I have recently fired my Neurologist and I am now waiting to see another. I recieved my MRI reports and I was wondering if anyone could help interpret or describe them in layman's terms. For that matter any input would be helpful. Thanks!
EXAMINATION - MRI of the whole brain performed without and with intravenous gadolinium protocol.
1. There are numerous large round and ovoid areas of abnormal signal emanating from the periventricular white matter out, into the more peripheral white matter consistent with the pattern of “Dawson’s fingers”. There are also subcortical areas of abnormal signal in several locations within the cerebral hemispheres. There is a large dominate focus of abnormal signal in the left lower frontal white matter, which measures approximately 15mm in size. The presence of one or two small areas of hyper attenuation are scattered in the left brain stem and right deep cerebellar hemisphere.
2. After contrast demonstrate that there are numerous periventricular and peripheral white matter foci of rounded abnormal signal enhancement, representing breakdown of the blood brain barrier and active plaques, which are present in both cerebral hemispheres and in the left cerebellum.
3. The T1 weighted image sequence demonstrates there are only a small number of plaques exhibiting cystic change (chronic).
1. The abnormality is multifocal, and the changes are compatible with the given clinical diagnosis of acute demyelination within the brain with active and subacute multifocal zones of demyelinating disease compatible with a variation of MS.
EXAMINATION – Cervical spinal MRI examination performed without and with intravenous gadolinium contrast.
1. There is a distinctive zone of abnormal signal and modest enlargement, eccentrically placed through the mid cervical spinal cord at the level of the vertebral body levels C5 and C6. A tiny satellite focus of enhancement is demonstrated slightly more caudally in the dorsal fibers of the cord but otherwise the remainder of the cervical spinal cord shows only very small additional areas of minimal enhancement noted at C3-C4 level.
2. Cervical spinal cord demelination of an acute nature is present.
EXAMINATION - MRI of the whole brain performed without and with intravenous gadolinium protocol.
1. The zones of scattered white matter hyperintensity and the extensive periventricular foci of confluent hyperintensity remain present in the subcortical white matter, areas have both receded and increased in size in conspicuity compared to the FLAIR imaging of 6-3-07.
2. On the post-contrast imaging, the dominant round focus of abnormal enhancement in the left frontal white matter and additional small foci of abnormal signal hyperintensity scattered about the white matter of the hemispheres have largely involuted and resorbed. However, there are now new areas of punctate and curvilinear enhancement in the distribution of the cerebral hemispheres, which were not present on the prior study and are indicative of additional areas of acute demyelynating change seen both in subcortical areas, as well as in the corpus callosum and adjacent deep white matter. None of these individual areas are larger than 1cm in size presently.
3. There is no sign of intracranial subdural fluid collection or incidental mass lesion. The ventricular system remains normal in size.
1. White matter disease of the brain exhibits signs of new and additional active scattered demyelinating plaque formed since the prior MRI of 6-3-07.
EXAMINATION - Cervical spinal MRI examination performed without and with intravenous gadolinium contrast.
1. A large zone of enhancing cervical spinal cord demyelination identified at the level of C5-C6, has diminished somewhat in size, while it remains visible in the centrum of the spinal cord, the degree of enhancement and portions of this focus have diminished.
2. There are areas which enhance in a low grade fashion now at the level of C3-4 and at the level of T1-T2, which were not evident on the prior examination, and are now represented on the sequences as additional lower grade active areas of new demyelination in the spinal cord.
I'm assuming you fired your neuro on the lack of a diagnosis.
After reading your MRI reports,I would definatly seek a neuro whom specializes in MS.You don't see to many reports that describe the dawson fingers,you had a very good radiologist.
Demyelinating disease usually refers to MS,someone correct me if I'm wrong.
A MS specialist really needs to see you and your MRI's.
I've seen many of weenie neuro's but if your's failed to dx you he's gotta be one of the biggest here.
I'm sure others will come along and give you better answers.
Hi, I'm sorry to read that this is the appearance of your MRI's. I'll be glad to give you a layman's take on the MRI readout and hope we also hear from Burban-chick, who is also an MRI technician. I definitely see why you got the diagnosis of MS from two different neurologists. Sounds like one of them, though, was a real "weenie" as we like to refer to defective, dismissive, or disdainful neuro's here.
Here is a quick and dirty analysis of your 6/2007:
The white (myelinated) part of the brain shows multiple, ovalish and very clearly edged areas of increased signal intensity. This means they look lighter/brighter on the T2 images. These are located such that they appear to form a radiating pattern outward from the ventricles (which are the fluid-filled spaces inside the brain, filled with CSF). They follow a pattern which has been descibed as "Dawson Fingers". This is a classic pattern that is used to describe the lesions of multiple sclerosis. There are other areas which are similar in appaearance and are located just below the level of the brain's cortex, one large one in the frontal lobe and others scattered. Specifically there are also lesions located in the brainstem and in the cerebellum.
When the contrast agent, gadolinium, is used some of thse areas of increased signal (lesions) "light up". This indicates that they are inflamed and have increased blood flow to them as an inflamed area would. In analyzing such lesions these are considered to be acute and active areas of demyelination.
On the T1 images (another technique of using the electromagnet of the MRI to obtain images) there are areas where the lesions have been or are being reabsorbed leaving blank areas in the brain, sometimes called cyst (fluid-filled cavities) or also known as "black holes." These are areas where the nerves have completely died and the brain tissue is disappearing.
I'm not sure what the radiologist is referring to when "a variation of MS" is mentioned, unless it is a reference to one of the "types of MS" such as relapsing-remitting or progressive.
