usefulness of follow-up MRI's in MS

[doublevision1]

Dr. Kantor:

I have a couple of questions re: MRI.

Could you please provide your view on the usefulness of MRI in multiple sclerosis, for monitoring of disease progression and monitoring of therapeutic response, post-diagnosis?

My MS Specialist has stated that he does not typically order follow-up MRI’s on any regular basis (ie: annually) once a patient’s MS diagnosis is confirmed.  He often states “I treat the patient and their symptoms, not their MRI.”  So unless I specifically request that he order an MRI for me (which he stated he would do), he will typically not do so unless there was some indication of my condition worsening and/or a poor response to my DMD (Copaxone).

I recently read in an MS textbook that follow-up MRI’s must be repeated exactly as previous ones were done, to be of any value in monitoring for disease progression and therapeutic response.  Would you agree?  If so, how can a patient ensure that this occurs?

Thank you for any insight you can share on this topic.

~doublevision1~

[Dr. Daniel Kantor, MD]

About the same MRI technique -- this is indeed preferrable but not always realistic. Of course you can use the same imaging center and remind the technicians that you have been scanned before.

With that said more of us are ordering 3 Tesla (3T) MRIs instead of the 1.5 Tesla (Tesla is the measure of magentic strength, named after Nikola Tesla in 1960) which does show more white spots than the 1.5T because it is a better, more detailed, picture.

[Dr. Daniel Kantor, MD]

Gadolinium is a heavy metal and therefore appears white on MRI. Triple dose gadolinium was picking up interest until people realized that since Gadolinium is a heavy metal in can be deposited in the skin and kidneys etc. in patients with kidney disease (because the Gadolinium is not cleared fully).

we are doing clinical trials of new, hopefully safer, forms of Gadolinium and all patients have their kidney function checked.

Gadolinium enhancement indicates an active MS lesion and is therefore useful in the diagnosis of MS and in established patients to look for MRI activity.

The reason for the statement above is that without new clinical activity, it is not clear what a Gadolinium enhancing means clinically -- but I do believe it is useful information (just like the discussion on yearly MRIs).

[Dr. Daniel Kantor, MD]

Your neurologist sounds very intelligent, receptive and thoughtful ... you are very lucky.

I have sat on consensus panels about this very topic, and the consensus is that there is no consensus. Some of us order MRIs frequently and some very infrequently. I do generally order MRIs yearly (if cost to the patient is not an issue) because I use it along with medication effects, symptoms, side effects etc. to guide therapy.

But remember that MS is treated very well in countries without many MRIs.

[doublevision1]

Thank you for your quick reply.  You are absolutely correct about my neurologist; he is excellent and I do feel very fortunate to be his patient.  

One more point of clarification needed that I forgot to include in my original post, is regarding the use of gadolinium in follow-up MRI’s.

The “Clinical Guidelines for Brain and Spinal Cord MRI in MS”, as per the “Consortium of MS Centers: MRI Protocol for the Diagnosis and Follow-up of MS” published in June 2003, states that for “Established MS”, gadolinium is ‘optional’ in baseline brain MRI.

Can you explain why the use of gadolinium would be recommended for suspected MS but only considered to be optional in an established diagnosis?  Would it not always provide useful information, in determining whether there is a breakdown of the blood-brain barrier / inflammation; and, to determine which lesions are active and which are inactive, at the time the MRI is done?

Regards,

~doublevision1~

[mg2107]

Is there a safe alternative to Gadolinium  contrast agent? This is a worry to me having repeated MRI s.

[mg2107]

Ditto the above.

[doublevision1]

Thanks again.  This is very good information, for all of us in the MS forum.  Much appreciated.