I never really understood anything about this disease until I started working in MRI. MRI is a commonly used modality for detection of MS plaques and now I have found that is much more prevalent than I thought. MS plaques can appear as hyper-intensities on T2 imaging. It can be in the brain or spinal cord. It attacks the myelin that covers nerve fibers. When scanning for MS in the brain our protocol is additional T2 FLAIR imaging in a sagittal plane. Flair uses an inversion pulse which makes CSF dark making T2 hyper-intense plaques "stand out". Our radiologist looks in the white matter where myelin is found and for a pattern scattered away from corpus callosum. We typically give contrast to see if any plaques enhance that may represent an "active plaque". We also like to do delayed post contrast imaging because some experts believe MS plaques do not enhance until a delayed phase.
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