MRIs use strong magnets and radio waves to create images of internal structures of the body. An MRI scan of your brain and spinal cord can reveal the lesions, or areas where the myelin that normally protects nerve fibers has been damaged, that are typical of MS. Over time, repeat MRIs show your doctor whether you have developed additional lesions and whether existing lesions have enlarged or otherwise changed. Most healthcare professionals recommend that people with MS receive annual MRIs to track progression and assist in treatment decisions. Evidence of new or growing lesions, for example, may indicate that a change in treatment is needed.
Before You Get an MRI: Safety Issues
Before you get an MRI, you and your doctor need to make sure this type of scanning is safe for you. The powerful magnets used in an MRI machine mean that metallic items, including some implanted items and devices, need to be kept out of the scanning area. If you have a pacemaker, cochlear implant, or some other device in your body, you may not be able to have an MRI, or the test may need to be modified in some way. Such issues should be discussed before you schedule the exam. As part of your safety discussion, you should let your doctor and the MRI technician know if you have any tattoos. While not all tattoos rule out having an MRI, tattoo inks that contain metal such as iron can heat up and cause burns during an MRI. This is of particular concern if a tattoo is located near the eyes, but any burn causes pain and discomfort. A tattoo located over the body area being scanned can also distort the image, making it difficult or impossible to interpret. Again, this is an issue that should be discussed ahead of time. If you are pregnant, you may be advised to delay getting an MRI. Scans are generally not done during the first trimester and are only done during the second or third trimesters if the benefits appear to outweigh the risks. Historically, people with MS or suspected MS have often been injected with a contrast agent (sometimes referred to as a “dye”) containing the chemical element gadolinium prior to an MRI. The gadolinium was used to help identify active inflammation in the brain. Some people experience a headache, nausea, or dizziness for a brief time after the injection. A study published online on March 12, 2019, in the journal Radiology (and in print in the April issue) suggests that MRIs performed in 3T MRI machines without the use of the contrast agent are just as effective at monitoring MS progression as those in which gadolinium is used. In general, recent advances in noncontrast MRI technology, including 3T systems, have made gadolinium-free scans a more viable option. With or without contrast, during the scan, you’ll lie on a narrow table that is slid into the opening at the center of the tube-shaped MRI machine. You’ll be instructed to lie still, because movement can blur the images. An MRI can take anywhere from 15 to 90 minutes, depending on what body area is being scanned and how many images are taken.
Sidestepping Anxiety and Claustrophobia
The confined space and often dark environment in older MRI scanners often cause feelings of claustrophobia. Newer machines tend to have larger openings and better lighting, and the tube itself is open on both ends, helping to reduce claustrophobia. But even with the latest equipment, an MRI can cause anxiety. What can improve the experience?
1. Take a Sedative, if Needed
“The calmer you are and the less you move around, the quicker you get in, and the quicker you get out,” says Matt Gonzales, who was diagnosed with multiple sclerosis in 2010 at age 20 and blogs under the name Matt Allen G. Because he has an “aggressive” form of MS, he says, he’s been through countless MRIs. He particularly remembers the anxiety over his first MRI, because he has mild claustrophobia. “They offered me a sedative, but I’m stubborn, so I didn’t take it,” he says. He prefers to focus on relaxing, staying still, and getting the test done as quickly as possible. According to Lorenza Clausen, a radiologic technologist at Dignity Health Mercy Methodist Hospital of Sacramento, taking a sedative is an option if MRIs make you very nervous. But she advises you to speak to your doctor before your MRI if you feel you need a sedative to get through the scan. Keep in mind that if you take a sedative, you will not be able to drive immediately after your MRI and will need to arrange for a ride home. Plus, sedatives may interact with other medications you’re taking or cause other health complications, Clausen adds.
2. Block the Noise
An MRI is a loud experience. Gonzales compares the bangs and buzzes of the machine to a construction site. While he doesn’t mind the noise, many people do. If you’re worried about the noise, Clausen suggests asking the MRI facility for earplugs made of foam or silicone, or for noise-canceling headphones. Regular commercial headphones cannot be worn during an MRI, she says, but some MRI facilities have noise-canceling headphones you can wear during your scan. Some facilities offer the option of listening to music during your scan, and you may even be able to bring your own music on a CD, MP3 player, iPod, or other device. If you wish to bring your own music, ask whether the center can accommodate that when you schedule your MRI.
3. Close Your Eyes and Visualize
“If patients are claustrophobic, I advise them to keep their eyes closed, because if you open them, you see yourself in the machine,” says Zulma Hernandez-Peraza, MD, a neurologist at the University of Illinois Hospital in Chicago. While your eyes are closed, it can help to visualize yourself in pleasant surroundings, such as a beach, forest glade, or any other place you associate with feeling happy and calm. Some MRI scanners have a small mirror positioned over your eyes so that you can see out of the tube. For some people, this also helps with claustrophobia.
4. Bring a Friend
Having a friend or family member with you in the room can be helpful, says Clausen. That person will also need to leave any metal items and clothes with metal parts outside the room, and anyone with a cardiac pacemaker cannot be in the room during an MRI. Generally, your friend can sit or stand next to the MRI table during the scan. “Patients often see a benefit in having a spouse, relative, or friend with them at the appointment,” Clausen notes. “They can be allowed to accompany the patient into the room to sit nearby, hold their hand, or lay a hand on their leg if facility policy allows. The person accompanying the patient into the room will have to complete a screening form and not have any contraindications to MRI. Even though they are not in the scanner being examined, the fact that they enter the room makes it unsafe if they have a pacemaker or other implant. They will also be required to empty all items out of pockets and leave their valuables outside the scanner.” Children should always have a parent or other caretaker with them during an MRI.
5. Talk to the Technician
Although the technician isn’t there to chat, you can certainly reach out if you’re feeling uncomfortable or anxious during the test. The MRI machine will have both a microphone and a speaker inside it. “Technologists should be speaking to you before and after every series of pictures,” Clausen says. “Three or four minutes for a series can seem like a long time. The exam should pause between each series to allow the technologist to check in with you.” According to Clausen, most MRI machines feature “a call button in the form of a squeeze ball” you can use to call the technologist if you’re not feeling well or are getting anxious. “But you shouldn’t try to talk during the series or when the noise is on, as you may move involuntarily,” Clausen emphasizes. “It’s very important to not move during imaging.” Additional reporting by Brian P. Dunleavy.
