Are the white lesions on brain mri normal?

[logmum]

I have been feeling weak, achey and tired for over a year now. In the morning the pain in my feet is terrible. My legs and arms ache pretty much constantly. A few weeks ago the entire right side of my body went numb from my scalp to my toes. Even my right ear went the way it would on an airplane and my right eye blurred. I've had tingling in my fingers and toes and numbness in my arm prior to this. I thought I had had a mini stroke and went to the dr. An MRI of my cervical spine showed a hernia, athritis and nerve damage. The MRI of my brain showed white lesions. I was sent for a second MRI, this time with contrast. I called for the results this morning and was told that my MRI was completely normal. The rest of my symptoms are being put down to my neck and stress. I'm really confused. Is it a definite I don't have MS or another neurological disorder? I just can't understand how the MRI without contrast showed these lesions along with my complaints and then one with contrast comes back completely normal. Should I insist on a referal to a neurologist or is that second MRI pretty conclusive?

[COBOB]

I should have added that you can not compare a 1.5T T2W sequence to the 3.0T T2* sequence.
The 3T MRI should make and image twice as good (100% gain) as a 1.5 T but really only works out to be 30-60% better.  The problem in that the same T2 Spin Echo sequences would expose human tissue to 4 times the electromagnetic radiation and exceed the FDA SAR limits for tissue heating (the limit is based on not raising the tissue temperature more than 1 degree C.)

So on 3.0T units they use a T2* sequence that is a "Gradient Echo" sequence.  It doesn't flip the molecule 90 degrees like the T2w "Spin Echo" sequence.  While this reduces the energy, it can increase local image artifact.  Newer software corrects for some of these problems, but the higher energy physics of these newer MRIs change the rules, and you do loose some of the ability to compare new study sequences against older study sequences.

U. SALVOLINI et al., "HIGH FIELD BRAIN MRI: USE IN CLINICAL PRACTICE",  SPRINGER 2006

[COBOB]

On T1 GAD enhancing lesions are very white.  Now MS lesions seen on a T2 or FLAIR image are not really all that white.  They look like smudge marks.  You may want to go look at The MRI Atlas of MS Images.  http://www.scribd.com/doc/8817608/MRI-Atlas-of-MS-Lesions,

Big Bright White "things" on T2s and FLAIRs tend to be artifacts or UBOs (unknown bright objects,) not lesions.  Lesions can be very subtle and that is why you always want brain and spine films read by a neurologist, neurosurgeon or neuroradiologist.  General radiologists (like the have at many imaging centers) miss the subtle lesions.  

The ability to detect T2 signal abnormalities has more to do with the reader, the software and the technique of the study than the density of the magnetic field.  Sure, 3.0 Tesla is better if the software is up to date and the person reading the study is a neuroradiologist  3.0T and some hack is not a good situation.  

Studies have show that with the same doctors and software 3T fields will demonstrate about 20% more lesions than a 1.5T field.  So 10 lesions on a 1.5T might be 12 on a 3.0T.  I'd still say your best bet is getting your study on disk and finding a neuroradiologist to give you a second read. That would also be cheaper than repeating an MRI.

Bob

[logmum]

Thankyou so much for the replies. I'm unsure what strength the contrast was. I haven't even been into the clinic to see the report, just a conversation with the nurse on the phone this morning saying all was "normal". I really have no idea what to thin or what's going on. I have made an appointment to go talk with the PA next week and have him explain the difference between the two. I think I will insist on a referral to a neurologist. It just doesn't add up to me....  I trully appreciate the information and input.

[jensequitur]

What strength was the second MRI done at?  That can be very important.  Since the first MRI showed lesions and the second one did not, I would think that the second one was probably at a lower strength.  I would recommend finding a 3T MRI.  I think at this point you can't rule out MS, especially since it looks like you're having neurological symptoms.  I would also see if you can get the actual MRI report from the clinic, and the films.

Your description of your ear sounded very familiar.  Before my diagnosis, I had a weird ear incident - my ear suddenly felt like it was filled with cotton wool, and it started buzzing.  It was very disconcerting - I was already feeling poorly that day, and the buzzing made it very hard to think clearly.

I would try to get a follow up with a neurologist.  See if you can do some research beforehand to find a good neurologist.  The training is very irregular, and you stand a good chance of ending up with somebody who isn't good at looking at the whole picture.

[Millsinc]

I hate that limbo feeling. I'm no medical professional but alot of your symptoms sound similar to MS. The MRI results sound kinda weird so I'd suggest a second opinion and see a neurologist.