Bringing Imaging to Bear Against Multiple Sclerosis

Neuroradiology plays an increasingly important role in the evaluation and treatment of patients with Multiple Sclerosis (MS), a disease that affects an estimated 2.1 million people worldwide.

UCSF neuroradiologists work closely with the neurologists in the UCSF Multiple Sclerosis Center to achieve the best possible care for patients with MS.  Our neurologists are world renowned for their diagnostic and therapeutic skills in caring for patients with inflammatory brain diseases, for being on the cutting edge of treatment, and for their tightly integrated clinical and research enterprises.  UCSF neuroradiologists also play a key role in the care of patients with MS because the assessment of disease status is not based solely upon clinical evaluation.

Despite many years of research, the causes of MS remain poorly understood. It is recognized that the anatomic effects of the disease and the impact of these changes on brain function are tightly coupled.  Imaging, when performed correctly, can provide critical information about disease activity to complement clinical assessments.  Our imaging protocols use high-resolution, three-dimensional MRI techniques that can be reformatted in multiple planes in order to accurately depict changes in the brain associated with MS and to determine whether the disease is active or dormant.

Neurologic deficits in MS are characteristically separated in both time and in space. This means that there must be more than one separate episode of symptoms over time, and that symptoms must not correspond to disease activity in the same area of the brain. Imaging is an essential tool for the initial diagnosis of MS as it can show lesions of varying ages and in different brain locations, thus establishing the diagnosis by showing that the abnormalities span both time and space.

Neuroradiologists also perform an important part in monitoring the disease once a patient is on medication.  Often patients experience fewer symptoms in the course of their disease after appropriate treatment has been instituted.  While patients may not have attacks when they are on medication, imaging may still show significant but clinically silent progression of the disease. The information from imaging can lead treating neurologists to consider different strategies for disease management.

While the brain is the primary target of MS, any portion of the central nervous system can be affected by MS, including the optic nerves and the spinal cord.  Some patients have symptoms in these structures that may be mistaken for brain disease. UCSF neuroradiologists can provide clarification by using imaging protocols that are designed to help identify disease outside as well as inside of the brain.