Do I Really Need Another MRI?

Here is My Question:
Do I really need another MRI?
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Over past three years I have been followed by specialist and symptoms have been minimal: tingling, heat insensitivity and chronic fatigue for which I take mess. During this time I was also dx'd with optic atrophy from optic neuritis but again symptoms were subacute. I have had 3 Brain mris. First showed 4 nonspecific white matter changes, with second some had disappeared and with third I was told it was possible to count 8, still nonspecific but radiologist still reports as normal MRI. So now I have to have a 4th a year later. Is it worth it? I mean from point of view of expense as well as exposure to contrast- I have also had spine mris which showed nothing. Is there a real chance I could have MS or am I being followed from an excess of caution? Is another MRI the way to go or would you suggest other testing or nothing? I would really welcome your advice as I am feeling very unsure.

Answer:
​I can understand why you are perplexed. For instance, I would never tell a person with MS that they have “8 lesions” and then turn around and say their MRI is normal. It is possible for an MRI to display innumerable non-specific white matter hyperintensities but this would not be supportive of a diagnosis of MS. The ultimate question is why are your physicians obtaining MRI scans on a regular basis. It sounds as if they are not at all certain of the diagnosis. If this is the case, spinal fluid analysis is quite useful. This is done with a procedure called a lumbar puncture or “spinal tap.” 
If it is felt that your MRI has not shown any significant changes over 3 years (this is a big if), there is little reason to repeat MRIs frequently. My practice is to obtain monitoring MRIs at 6, 18 and 36 months then 5 and 10 years in people with symptoms and findings consistent with MS (such as your residual optic atrophy) but minimal evidence to support an active diagnosis. Clinical re-evaluations are done on a yearly basis and we move up an MRI scan if we believe the disease has become clinically active. I would never treat an individual without stronger evidence to support a diagnosis of MS.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego