Brain Atrophy

While in Barcelona, I was lucky to hear Dr. Frederik Barkhof speak about medical imaging in relation to MS and the topic of brain atrophy.

Dr. Barkhof is a professor in Neuroradiology in Vrije University Medical Centre, Amsterdam. During his presentation it was mentioned that there is an increasing focus being placed on the link between inflammation and neurodegeneration. Brain volume loss happens to everybody over time as part of the natural ageing process, with typical brain volume loss happening at a rate of .2% to .4% per year for a ‘healthy’ person. For someone with MS this increases to .5% or even 1% per year. With debilitating conditions, the more a person is effected by brain atrophy, the worse their level of disability is likely to be. During later stages of MS ventricles widen, lesions darken, axons collapse and the brain shrinks in size. This can be monitored through MRI, and brain volume loss can be seen over time. It was said that damage to neurons and axons happens early in MS, but that early treatment could help prevent this. 

Imaging is becoming more and more important in monitoring MS progression. I think this is great advancement. For me, having an MRI done is not invasive. I don’t mind having them done, the noise used to bother me a little, but I have come to know the sounds and knowing that this process is helping me gives me comfort. I was a little taken aback recently when I went for my routine MRI and was informed that the scans had been decreased from 5 to 2 and that the contrast enhanced scan using gadolinium was not being performed. Gadolinium was routinely used during MRI’s as the contrast enhanced element of the scan made active lesions ‘glow’.  It made them easier to spot upon inspection of the MRI. I spoke with my neurologist about this recently and I was told that acitivity could still be monitored by measuring the lesions and looking at past scans to see any changes. A fair point I thought! But my concern is; What if a lesion becomes active again? One that was already there that may not have changed in its margins. An old lesion that has become active again is surely a possibility and issue? As far as I know gadolinium will still be used in some of my scans, just not as frequently as it has been used up to now.

Have any of you had your scans decreased in frequency or number?

At a time when more emphasis is being placed on the importance of MRI monitoring, I just can’t understand why they are being cut down.