MRI: Magnetic Resonance Imaging AKA the procedure wherein many non-claustrophobic people find out what claustrophobia kinda feels like. MRI is an important tool in diagnosing Multiple Sclerosis and in monitoring disease progression. Last week I underwent the least stressful MRI that I have ever experienced (thanks Ativan!). What is MRI for Multiple Sclerosis?
Depending on your disease activity and medication you are probably being scanned anywhere from every 6 months to every 2 years. How does the MRI work and what does it teach us? Today we are discussing traditional MRI for Multiple Sclerosis.
How It Works And What It Reveals
MRI works by realigning molecules in the body using powerful magnetic fields which are then measured and recorded by radio frequency fields.
When an MS relapse or exacerbation occurs, the blood-brain barrier has been weakened, allowing the immune system to attack the central nervous system. If an exacerbation has happened recently, the still-weakened barrier will also allow contrast agents to pass through. Because contrast fluid shows up very brightly in new areas of damage, MRI can distinguish new damage from old damage.
MRI records the scanned area in 3-D which allows us to see exactly where damage has occurred and how much of the brain is scarred. While much is still unknown about how we are affected by location of lesions, and many lesions cause no symptoms at all, we do know some things. Certain parts of the brain do tend to affect specific parts of the body. Therefore, a lesion in a specific area of the brain can often be identified as the cause of a symptom in the correlating area of ability.
We also know that brain atrophy is a part of living with Multiple Sclerosis. MRI measures this as well. Check out this graphic to see the contrast between a healthy brain and brain scans showing atrophy related to MS.
What To Expect
Your MRI will usually occur at a hospital which will contact you with a proposed time for the appointment after your referral. Your referring doctor may prescribe something to keep you calm during the procedure. I highly recommend that you accept this medication as long as someone is available to drive you home. If you dislike taking medication, you can always abstain unless you find it too difficult to undergo the procedure.
When you arrive at the facility, check in. You will need to register (even if you have pre-registered over the phone) and you will need to fill in paperwork about your health history, any tattoos you may have (inks have contained metals in the past) and any metal that may be in your body. When it is time, you will be taken to a room to change into clothing provided by the facility for MRI. A locker will be assigned to you – leave absolutely everything in this including glasses, jewelry, etc. Nothing that may contain any metal is allowed inside the MRI room.
A companion is usually allowed to accompany you into the MRI room. Once inside the room, you can choose to use ear plugs to help dampen the noise inside the machine. You will lie down on a sliding tray and your head will be secured with a cage. Some facilities will cover you with a blanket and surround you with towels to help keep you still. The technician will run an IV into your arm if you are receiving contrast (contrast is typically used in MRI for MS). The technician will put a call button in your hand for you to use if you need assistance and will then slide you into the machine.
For brain scans, you will usually be confined within the machine from the waist up.
Usually the technician’s voice will be transmitted via speakers inside the machine – they may ask you if you are alright. Hold as still as possible for the duration of the procedure – movement can ruin the image. A brain scan takes less than an hour – about 3/4 of the procedure will be complete before you are removed from the machine briefly as the contrast agent is administered. The machine makes a variety of very loud sounds while it is in use.
How To Stay Calm
- First and foremost, be prepared. Have a plan of what to think about while inside the machine and control your thoughts. Plan to think about something you enjoy. Try to recite song lyrics to yourself, or recall stories word-for-word. Practice telling a story about something that makes you happy. The goal here is not to succeed in a memory exercise, but to distract your mind as much as possible.
- Close your eyes before they slide you into the machine and do not open them until you are fully out. If you open your eyes you will discover that they are astonishingly close to a wall. Bring an all-cloth sleeping mask if you are uncertain that you can keep your eyes closed.
- Having a friend or loved one in the room can be very soothing. They can provide physical contact with any part of you not inside the machine if you need reassurance.
- Some facilities can provide music to you during the procedure. I have never personally experienced this, but I would love the chance to. I’m certain that this would help.
- Drugs. I could not do it without drugs, but I am admittedly a claustrophobic in normal life. Many people do not expect to have trouble in an MRI and only discover that they are wrong when they undergo the procedure. My last MRI technician stated that about 1 in 8 patients daily unexpectedly panicked inside the machine. I recommend that you discuss this with your doctor so that you can receive a prescription for a couple of pills to keep you calm.
- Rhythmic, regular breathing. Try to control your breath – this will also help to keep you still.
While many of us will always have anxiety when faced with the machine, there is truly nothing to fear. The information you will gain from this procedure will help you arm yourself against the future.
MRI is an inescapable part of a Multiple Sclerosis diagnosis. It is important to find out what works for you as quickly as possible because I promise you will experience more than one.
How do you stay calm during an MRI?