Bright Spots?

[Heather3418]

Can anyone tell me what the difference is on an MRI report saying "bright lesions seen," but yet they do not take up the contrast dye, showing "no current demyelination?"

Question:  How can they be bright spots, but yet, not be active?  Can radiologists estimate the "age" of a lesion?  If shadows (grey) lesions show up, I know that is scarring from a previous lesion.  If they show up as "bright spots," but do not absorb the dye, can we tell if these lesions are causing active "symptoms?"

If I have confused you, I am sorry.  I think I confused myself.  This is one area of MRI's that I have never understood.  Maybe Jon or Quix can sort this out, unless someone else happens to know.  I would certainly appreciate input from anyone.  I have tried to research this question before posting my question, but I still do not seem to understand.  Brain burps I guess.  Just for your information, 7 old lesions seen (greyish appearance on MRI) 4 new lesions since last study of 22 months ago. (bright intensity) but no active demyelination seen. Why do they show as "bright" at all?

Thanks, Heather

[Heather3418]

Depending on how your course of MS is going it will depend on the individual doctor, how often he wants them done.  Most Neurologists like to do them at least once a year.  If you are having alot of trouble despite MS therapy, they may want to do them more often.

I have been diagnosed for 12 years and mine have been about every two years.  In the past week, I was finally approved to see a new Neurologist, so we will see how often she wants them done, since I show new activity on MRI.

Usually your Neurologist will order MRI scans once you are in there care.  The family doctor usually steps out of that role once you are seeing a Neuro.

Heather  

[ladygrace]

I'm newly diagnosed.  How often should your neurologist or practitioner have MRIs done?  Are there things that mean an MRI should be done?  

Is there a rule of thumb on MRIs?

[cjacks]

Quix,

thanks for the clarifications.  I haven't had an MRI yet but its good to go into these things with some knowledge.  I have my first neuro on Thurs.  So I'm sure all the testing will begin soon after.

Merry Christmas to you and your family and the kids .. hem ..  I mean kitties

Jo

[Quixotic1]

Merry Christmas!

The older lesions are bright, also called hyperintense.  The enhancing new areas are even brighter in comparison.  The "comparison" is the key.

Different radiologists use the terms differently and it is confusing.

Quix

[Heather3418]

Thank you Quix...yes, I am still confused...but this is just me, I am sure it is clear for others.  I am still awaiting an appointment for my spinal MRI.

I think this post of yours SHOULD be added under your MRI series that will become a link, for other posters, in the future with the aid of MedHelp.

You are most gracious to answer this question with all that you must do to prepare for the holidays.  I thank you.  My PCP wasn't of much help explaining the MRI report to me, even though I have it in my own little hands.  My PCP needs to educate herself and her colleagues, since they know have a patient in their care that has MS.  Knowing what is a problem in my body not associated with MS, and then knowing what is caused by MS, seems to be a problem for them.  I think this can be hazardous to blame everything on MS...

Thank you again my dear and Happy Holidays, Heather

[steeldrum8]

Wow. You explained that really well and I actually understood that. Thanks Megan

[Quixotic1]

Hi, Guys, just a quickie, because I have a lot to get done today.  Bright spots are the same as T2 hyperintensities.  Old lesions show up on standard imaging as lighter than the surrounding tissue.  UBO's are lighter, brighter spots of higher intensity.  Scarring, because it is less dense than the surrounding brain tissue will be referred to as more intense or brighter.  Basically there are equating lighter with brighter.

Enhancement with contrast on the other hand is even mo' brighter.  And when compared to the other lesions seen without contrast looks white instead of light gray.  It's all relative.

You can almost never tell if a given lesion is causing active symptoms.  Reread my essay on whether you can match up lesions seen on MRI with symptoms.

Reading MRIs is an art as much as a science and there is a huge difference between radiologists who rarely look at them and neuroradiologists who did substantial extra training to understand the small variations and the different patterns with different disease processes.  There is no "reference" used.  It's the comparision on the same film and between films of the same patient that allows them to determine old (older than about 6 weeks) but still bright (hyperintense) and new lesions which show up as even brighter and whiter.   The enhancement is also often seen as a ring or rim of increased brightness around a duller gray lesion showing that there is new activity (taking up the contrast dye) occurring around a older, scarred lesion.

Jo, you are correct about the gradations.

This next paragraph is for those that don't think they are confused.  My 1.5T spine films from last February were read by the neuroradiologist as negative - clear.  But, my very smart, intense and thorough Neuro pointed out at least 4 areas on the brainstem and C-spine where he was suspicous of lesions.  To the first look, they looked normal, but then he point out that there was a subtle speckling (a loss of homogeneity - loss of even texture).  When we did the 3T a few weeks later, those exact areas were clear lesions/plaques.

Now this paragraph is for the really adventurous.  I hope I can describe it.  As you look at an regular MRI the outside rim of the brain shows a layer of brightness.  This is the cortex.  The surface of the brain has deep folds and wrinkles, called sulci (sulcus for singular).  Sometimes, there will be a hyperintense area that appears separate from this lighter rim layer.  But if you "scroll" through all the images back and forth, you can see that this bright spot is actually the deepest portion of a fold and is actually a part of the cortex rim layer.  Thus, on one or two images it will appear to be a lesion, but with careful looking you see that it is just a part (a continuation) of another structure that is "brighter" by nature.  

This is one of the many reasons that I believe trying to compare MRI's online to look for abnormalities is folly.  It may be interesting, but, unless you really know your brain anatomy and know how all the different structures, including blood vessels look on MRI, you will likely misinterpret what you see.  IMO.

Should this explanation be added in some way to the series of MRI explanations?  We are going to have all of the helpful essays that Heather and I have written placed in a FAQ section at the top of the front page of the forum, so we no longer need  find and "bump" them.  I will submit them in a cleaned up form to MedHelp after the holidays.

Quix

[cjacks]

Hello,

Is there a reference that is used to chart , calculate the age of a lesion or is it just discretionary ??   What does dye do to an already bright lesion(  the appearance ) ?     Bright ones are active ..  with or without contrast ??  So grey ones are older scarred .and black is empty space where an old one had previously resided   .

Don't worry about confusing me ,  I already am.

Jo

[Heather3418]

Is there a big difference in who reads the MRI scan - radiologist versus - MS Radiologist?  Does it take a person well versed about MS and it's findings on MRI versus a radiologist that has no formal expertise reading films in someone with MS?