MRI is one of the cornerstones of multiple sclerosis (MS) management, fulfilling diverse roles such as:

• Initial diagnosis in conjunction with clinical evidence;also diagnosis of flares. Especially in the presence of clinical findings suggestive of MS, positive MRI studies provide confirmatory and prognostic evidence.
• Following disease progression—Enhanced MRI detects new disease activity seven times more frequently than does merely monitoring clinical events and twice as often as unenhanced MRI in patients with relapsing-remitting or secondary-progressive MS.
• Assessing the efficacy of the current therapeutic options, MRI documents disease activity and lesion loads in patients.

MRI techniques are an important tool used to confirm the presence of the disease and also to exclude other conditions that may mimic MS, for example, systemic lupus erythematosus, migraines, Lyme disease, acute disseminated encephalomyelitis, metastases or brain abscesses. The sensitivity of MRI in the context of MS is such that many clinicians will refrain from making an initial diagnosis of MS if the MRI is normal even if clinical findings suggest the disease.

Several MRI techniques are employed in the management of MS in addition to classic protocols including diffusion imaging, T2 relaxation analysis, proton spectroscopy, FLAIR sequences and magnetization transfer. Some of these techniques utilize contrast agents such as MAGNEVIST® (gadopentetate dimeglumine) injection, while others involve unenhanced imaging.

At present, MS is thought to be a progressive disease but it is difficult to predict which patients will experience rapid debilitation versus those whose clinical course is more favorable. MRI activity may correlate with long-term disability and MRI studies suggest that patients with high initial lesion loads tend to have more rapidly progressive disease clinically and pathologically than do those presenting with lower lesion loads. MRI can be used to help monitor long-term response to MS therapies.

It is important for clinicians to determine which patients are more likely to have progressive conditions since early aggressive treatment may help prevent the development of severe neurologic disabilities.

The exact relationship between MRI findings and the clinical status of patients is not completely understood.

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