All Right, Mr. DeMille, I'm Ready for my Close-up
It’s the ultimate close-up - detailed imaging of your brain. I’ve now had three MRIs in less than a year. I expect that I will now be on more of a once per year schedule, but even so, that means that I have a great many dates with the MRI machine in my future. Each time that I have an MRI, I count my lucky stars that I have arachnophobia and not claustrophobia. We don’t talk about spiders, no, no, no…
What is an MRI and how is it used in diagnosing and monitoring MS?
Magnetic Resonance Imaging (MRI) is a medical imaging technique that uses a magnetic field and radio waves to create detailed images of bodily tissues. The MRI machine is a large, tube-shaped magnet that is open at both ends. MRI is the most sensitive non-invasive way of imaging the brain, spinal cord, or other areas of the body. As I write this, MRI is the preferred imaging method for the diagnosis of and monitoring of MS. Because the myelin that protects nerve cell fibers is fatty, it repels water. Where myelin has been damaged by MS, the fat is stripped away. With the fat gone, the area holds more water. This appears on an MRI scan as either a white spot or a darkened area. Evidence of this scarring to the myelin is a key piece of evidence used in diagnosing MS.
Once an MS diagnosis has been made, subsequent MRI scans are important for tracking the progress of the disease and making treatment decisions. If you are developing new lesions, this can be a sign that your treatment approach isn’t having the desired effect, regardless of whether new symptoms have presented or not.
What is it like to get an MRI?
Here in Canada, MRI time is precious and they run those machines 24/7. Could you get assigned a 3am time slot? You sure can! I have been fairly lucky with my time slots to date, though did have to get up at 4:30am to make it to my 7:20am time slot for my most recent scan (driving from Innisfil, I figured I needed to be out the door by no later than 5am to get to downtown Toronto for 6:50am - I ended up having time to spare, but you never know with DVP traffic).
You are asked to arrive 30 minutes before your scheduled scan in order to fill out paperwork and get changed. You strip down, remove all jewelry, and don a robe that seems to have oddly placed ties. You are allowed to keep your underwear and socks on, but that’s it. Then you wait. As St. Michael’s Hospital is a trauma centre, you can get delayed by emergencies coming in and needing the equipment. CP24 plays in the small waiting room.
Ready for my close up… almost! I always forget to remove at least one thing and have to get back into my locker to put it away. This time, it was my FitBit.
When you are called in for your scan, you are given a pair of ear plugs. All of my scans have happened during the COVID-19 pandemic, so I have also been given a surgical mask without a nose wire to swap for the N95 mask that I wear coming in. You lie down on a moving table. Headphones are placed over your ears to further reduce the sound from the MRI machine. A plastic cage is clipped down around your face (I imagine that this would trigger anxiety for those who are claustrophobic). Then the scan begins. The table slides into the tube-like machine and the machine starts making all kinds of strange sounds - thumping, knocking, noises that I associate with fax machines, and the occasional noise that borders on techno music. The scan is completely painless. You are given a ball to squeeze to trigger an alarm, in case you need assistance during the scan.
If contrast is required, the technician pulls you out from the scanner around the halfway point to administer a contrast agent, usually gadolinium by IV. I have had gadolinium in two of my three MRI scans to date.
I find that the second the scan begins, I have an itch somewhere on my body. My brain likes to play fun games like this. The second I can’t scratch it, I conjure up a fictitious itch that I can obsess over for the next hour or so. When you are asked to hold still for a lengthy scan, you become acutely aware of how much you move from breathing and swallowing. I distinctly remember wondering during my first scan whether I should be trying to hold my eyes perfectly still, as the scan was focused on my orbits for the purpose of diagnosing Optic Neuritis. I made a valiant effort to not move my eyes, though to this day I don’t know whether that was needed.
There are other hospitals and testing facilities that make some effort to create a more comfortable MRI experience. For example, I have heard tell of locations that are set up to play music for you, or even to watch a movie. I’ve even heard tell of locations that let you keep more of your clothing on during the scan. Unfortunately, these comforts aren’t on offer at St. Michael’s Hospital.
The super inviting set up at St. Michael’s Hospital.
Advice for getting an MRI
Use the washroom before your scan. These scans can last a long time. My last one was over an hour long. If you have to pee, it will be that much harder to lie perfectly still during the scan.
Eat a modest meal before the scan. You don’t want to listen to the sound of your belly rumbling over the sound of jackhammers and fax machines. However, before the scan is probably also not the time for an AYCE feast either. You want to be comfortable, so eat a comfortable amount.
If your scan involved contrast, make sure to drink lots of water after the scan to help to flush out the contrast.
If you know that you are claustrophobic, ask for help. Many people take a sedative before their scan. I don’t need to medicate for my scans, but if I felt about enclosed spaces the way I feel about spiders, I would definitely be saying “pass the Ativan”. There’s no reason to suffer through it. Ask for help.
Cover your eyes. I’m not claustrophobic, and I still usually keep my eyes closed during the scan (I’m not going to lie, there’s a certain coffin-vibe). If you are claustrophobic, consider bringing an eye mask or a towel to cover your eyes.
You will have to get undressed and dressed again, so wear clothes that are easy to change in and out of, and remember to wear socks and keep them on (it’s cold in there).
Related to the last one, leave your jewelry at home. There are lockers for storing your things, but I swear I always forget to remove at least one thing and I have to go back to my locker to put it away when I eventually figure it out. The less you are wearing, the less likely you are to forget to remove something metal. I regularly fail to heed my own advice on this one.
Celebrate when it’s over. Getting an MRI is always a bit stressful, even for those impervious to enclosed spaces. It’s a reminder that you are sick. It’s only natural to worry about the results. Reward yourself for getting through it. I got myself a sushi lunch to celebrate getting through my last scan.
