If you suspect a current MS attack or trying to diagnose, with contrast is important, if simply monitoring year after year, you don’t need contrast, new MRI can be compared to prior ones to find new lesions, the dye is not particularly good for you, so being exposed to it year after year is no longer advisable

WITH!! About 4 or so years ago, and a different neurologist, I had an MRI done. For the first time, my labs had shown liver function changes enough that they Wouldn’t use the gadolinium! The next visit I had with him was a total waste of time bc he was basically put out for the fact there was really nothing much to see besides my brain having gotten smaller (😳). The lesions can’t be determined as being active or not, or show up as well in general.
I would say to hydrate, hydrate, hydrate in anticipation of Any needle poking into your veins. Mine have been well used and have developed scar tissue, they don’t pop up like they used to, but the MRI folks...I trust them more than a phlebotomist. (I happened to be excellent where there was no obvious presence of a vein and there’s many more ppl I’ve had that have gotten blood from a stone, so no bashing here!!) They aren’t trying to draw out, just put in! So I think it goes easier! But the more water you can get in the day before or even a couple of days, you shouldn’t have any problems.
But if the doc wants it with contrast-do it with contrast!! Otherwise. It’s basically a very expensive X-ray! Godspeed!

I agree with @A MyMSTeam Member. It's not a clear cut answer. An MRI without contrast will still show all lesions but an MRI with contrast will show those same lesions and will indicate if any of them are enhancing (ie. if you are in the middle of a relapse). During the diagnostic process it's probably best to have both especially if you think you are in the middle of a relapse, to confirm it. But otherwise, it may not be 100% necessary. They can still spot new lesions without contrast. There is some debate about potential health risks of getting contrast especially if you get it over and over again in annual scans for the rest of your life. Doctors will almost always order it because it makes it easier for them and gives them the most information but if you ask they may admit that it's a nice to have but not a necessity.

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A MyMSTea...

With, always with unless you're allergic to the dye. The contrast highlights any new lesions. Without it all lesions look alike. With you can spot newer spots and gauge progression better.

The MRI without contrast shows all lesions, but adding contrast shows if any lesions are active meaning a relapse.