Do Ms Patients Always Have Lesions On Mri?

Question

Asked by tpwoods

Do Ms Patients Always Have Lesions On Mri?

Do MS patients always have brain lesions on an MRI scan? Can I be diagnosed with MS without lesions?

Answer

MRI is one of the best tools used to gather evidence to make a diagnosis of Multiple Sclerosis. When I had optic neuritis years before my MS diagnosis, inflammation was seen around the optic nerves but no demyelination (which is the causes of MS lesions).  See Beginner's Guide to MS: What is a Lesion?

Making a diagnosis of MS can be tricky and it truly depends upon the evidence (or lack of evidence) and the clinical signs of MS. The current criteria used to diagnose MS incorporates the use of MRIs to make an earlier diagnosis possible. See By What Criteria Were You Diagnosed with Multiple Sclerosis? and be sure to read Julie's comment.

As for me, my lesions have all been in my cervical spine. At diagnosis, I still did not have brain lesions. I hope that your neurologist had ordered an MRI with and without contrast for both your brain and neck at least.

Imagine just 30 years ago, there was no MRI testing and a diagnosis of MS came from observing clinical symptoms and eliminating other possibilities. It was truly a wait-and-see game.

Here is what the National MS Society says about diagnosing MS without the presence of lesions....

"Because MRI is particularly useful in detecting central nervous system demyelination, it is a powerful tool in helping to establish the diagnosis of MS. It should be remembered, however, that approximately 5% of patients with clinically definite MS do not show lesions on MRI at the time of diagnosis. Also, since many lesions seen on MRI may be in so-called "silent" areas of the brain, it is not always possible to make a specific correlation between what is seen on the MRI scan and the patient's clinical signs and symptoms. In addition, with advancing age (probably over age 50), there are often small areas seen on MRI in healthy people that resemble MS but are actually related to the aging process."

When searching for a diagnosis, it can be frustrating to not get answers or even to not have a name for something which we know is going on inside our bodies. Keep working with your physician and always be willing to get a second opinion.