change in treatment was quickly followed by optic neuritis which has not totally cleared up after 18 months. I worry about over reaction to MRI results.

  • skcullers
    3 years ago

    My Stanford brainiac neurologist explained to me that some have allot of activity shown on their MRI with minimal symptoms and other little and terrible symptoms . I haven’t had one in 5 years.

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