Diagnosis of Multiple Sclerosis: which instrumental tests are essential?

By Cristiano Antonino On Feb 9, 2023

To diagnose Multiple Sclerosis, the doctor essentially relies on instrumental and laboratory tests which confirm the demyelination process typical of the disease

Multiple Sclerosis, what is Computed Tomography (CT) used for?

CT scan with contrast medium can highlight less dense areas in the areas around the ventricles which correspond to those in which the myelin has been definitively replaced by plaques, or it can provide a cerebro-atrophic picture in the forms of the disease which have been present for more time.

Furthermore, the CT scan also manages to highlight areas of accumulation which are typical of the pathology in progress and which, on the other hand, disappear after treatment with steroid drugs.

Magnetic resonance imaging (MRI) in the diagnosis of multiple sclerosis

This instrumental exam provides the doctor with images and is probably the most suitable exam for diagnosing multiple sclerosis.

MRI highlights the alterations of water content in the body, which correspond to the areas where the myelin has been replaced with plaques and which, in this case, are found above all in the bridge, in the corpus callosum and around the ventricles.

The use of a contrast agent highlights local BBB alterations which usually precede the signs of disease exacerbation; moreover, MRI with contrast medium also allows to highlight any lesions to the optic nerve, although it is not an examination capable of highlighting spinal cord lesions, for which the analysis of the cerebro-spinal fluid is usually used.

Analysis of the cerebro-spinal fluid

Cerebrospinal fluid is the fluid in which both the brain and spinal cord are immersed; it is made up of proteins, sugars and salts and has the function of nourishment and protection against any trauma, absorbing shocks.

Analysis of this fluid can provide invaluable information about the condition of the spinal cord and brain.

Samples of cerebrospinal fluid are taken with a lumbar puncture.

The patient is made to lie down in the fetal position and the doctor, using a syringe with a needle inserted directly into the back, is able to take a sample of liquid to be analysed.

After the sampling, however, the patient is forced to remain motionless for at least 12 hours.

The analysis of the cerebrospinal fluid goes to investigate the count of the cells present, the levels of proteins and glucose, the colour, the presence of antibodies and their quantity and of a possible infectious agent.

XP test (Summoned Potentials)

This test is done to measure the transmission and interpretation time of sensory messages that travel through the nerves.

The existence of slowdowns in transmission can be a sign of multiple sclerosis, due to the demyelination process.

It can be considered the exam par excellence for diagnosing multiple sclerosis as it gives detailed information on the functionality of the nerves, which is not possible to obtain with other diagnostic means; furthermore, it is also able to take into consideration areas of the body that cannot be investigated with other diagnostic means, such as the optic nerves and the spinal cord.