MS activity appears on an MRI scan as either bright or dark spots. Typical MS lesions tend to be oval or frame shaped. MS lesions can appear in both the brain's white and gray matter. Healthcare professionals may use a chemical contrast dye called gadolinium to improve the brightness of MRI scan images.
Several types of MRI scans can be useful for detecting specific forms of MS lesions. The ones most commonly used in clinical practice include T1-weighted scans that detect active inflammatory lesions, and T2-weighted scans, which detect both old and active lesions (the total lesion load).
T2 MRI sequences are used to highlight areas of demyelination, which happens when the outer layer of the neurons is damaged due to MS activity. T2 sequences can be used to count the total number of MS lesions, which look like bright white spots on T2 sequences, and can be called “hyperintense”.
When a damaged nerve “short circuits,” it can cause a sharp pain or a burning or squeezing sensation. A common pain in MS is what's known as Lhermitte's sign. “This occurs when there's a lesion on the cervical spine, the neck area of the spinal cord,” says Dr. Scherz.
MS-related lesions appear on MRI images as either bright or dark spots, depending on the type of MRI scan. This imaging technique is useful because it shows active inflammation and helps doctors determine the age of the lesions. Also, some specific types of lesions can indicate a flare-up of MS or damage in the brain.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
Most symptoms develop abruptly, within hours or days. These attacks or relapses of MS typically reach their peak within a few days at most and then resolve slowly over the next several days or weeks so that a typical relapse will be symptomatic for about eight weeks from onset to recovery. Resolution is often complete.
Active or not active is used in all types of MS to describe whether or not you're having relapses and/or if new lesions can be seen on an MRI scan. For instance, if you have RRMS and you're experiencing relapses, your MS would be considered active.
An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.
Contrast agents like gadolinium are typically used to detect areas of active multiple sclerosis (MS) driving inflammation on MRI scans. However, contrast agents are not needed for scans that detect any MS lesions (actively inflamed or not), so it is possible to diagnose MS without the use of these agents.
In MS, the word lesion refers to an area of damage or scarring (sclerosis) in the central nervous system. Lesions are sometimes also called plaques. They are thought to be caused by inflammation that results from the immune system attacking the myelin sheath around nerves.
MRI plays a vital role in how we diagnose and monitor MS. In fact, over 90% of people have their MS diagnosis confirmed by MRI.
Meaning Behind an MS Lesion That "Lights Up"
If a lesion on the MRI lights up, it means that active inflammation has occurred usually within the last two to three months.
To figure out if disease is progressing, doctors use a scale called the Expanded Disability Status Scale (EDSS). The EDSS is a way of measuring physical disability. Two-thirds of those with MS will not progress past level 6 on the EDSS.
Active lesions are located close to the gingival margin when the lesion is in a smooth surface. Inactive lesions are located farther away from the gingival margin when the lesion is in a smooth surface.
Sjogren's syndrome is an autoimmune disease that can mimic some of the symptoms of MS such as fatigue and joint pain.
Multiple sclerosis lesions can occur in any portion of the cerebellar white matter and peduncles, frequently involving the middle and superior cerebellar peduncles (Fig. 3).
Context. Progressive myelopathy can be a manifestation of a variety of disorders including progressive multiple sclerosis. However it is extremely uncommon for a single lesion to cause a progressive myelopathy in MS.
MS lesions developed preferentially in the supratentorial brain, particularly the frontal lobe and the sublobar region.
The term benign MS is sometimes used to describe a version of relapsing remitting MS with very mild or no attacks separated by long periods with no symptoms. 'Benign' means 'something doesn't cause any harm'.
“Fulminate MS” is a rapidly progressive disease course with severe relapses within five years after diagnosis; also known as “malignant MS” or “Marburg MS,” this form of very active MS may need to be treated more aggressively than other forms.
People with MS can benefit from at least 30 minutes of physical activity at least three days a week. For someone with MS , exercise that's too aggressive can bring on severe fatigue and injury and exacerbate symptoms.
In MS, the term lesion refers to an area of damage or scarring in the central nervous system. Lesions are caused by inflammation or the immune system attacking the myelin sheath on nerves in the brain, spinal cord or optic nerve.
When the first MRI does not meet diagnostic criteria, a repeat MRI every 6 months is recommended; Spinal cord MRI is not recommended for routine follow-up, although it's still crucial in making the initial diagnosis, as it provides important prognostic information.