As a multiple sclerosis patient, you will have many MRIs (magnetic resonance imaging) in your lifetime. There are the MRIs that lead up to a diagnosis, the MRIs that monitor disease activity, and the MRIs that check for drug effectiveness.
An international group of neurologists and radiologists have developed revised guidelines for standardized brain and spinal cord MRIs for the diagnosis and follow-up of multiple sclerosis. An important component of the MS protocol is the use of gadolinium, a contrast agent injected into a vein that accentuates active inflammation.
New MRI guidelines for MS
- A standardized brain MRI protocol with gadolinium is recommended for the diagnosis of MS.
- A spinal cord MRI is additionally recommended if the brain MRI is non-diagnostic, or if the presenting symptoms are at the level of the spinal cord.
- A follow-up brain MRI with gadolinium is recommended to demonstrate dissemination in time and ongoing clinically silent disease activity while on treatment, to evaluate unexpected clinical worsening, to re-assess the original diagnosis, and as a new baseline prior to starting or modifying therapy.
- A routine brain MRI should be considered every six months to two years for all patients with relapsing MS.
- The standardized brain MRI protocol includes 3D T1-weighted, 3D T2-FLAIR (fluid attenuated inversion recovery), 3D T2-weighted, post single-dose gadolinium-enhanced T1-weighted, and a diffusion-weighted sequence.
- A simplified progressive multifocal leukoencephalopathy (PML) surveillance protocol includes fluid attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) sequences only.
- The spinal cord MRI protocol includes sagittal T1-weighted and proton density, short time inversion recovery (STIR) or phase sensitive inversion recovery (PSIR), axial T2- or T2*-weighted through suspicious lesions, and, in some cases, post-contrast gadolinium-enhanced T1-weighted imaging.
- The clinical question being addressed should be provided in the requisition for the MRI.
- The radiology report should be descriptive with results referenced to previous studies. MRI studies should be permanently retained and available.
Dangers of gadolinium
Reported by ProPublica, patients who have undergone MRI with contrast have been experiencing concerning side-effects, such as cognitive effects. It is known that patients with impaired kidney function who are unable to excrete gadolinium should avoid contrast agents. However, three recent studies reveal that even patients with healthy kidneys are retaining traces of gadolinium, a potentially toxic metal, in different parts of the body.
Of the nine gadolinium-based contrast agents sold in the US, Omniscan and Magnevist are the ones causing problems. Radiologists are encouraged to change their prescribing habits, rather than stop using contrast agents because of their proven benefits to patients.
In a statement, an FDA spokesperson said the agency is “carefully reviewing” the new studies to “better understand the potential consequences to determine what further action is needed, which may include taking steps to ensure the public is aware of these preliminary findings.”
My experience with gadolinium
Do you know what brand of gadolinium your MRI center uses? I have to admit that I do not.
There was one time that the gadolinium leaked from out of my vein into my arm. It didn’t really hurt much at the time, but later that evening my arm was in pain. I finally called the MRI center and described my symptoms. Now I know that gadolinium hardens if it gets into your tissue.
The MRI center suggested that I use a heating pad to help ‘liquify’ the contrast so that it could disperse more easily. They also suggested that I should not wait so long before calling when there are problems. Now I know.
More helpful information:
2015 Revised CMSC MRI Protocol and Guidelines. CMSC website. April 6, 2015.
Gerth, J. Left in the Brain: Potentially Toxic Residue from MRI Drugs. ProPublica. June 11, 2015.
Hocter, J. Problems with ‘picture juice’? Gadolinium contrast deposits raise concerns. Health Imaging. March 30, 2015.