This has contributed enormously to the diagnosis and understanding of MS. Normal white matter appears dark with low signal intensity in T2 weighted images. Myelin breakdown produces a longer relaxation time and increased signal on T2. Gliosis produces similar changes. The presence of white matter abnormalities with a periventricular distribution is suggestive but not diagnostic of MS. Paramagnetic contrast (Gadolinium) will show active inflammation. A combination of MRI and CSF (oligoclonal band) will rule out MS if both are negative. MR may predict long term outcome - following a single episode of demyelination (e.g. optic neuritis or transverse myelitis). Those with cranial MR abnormalities will relapse sooner than those without. At present MRI does not correlate well with disability, but newer techniques may be more sensitive measures of disease progression.
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