Diagnosis

MRI in multiple sclerosis

introduction

Magnetic resonance tomography, in short MRI or Magnetic resonance imaging, the disease is multiple sclerosis (MS) always indicated as it is important to recognize the lesions and thus to be able to assess the severity of the disease. An MRI is magnetic resonance tomography, which is mainly used when soft structures such as muscles, fat or, for example, brain matter are to be assessed.

In the case of multiple sclerosis (MS), it is important to do an MRI, as this shows the areas in which the myelin sheaths have been destroyed due to the disease and thus an inflammatory process (Inflammation) formed. These inflammatory processes are called lesions. The more lesions a patient has, the more serious (more progressive) is the disease with him.

Diagnosis of MS in the MRI

The MRI is used to diagnose multiple sclerosis (MS). To be able to diagnose MS, this is MRI is usually the last but also a very important tool of choice. Previously, a Neurologist (Neurologist) had a long conversation with the patient (anamnese) and then various neurological tests are done to rule out the possibility that the diagnosis could be other than MS.
In addition, the patient Blood and / or liquor (Nerve water) removed. All of these tests can provide clues to MS, but a reliable diagnosis can best be made with the help of an MRI, as this is the best way to identify the lesions in the brain.

Early stage

In addition, the MRI is also very helpful in the early stages of MS because it recognizes almost all patients with MS what is neurological examinations or one Liquor puncture is not always the case. Thus, the MRI is very important to that Early stage diagnose MS.

In the early or early stages of multiple sclerosis (MS) it happens that individual Nerve fibers their protective covering, the so-called Lose myelin. This leads to an inflammatory process, which in turn attracts various messenger substances. This Inflammatory processes, which leads to an exposure of the central nerves, ensure that it becomes so-called Lesions in the brain (later also in Spinal cord), which can then be detected using the MRI.
In the early stages or early stages, multiple sclerosis (MS) is thus mainly detectable by MRI during Symptoms rarely occur at this stage and if only very unspecific. It is therefore important to have an MRI scan if multiple sclerosis is suspected, as there are noticeably high inflammatory parameters in either the CSF or the blood that could indicate the disease. The neurological examination is also mostly inconspicuous and could also be triggered by a harmless increase in reflexion.

Identify lesions

If MS is suspected, an MRI can provide additional confidence in the diagnosis.

Although the MRI examination is not necessarily one hundred percent reliable, it still offers the best chance of diagnosing MS in the early stages, since the lesions in the brain (possibly also in the spinal cord) also occur in other diseases or in the presence of degeneration, but together with the mild initial symptoms (initial stage) are a very important indicator for the diagnosis of multiple sclerosis.

MRI with contrast agent

In order to be able to see exactly what the lesions are, it is important that a MRI of the brain with the help of Contrast media (most of time Gadolinium) is made.
This contrast agent is injected into the patient's vein and it is then distributed throughout the body, including the brain. Here The contrast agent mainly accumulates in the areas of the brain that are particularly metabolically active.
As the lesions are MS in the brain, which are metabolically active areas caused by multiple sclerosis, a particularly large amount of contrast agent collects here. This can then be seen particularly well on the MRT image and thus the multiple sclerosis caused by the contrast agent in the MRT image can also be recognized much better than without the contrast agent.
In particular, the active (fresh) MS areas can be easily distinguished from old lesions (scarring) using the contrast agent.
However, since there are some patients who are allergic to contrast media, one can MRI image of the skull can also be made without contrast media.
Recently, there have been indications that too many contrast agent examinations could lead to accumulation in the brain.
Also read more on the topic: MRI with contrast agent

Symptoms / initial stage

The symptoms of multiple sclerosis are quite diverse and difficult to interpret, especially in the early stages. As the protective layer of the nerves is broken down, the symptoms often arise Problems with nerve conduction traced back. Sometimes the most common symptom in a patient suffering from multiple sclerosis is in the early stages strange feeling in your arms or legs. These sensory disturbances can manifest themselves as tingling or a lack of feeling in the arms or legs.

Another very common symptom, especially in early-stage young patients, is this Feeling of not being able to see properly. These visual disturbances usually manifest themselves when the patient complains that they have one Veil in front of the eyes (optic neuritis)as if looking through a frosted glass pane.
The visual disturbances can, however, also manifest themselves in the fact that the patient has difficulty looking into the distance or the patient can see objects in the vicinity less easily.
Therefore, in the early stages it is difficult to tell whether the symptoms are now referring to the multiple sclerosis or whether the patient simply has slight visual problems and needs glasses.

That's why it's so important, in addition to one patient suspected MS have an MRI scan to make because you here through the Lesions in the brain (in this case in the area of the Optic nerve) can then assess whether the visual disturbances could be attributed to multiple sclerosis.

The other symptoms are also rather unspecific and therefore difficult to assign to multiple sclerosis. On the one hand, the patient may notice that the Strength in muscles either decreases and the patient tired quickly or that it becomes a kind Spasticity comes when the muscles become very stiff. Additionally can Coordination problems and or Balance disorders occur. Sexual disorders are also possible, albeit rare.

Also problems with the bladder such as the constant feeling of having to go to the toilet or one Urinary incontinence, are rather rare. Some patients fail indistinct or slurred speech as if the patient was drunk and could no longer express himself properly. However, this symptom occurs quite rarely, and most importantly, it appears very rarely in the initial stages.

However, it often happens that the patient can no longer control the fingers precisely, for example, and thus it is difficult for him to guide the finger to the tip of the nose with his eyes closed, as this is a special one Fine motor skills which is often no longer possible in MS patients.

Besides these physical (somaticHowever, symptoms can also be a number of mental disorders, how depressions or in rare cases too aggressions, occur.

However, it is important to know that all of these symptoms are very general and alone do not constitute a clear diagnosis for multiple sclerosis.
It is much more important to deal with the symptoms MRI image of the head to compare. If a patient has visual disturbances, im MRI in the area of the visual pathway a lesion can be identified, which then causes the visual disturbance. If, on the other hand, a patient has problems with language, a lesion in the area of the language center should be visible on the MRI, which explains the language problems. Therefore, when the first symptoms appear, one multiple sclerosis the MRI Always the means of choice as evidence.