Doctor thinks I may have MS

[csuslady]

I had an MRI and my MRI shows: "Few foci of subcortical, periventricular and deep white matter
hyperintense T2/FLAIR signal abnormality which are nonspecific
and may be secondary to chronic microvascular ischemic changes. "
Also shows: "normal in caliber. No abnormal brain parenchymal enhancement. A
small focal area of susceptibility signal abnormality within the
left parietal lobe which may represent a small focus of chronic
Microhemorrhage, mineralization or a small cavernoma. "
What does this mean? Docttor says I may have MS.

[jensequitur]

It really does make a difference who reads your MRI! I've seen at least six different radiologists' reports, and some of them use the word 'demyelination.' Some use 'enhancement' when talking about the FLAiR results, and some use 'hyperintensity.' The best thing is to have a good neurologist, so you can eliminate those discrepancies.

[Evalucia]

In my case, my first MRI report stated that I had numerous lesions in the periventricular and subcortical region, with one small foci within the splenium of the corpus callosum which was suggestive of demylineating disease but it also stated that ischemic changes due to my HTN could be a dxs as well.

second MRI showed no enhancement to gad but the impression was "stable lesions"

Third MRI gave no mention of demylineation and it stated that it was due to ischemic changes but it stated that the number of lesions was too great for a person my age (45 years young).

My neuro stated that it might not be ischemic in nature since my MRA was completely normal, my neuroopthalmologist was angry when he looked at the MRI stating that the lesions were clearly not ischemic but demylineating.  

I guess this all depends on who reviews the MRI.  My first neuro exam was slightly abnormal with nystagmus, brisk reflexes.  By the time I went to this other neuro which is the MS neuro, all those problems had resolved and the exam was normal (Go figure)  So I am still in between "ischemic" or "demylineating" with no definite answer as of yet.

[kwarendorf]

I think it's important to choose words carefully. In MS Land enhancement generally refers to the appearance of a lesion in the presence of a contrast element, like gadolinium. Lesions that light up, or enhance in the presence of contrast are likely to have been active within the last 30-40 days. This is a sign of disease activity.

Yes, enhancement is sometimes used in the definition of hyperintensity, but onl to indicate that there is a bright spot seen on the MRI. it generally means that there is a bright spot on a specific type of MRI (T2 FLAIR) but does not give much information about the cause of the bright spot.

Hyperintensities seen on T2 FLAIR images can have many causes including stroke, high blood pressure, migraine and MS. The impressions given by a radiologist are not diagnostic, but based on experience give possible, if not likely, causes for the hyperintensity. They are given in a vacuum and are only valuable when put into context by a neurologist.

Kyle

[HVAC]

Of course to be diagnosed with MS the Neurologist takes your history, your symptoms, your Neurological exam, MRI and other tests. The way Neurologists work is it could be MS until they have enough evidence to diagnose you with MS. I was told by several Neurologists I would be diagnosed with MS someday but none of them would actually diagnose me until a MS Specialist did after following me for a year.

Alex

[immisceo]

Radiologists typically list all potential differentials in an initial MRI, and leave it to the neuro to winnow them down. They take the 'cover all bases' approach more so the 'hedge' approach in my experience. They don't need to hedge as they don't make any diagnoses themselves.  

Demyelination was at the top of that list with my first MRI and several others on this forum. It's nowhere on this person's list while several differentials are mentioned, and they all seem to have the circulatory system in common. Of course, this doesn't mean it mightn't be MS, but as csuslady didn't mention why the MRI was ordered, I just went on the written word.

[jensequitur]

I'm going to have to disagree with immisceo. This is pretty typical for a first-time MRI. When there's no diagnosis, the radiologist will hedge their findings and not say unequivocally that it's demyelination.

Two things:

Hyperintense means that the FLAIR scan enhanced a lesion that was already there. In my experience if a lesion enhances, then there's a good chance that it's related to MS.

Also, a 'few foci' isn't a normal finding on an MRI. It means that there are a few white spots on your MRI. If it was only one white spot, it's more likely to be from a stroke. If it's several small white spots scattered in the periventricular area, then it's more indicative of MS.

I would definitely follow up with the doctor and have a thorough neurological examination. They still run you through the spinal tap and oligoclonal banding test, even though these days they're perfectly capable of diagnosing you from MRI and neuro exam alone.

[SarahL2491]

ischemic, as immisceo says, is not MS, but usually a cardiac term.  There are also many "mimic" diseases that need ruling out with blood tests, etc., and yes, I'd either get a 2nd opinion or look for an MS neuro.  You might ask your doctor to point out why he thinks its MS…..

You didn't mention why they sent you for an MRI, that might help too.  We are MS patients who try and help each other and those in limbo land,

[immisceo]

Is your doctor a neurologist? To be honest, this report doesn't show any of the watch words that usually indicate MS as a possibility such as 'ovoid', 'demyelination', 'lesions' and instead uses many words connected with blood flow/circulatory conditions like 'ischemic changes' and 'chronic microhemmorrhage'.

We're not doctors here, just patients, but I'd be curious if your doctor is basing their opinion on an examination you've had - because it doesn't look like this MRI would have given them the impression of MS being the likely culprit. Best bet is to have a chat with them about their reasoning.