Magnetic resonance imaging (MRI) is an extremely valuable method for diagnosing and monitoring MS. 

Unfortunately, having an MRI may provoke anxiety due to the confined space and the loud noises that are generated by the machine.  There are ways to decrease the anxiety that may occur with MRI scanning.

MRI—The Basics
MRI produces very detailed images of the brain and spinal cord.  This is accomplished by using a very strong magnetic force (about 100,000 times greater than the magnetic pull of the earth) that allows the machine to obtain signals from specific molecules.  These signals are then used to create images.  Importantly, MRI, unlike x-ray and CT scanning, does not use radiation.

With MS, abnormal areas may be seen on the MRI of the brain and spinal cord.  These typically appear as white spots, which are often referred to as “lesions.”  If a person has experienced neurological symptoms that are typical of MS and the MRI has “lesions” that are typical of MS, then it is very likely that this person has MS—in this way, MRI is extremely important for diagnosing the disease.  In addition, after the diagnosis has been made, MRI can be valuable to determine whether new lesions are forming and to determine whether medications are effective in decreasing disease activity.

Safety
Due to the very strong magnetic field, those undergoing MRI’s must remove metallic objects, such as jewelry, cell phones, and keys.  Rarely, metallic objects that are implanted in the body can prevent one from being able to safely have an MRI—these objects include pacemakers, defibrillators, some forms of “stents,” inner ear implants, and shrapnel.

Those with kidney disease need to discuss this with the MRI center because gadolinium, the intravenous material that is used with MRI’s, may cause a serious medical condition in those with kidney problems.

Anxiety and Claustrophobia
The closed space and loud noises of the MRI may cause anxiety, especially in people who are known to have anxiety or claustrophobia.  There are several strategies that may make the MRI experience more tolerable:

• Bring Someone With You
Having a friend or family member who can be with you and talk with you during the procedure may make the MRI more relaxing.  In addition, if needed, this person can drive you home after the procedure.

• Arrive Early
It may be helpful to arrive early and have time to get familiar with the facility and the MRI machine.  Anxiety may also be decreased by expressing your concerns to the MRI staff prior to getting into the machine.

• Use Relaxation Methods
Simple methods, such as wearing a blindfold or putting a cool cloth on your forehead, may be helpful.  Earplugs or music may be used to decrease the MRI-associated noise.  More sophisticated relaxation strategies, such as guided imagery or meditation, may be considered, especially by those who are already familiar with these methods. 

• Communicate with the MRI Technician
The MRI machine has a microphone system that will allow you to talk with the MRI technician during the procedure.  Use this system to discuss any problems or concerns that may arise.

• Consider an “Open” MRI
There are MRI machines that have a more open design and allow one to lie in a less confined space.  Importantly, some of these “open” machines may have weaker magnets and thus may not produce high quality images.  These issues related to “open” MRIs should be discussed with your physician prior to having the MRI scheduled.

• Consider Sedation
For those who have had difficulty with MRIs previously, sedation with medication may be helpful.  Sedation may be obtained with oral medications, such as diazepam (Valium) or alprazolam (Xanax).  For those with more severe anxiety, intravenous medication may be used.

The Future
In the future, technological development may allow MRI machines to produce images in less time or have a more open design.  One small study recently reported that MRI-associated anxiety may be decreased with the use of virtual reality devices.

References and Additional Reading
Anon. Conquering claustrophobia during your MRI. Johns Hopkins Med Letter. Nov 2002:3.

Anon. MRIs and claustrophobia. Mayo Clinic Health Letter. May 2007:3.

Anon. MRIs with less fear. Consumer Reports on Health. Sept 2007:10.

Dewey M, et al. Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients. J Magn Reson Imaging. 2007;26:1322-1327.

Garcia-Palacios A, et al. Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: a case report. Cyberpsychol Behav. 2007;10:485-488.

Tornqvist E, et al. It’s like being in another world—patient’s lived experience of magnetic resonance imaging. J Clin Nurs. 2006;15:954-961.