On the 6/2007 MRI of the spine there is a good-sized lesion, and "enlargement" (I THINK might have been a misstatement and the radiologist meant to say "enhancement". I say this because in the following MRI it talks about the lesion looks smaller and the enhancement has lessened.) A few small areas are also seen which enhance with the contrast and would indicate active disease.
The MRI continues to show extensive lesions, but some areas are smaller and some areas larger or new. This indicates that some lesions have "healed" and disappeared from the MRI image (or at least faded or gotten smaller) and some new ones have reappeared. There are also new lesions in other regions of the brain.
The larger spinal lesion at C5-C6 looks improved, but there are two new and active lesions at C3-C4 and T1-T2.
There are several diseases of demyelination, but by far the most common one is MS. Others are much more rare. This report sounds like it was taken directly from an MS textbook. I have never heard of "Dawson's Fingers" being described in other diseases, but this is not my area of specialty. I have been reading extensively on Lyme disease, and, while Lyme "can" cause lesions of demyelination, it really is not very common (this is according to research I read following the Lyme sites' links) and, I would be mammothly surprised if it ever caused lesions that are this extensive or in this pattern, unless the Lyme was causing a fulminant and life-threatening encephalomyelitis (ovewhelming infection of the brain and spinal cord). But you would be in an ICU.
Have they spoken to you about which form of MS they believe you have? Have you had symptoms for a long time?
There is a thread called "MRI's, Lesions, and Symptoms" that is a little tutorial on MRI's and how they show up MS lesions. I'll bump it up to the top. I might help you understand a little of the tech-talk that neuros and others throw out.
Would you like to tell us what you have been going through? From your MRI it sounds like you have been suffering a great deal. I invite you to join, ask questions and where we don't know the answers we'll send you to someplace that can.
I'm here to chime in, but I don't really know what to say. Quix pretty much hit the nail on the head!
I have to also agree with Quix when saying that "enlargement" was a mistake in dictation, it is most likely supposed to read "enhancement". Most radiologists would give dimensions for an enlargement, like what is said in the other report.
When the Radiologist says "variation of MS" I take that as another way of referring to a demyelinating disease. Like you said, there are not many other types of demyelinating disease besides MS.
Radiologist will often not say the disease name in a report, but will almost motion toward it using terms like, Dawson's Fingers, plaque's, demyelination, and so on...I
usually only seen them mention it if the patient has already been diagnosed. They will often say "findings correlate with patient's diagnosis of disease X."
Good luck with the new neurologist! I hope it goes well. Keep us posted!
I have not been told of a specific form of MS as the communication and explanations were a big part of the problem with my now fired Neurologist, as the way I see it he just wanted me to sit there and shut up at appointments. This for me was very disturbing.
I have numbness (not numb completely) in my hands (middle finger to pinky and same location on palms on both hands), feet, trunk and random changing locations of this numbness sensation on my legs, which sometimes make my legs feel pretty unusual - I now run every day like a relay style run not long distance but very hard to keep myself in check about my legs working correctly as I do not think my balance in as good as it was. I have this shocking feeling down to my feet and hands when I bend my neck, which is my most disturbing symptom as this shocking can get pretty bad at times but is there all the time. I have heard it is l'hermitte's sign and also a trademark sign of MS of course I am not sure of this. I also lost strength in the pushup motion only, don’t know why but is distinct. Aside from some slight head pressure, that’s all my problems at this point. The numb tongue lip and chin thing that was my first symptom, went away after about a month of onset.
I will be receiving some other results from all other tests that were preformed including Lumbar Puncture, Antibodies Test, Blood Test which I would happy to share. If anyone has any specific questions for me, please ask and I will do my best to answer.
I got to say Quixotic1, I really appreciate you following my situation so accurately and please let me know any specific questions you have for me. Also, I will now be seeing the Neurologist that gave me the second opinion.
Thank you everybody for all the wonderful help and information, as this is huge for me.
I need help interpreting my mother's mri as well. She was recently diagnosed with stage 4 lung cancer with bone metastatis. Now they say, based on her mri, that she has brain metastasis as well. How do they know from this report?
MRI of the Brain with and without contrast
Indication: Evaluate for metastasis.
The patient was scanned before and following an infusion of 15cc of Omniscan. The study demonstrates venticles that are prominent and midline in position. There are atrophic changes overall. There are areas of increased signal compatible with microvascular disease.
There appears to be an old small lacune present in the right frontal white matter. Following the infusion of contrast there are several small areas of enhancement that have a "ring like" appearance. One is located posteriorly in the right occipital lobe. Others are present above left lateral ventriole and in the left parietal lobe. Another is located in the right occipital lobe. All of these are less than a centimeter in size and closer to 5-6 mm. There is a a small area of surrounding vasogenic edema in the right occipital lobe. Flow void is present in the major cerebral arteries and dural venous sinuses. The sella and pituitary gland are normal. The craniocervical alignment is normal. There is no mass at the cerebellopontine angles. No acute sinus disease of intraorbital abnormality is seen.
There are several small ring like enhancing areas in the cerebral hemispheres bilaterally compatible with small metastatic lesions. Vasogenic edema surrounds one in the right occipital lobe.
No acute infarction.
Atrophy and microvascular disease.
Is is possible this is MS? If it IS metastatic disease, and it is bilateral, what can we expect? The doc told me 4-6 months so long as she completes whole brain radiation. She is already having trouble breathing. Could this be because of her brain? Please help explain some of this to me.
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