Exclusive Content

When symptoms change and you live with multiple sclerosis, an MRI often feels like the moment when everything is finally going to become clear. In reality, the scan is only part of the story.

After my symptoms continued to escalate, I went in for MRI imaging of both my brain and cervical spine. I have been getting MRIs for more than 20 years, so the process was familiar. Even so, familiarity does not make it pleasant. The first step was changing clothes. They even gave me paper pants. That may sound excessive, but MRI safety rules are strict for a reason. MRI scanners use powerful magnets, so patients are generally asked to remove metal objects and often change into a gown or facility-provided clothing because everyday items, including some zippers, fasteners, and even certain fabrics, may contain metal.

That is one of the first practical lessons for patients. Do not treat MRI prep casually. Wear simple clothing, expect to change, and answer the screening questions carefully. The safety portion of the appointment is not just routine paperwork. It matters. One thing I have noticed over the years is that MRI studies seem faster than they used to be. What once felt like an hour now seems closer to 30 minutes. That may not be true for every scan and every facility, but it was noticeable to me.

Even when the scan is shorter, it is still claustrophobic. You are lying still inside a narrow tube while the machine bangs, thumps, and pulses around you. If you are prone to claustrophobia or anxiety, it is worth telling the imaging center in advance. Some patients may benefit from extra support or a mild sedative prescribed ahead of time. For me, the only real option was to power through.

That brings me to the second lesson. Once the scan starts, do your best not to move. Do not twitch. Do not scratch an itch. Do not adjust unless the technologist tells you to. Movement can blur the images and force repeat sequences, which can lengthen the study and keep you in the tube longer.

About halfway through my exam, they injected gadolinium contrast through an IV. In MRI, gadolinium-based contrast is used to make certain findings stand out more clearly. In the MS world, contrast can help show areas of active inflammation or disease activity. That is the third lesson. If your doctor orders MRI with contrast, ask why. In many cases, there is a very good reason. But patients should understand what the contrast is for, and they should make sure their team knows about any kidney issues or other major health concerns beforehand.

When the scan ended, I did not get immediate answers. That is another thing patients should understand going in. MRI results are often not given to you on the spot. The scan has to be read, interpreted, and then communicated back through the ordering provider. So I waited for the call from my neurologist. When he called, his first reaction was that everything looked stable. If I had accepted that statement at face value, the conversation would have ended there. But I knew something was wrong, so I asked him specifically about my neck. That changed the discussion.

He asked whether I was concerned about the structure of my neck or MS activity. I told him both. Once he reviewed the cervical findings more closely, he noted that the stenosis at C4 and C5 had progressed from moderate to severe. That moment was important, and it is the main lesson I want readers to take from this experience: an MRI can give you information, but you still have to ask the right questions.

My neurologist was doing what neurologists often do. He was primarily looking for MS activity. That makes sense. It is his lane. But my concern was broader. I was dealing with structural neck pain, worsening hand dysfunction, and a history of cervical issues in addition to MS. I had to remind him that my question was not only, “Is my MS active?” It was also, “What is happening structurally?” Once that became clear, the next steps changed. He ordered an EMG nerve conduction study and told me to get on my neurosurgeon’s schedule.

That is the fourth lesson. When you live with MS and another chronic or structural condition, do not assume one specialist is automatically evaluating every angle. Neurologists may focus on demyelinating disease. Neurosurgeons may focus on structure. Primary care may focus on urgency and referral. The patient often has to connect the dots.

That does not mean you need to be adversarial. It does mean you need to be specific. If you are going in for an MRI and waiting on results, here is what I would suggest.

• Before the scan, follow the prep instructions carefully and disclose implants, devices, prior surgeries, and anything metal-related.
• During the scan, stay as still as possible and tell the staff ahead of time if claustrophobia is a problem.
• If contrast is ordered, understand why it is being used and make sure your team knows your medical history.
• When the results come back, do not settle for a broad statement like “everything is stable” if your symptoms tell you otherwise. Ask whether the provider is referring to MS activity, structure, or both.

The MRI did not show new MS activity, but it did show structural progression in my neck. That distinction mattered. It changed the plan. And it led directly to the next step: an EMG nerve conduction study and a return to my neurosurgeon.