Complicated question with some pretty unclear answers.
Tissue (myelin) damage shows up on T2 sequences. Microscopic damage can cause physical manifestations, but microscopic damage will not show up on existing MRI technology. (1.5, 3 or 7 Tesla MRI.) Same thing happens with GAD enhancement for active lesions. The damage needs to be visible on T2 sequences and the leak in the blood brain barrier has to be enough the it allow GAD into the damaged tissue to enhance in the T1 sequences. Much of the damage caused by MS is "occult" and not visible with standard MRI, but can be easily detected with Magnetic Transfer MRI (MT-MRI).
There are studies that show that damage in the brain may start years before a lesion may become visible in T2 sequences using Magnetic Transfer - MRI. MT-MRI is a special technique that is related to how healthy tissue transfers magnetic energy to other tissues.
http://www.ncbi.nlm.nih.gov/pubmed/12937086
The take away should be that T2 hyperintensities and T1 GAD enhancement are important in helping diagnose MS. So are positive VEP and the presence of unique oligoclonal bands in CSF. None of these is more important than the physical exam, patient history and the ruling out of mimics.
Welcome Buffy,
I'm glad you found this place, but I am sorry you needed to. Limboland is not a fun place to be...
I'm not sure about how long it takes to for a lesion to become visible, but there is great information in the health pages about MRI's, and so many other things. This is such a great place for information, and support. My neuro says that sometimes they are just not visible. Or perhaps the software or MRI strength is a problem. For example: I have multiple lesions visible in my brain, but none are visible in my spinal column. Nevertheless, my doctor is quite certain I have spinal lesions based upon my symptoms.
The mystery will eventually be solved, but it can take a very long time. Hang in there.
Tammy
Interesting stuff. I'll look into it. That would explain why some think MS even without obvious MS lesions.
Have you ever heard of radiologist and neurologist discussing MRI but not putting concerns in print? I had an MRI done of C-spine but radiologist mentioned abnormalities (verbally to neurologist) in brain (contrast showed very intense areas - insurance only authorized c-spine). When I asked neuro about intense bright areas that I could see he said that yes, the radiologist had mentioned it to him but it wasn't anything... ?
Based on what you and maxthecat have posted a follow up makes more sense. I thought the lesions came and went fairly quickly. Do you have the hug? Have you ever had it halfway? I have had constriction about where diaphragm (sp) is to varying degrees. What I'm curious about is sometimes it only seems to cross left side of ribs/chest. Once it actually felt like someone was trying to tuck the left side of my lower ribs under. I have possible footdrop and on/off problems raising toes on left foot.
What issues do you attribute to spinal lesions?
Happens all the time. Verbal conversations are not part of the medical record, but radiology reports are. Doctors will often discuss things that never end up in the chart.
There have been studies that show MRI misses lesions.
"Immunohistochemistry confirmed 70 WM, eight deep GM, 27 mixed GM-WM, and 63 purely cortical lesions. T2SE images depicted only 3% of the intracortical lesions, and 3D FLAIR imaging showed 5%. Mixed GM-WM lesions were most frequently detectable on T2SE and 3D FLAIR images (22% and 41%, respectively). T2SE imaging showed 13% of deep
GM lesions versus 38% on 3D FLAIR. T2SE images depicted 63% of the WM lesions, whereas 3D FLAIR images depicted 71%. Even after side-by-side review of the MR imaging and histopathologic results, many of the intracortical lesions could not be identified retrospectively.
CONCLUSION: In contrast to WM lesions and mixed GM-WM lesions, intracortical lesions remain largely undetected with current MR imaging resolution."
http://www.ajnr.org/content/26/3/572.full.pdf+html
Bob
There's a Health Page about spinal cord lesions and the symptoms they often cause. Some of the problems can be caused by conditions other than MS so keep in mind that these are not symptoms that necessarily mean you have MS. They are MS symptoms that indicate spinal demyelination likely exists.
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Spinal-Cord-Lesions/show/764?cid=36
The Health Pages are full of LOTS of information. You can find an index of them toward the bottom of the column to the right.
I hope you get some answers - and better yet solutions - soon.
Mary
Thanks for the information. Both of you have given me something to look into and I do crave answers.
Thanks for the link Mary. I haven't had time to explore this site yet and that link was helpful and interesting. There are some days I can't spell the word "coast" (seriously) and easy to understand info is most appreciated.
Sorry to read about your sister, Mary. It is terrible to wait for something like that but, as you say, you have the time together. Take care.