Difference between enhancing and non-enhancing lesions

Hey all -

Just a quick question that has been plaguing my mind.  Does anyone know anything about the differences between enhancing and non-enhancing lesions with MRI contrast?  None of my lesions (9 w/ only one > 3mm) enhanced with the contrast.  At first I thought that this was a good thing, but now I'm worried because I have read that the non-enhancing lesions are more consistent with PPMS, and no offense to all of you who suffer with that type, but I am very fearful of PPMS.  Do all lesions enhance with RRMS or only new and active ones?

Thanks in advance for any info!

Katie
p.s. I'm sitting here getting my third and final dose of Solumedrol IV - so far, so good!

[Lulu54]

Hi Katie, this is a great question and I think one of the most misunderstood things about getting an MRI.

Many times people think it is essential that you have contrast for the MRI to make the lesions appear.  That is not true.

The contrast agent will make relatively new/young lesions enhance and that helps the doctors to see if there is current disease activity The timing on lesions to enhance is thought to be about 40 days.  Once they get older than that they no longer enhance.

Whether you have contrast or not, the lesions will still be visible on the MRI (or at least if they are going to be visible, they will be seen with or without contrast.  

Having none of your lesions enhance is a good thing and has nothing to do with whether you have PPMS or not.  It simply means that your disease is not in a active state.  

Where it does become significant whether lesions enhance or not is if you are trying to meet the McDonald criteria.  If you have lesions that do not enhance and also have lesions that do enhance, it qualifies as a separation of time.  Once we are diagnosed, the contrast is used to see activity and to help determine if the current therapy is doing its work and keep the MS quiet.

I know all this is kind of talking in circles - I hope this make sense. Please ask for clarification if it doesn't.  Glad to hear you are almost done with the solumedrol.  

be well, Lulu

[risnerrose]

I think Quix's health page on lesions will answer your question better than I can.

http://www.medhelp.org/health_pages/Multiple-Sclerosis/How-MRIs-Show-Lesions-in-MS/show/23?cid=36

[Lulu54]

Hi Katie, this is a great question and I think one of the most misunderstood things about getting an MRI.

Many times people think it is essential that you have contrast for the MRI to make the lesions appear.  That is not true.

The contrast agent will make relatively new/young lesions enhance and that helps the doctors to see if there is current disease activity The timing on lesions to enhance is thought to be about 40 days.  Once they get older than that they no longer enhance.

Whether you have contrast or not, the lesions will still be visible on the MRI (or at least if they are going to be visible, they will be seen with or without contrast.  

Having none of your lesions enhance is a good thing and has nothing to do with whether you have PPMS or not.  It simply means that your disease is not in a active state.  

Where it does become significant whether lesions enhance or not is if you are trying to meet the McDonald criteria.  If you have lesions that do not enhance and also have lesions that do enhance, it qualifies as a separation of time.  Once we are diagnosed, the contrast is used to see activity and to help determine if the current therapy is doing its work and keep the MS quiet.

I know all this is kind of talking in circles - I hope this make sense. Please ask for clarification if it doesn't.  Glad to hear you are almost done with the solumedrol.  

be well, Lulu

[katie4242]

Thanks so much for your fabulous explanation.  I feel much better about the whole thing.  It might sound crazy, but I think that I've convinced myself that I can handle RRMS, but that if it turns into PPMS, I'm going to have to jump off a cliff or something.  I had my c-spine MRI on Friday and they told me to call for results on Tuesday.  I don't want to call.  Knowing what is there isn't going to do anything but scare me, and not knowing is going to drive me crazy.  I wish that I had a magic 8 ball that would be able to predict the exact course that my disease was going to take.

With respect,
Katie