MRI to Replace Painful Spinal Tap for Faster MS Diagnosis

Multiple sclerosis (MS) is a challenging neurological condition to diagnose due to its wide array of symptoms, with not all patients experiencing the same symptoms or at the same intensity, and the disease can progress at different rates. Currently, there is no universal consensus on the most effective way to diagnose MS. Commonly, individuals suspected of having MS undergo an MRI scan and a lumbar puncture, where a thin needle is inserted between the bones in the lower spine to collect cerebrospinal fluid. Patients often find this procedure painful, and it can lead to complications that may require hospitalization or time off work for recovery. While the fluid obtained through a lumbar puncture can sometimes provide evidence of MS, it doesn’t always yield conclusive results. Abnormalities may not be present in all MS patients, and similar abnormalities can be found in people with conditions that mimic MS but require different treatments. These factors contribute to the risk of misdiagnosis. Now, new research has demonstrated that MS can be successfully diagnosed with an MRI scan, eliminating the need for a painful lumbar puncture.

Researchers from the University of Nottingham (Nottingham, UK) have discovered that a new MRI scan method could diagnose MS in just 8 minutes. This breakthrough offers a more scientific, safer, cost-effective, and patient-friendly approach to diagnosing MS. The team used a clinical MRI scanner to perform a specialized T2-weighted MRI scan, which reveals lesions in the brain's white matter centered on a vein—an indicator commonly associated with MS. To provide a definitive diagnosis, the team established the "rule of six," meaning that if six lesions with a central vein were detected, MS could be diagnosed without the need to analyze every lesion.

Image: MRI can replace painful spinal tap to diagnose MS more quickly (Photo courtesy of University of Nottingham)

The researchers conducted a prospective study involving patients suspected of having MS but without a definitive diagnosis. Each patient underwent an 8-minute MRI scan and a lumbar puncture, and after 18 months, the final diagnosis was compared with the initial scan results. The findings, published in Neurology Open Access, demonstrated that the T2-weighted MRI scan, along with the "rule of six," was an effective alternative for diagnosing MS instead of a lumbar puncture. Based on these results, the International Committee for the Diagnosis of MS has confirmed that an MRI scan alone is sufficient for diagnosing MS, and lumbar punctures are no longer necessary.

“People who have lumbar punctures are required to spend at least most of a day in hospital, and for a health service already at capacity, this creates more issues. If there are complications with the lumbar puncture the stay can be longer,” said lead author of the study, Professor Nikos Evangelou, Clinical Professor of Neurology, School of Medicine. “With the MRI scan, it takes 8 minutes, is completely safe, and then you can go home. The findings of our research are particularly exciting as we have now shown that we can give the diagnosis of MS without this painful procedure.”