Q. My recent MRI taken for multiple sclerosis shows no new lesion. Is this a good sign?

Answered by
Dr. Ardit Tela
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Jul 11, 2019

Hello doctor,

I am a 34-years-old female. Last year I was diagnosed with MS. I had an MRI scan with the contract last year, which showed up lesions in the brain and two were active at that time. I had another MRI last week and got my results today. It shows no new lesions or activity also the lesions I had have shrunken. Is this a good sign? I read if lesions heal, that means the MS is progressing is this right? I have had dizziness for over a year, and it is not going away. I cannot understand it as I have no active lesions, and the ones I did have are healing.

Dr. Ardit Tela



Welcome to icliniq.com.

I have read your question carefully, and I will try to give you a detailed answer.

There are several types of multiple sclerosis, more precisely four,

1. The first type is the commonest one, relapsing-remitting, with temporary periods of exacerbation and feeling well between attacks.

2. The second type is secondary progressing, which means that after some time in the first type, the lesions could get the transition in the second type, where symptoms worsen gradually.

3. The third type is not so common, primary progressive when from the beginning, patients have slowly worsening symptoms.

4. The rarest type, progressive relapsing, with slowly worsening symptoms, accompanied by acute exacerbation, with no remission.

So, periodic clinical and imaging evaluation should classify the type. In general, conventional MRI measures do not fully correlate with clinical standards. Said, someone might have more lesions in MRI and feel better than someone who has fewer lesions. In current medical practice, MRI features that correlate more to progression are, accelerated brain volume loss (atrophy), the formation of black holes (permanent damage of axons), which indicates more degeneration. About half of them will go away, providing the sign remyelination. When they remain, it is a sign of permanent scarring. I hope I was clear in my answer. Feel free to ask further questions any time.

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Thank you doctor,

I was diagnosed with relapsing-remitting, MS. I read that if lesions shrink, it could mean that the disease is progressing. I was so happy when I got told the results today now I am unsure since I read that.

Dr. Ardit Tela



Welcome back to icliniq.com.

There is a study where atrophied lesions could be related to neurodegeneration, hence disability and progression. And the research was done with a powerful MRI machine (3T) that is not possessed and used regularly in everyday clinical practice. But, atrophied brain lesions are very distinct from other disappearing and shrinking lesions, described in your case, which may be related to the beneficial repair. So, I would not worry about your results.

However, if you still feel in doubt, I recommend consulting your (neuro) radiologist for a more detailed explanation of your MRI scan. My second (more friendly) recommendation is that google search is very beneficial and trustworthy for more common health problems. I do not recommend any specific issues, especially new studies, where the interpretation of results and terminology is not so easy to understand and use for non-healthcare professionals. It may lead to misunderstanding and unnecessary stress and concern. I hope I answered your question.

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