Gadolinium question please:o)

Hi,
Anyone have any insight on this.  My first brain MRI was done on 4/16/09 about 6 weeks after I basically lost my ability to walk or should I say EXTREME lower extremity weakness.  It was done by my first neuro (who called me stupid 4x for not going to the hospital, got rid of her asap).  Anyway it was done without contrast and only showed "several scattered punctate T2 hyperintensities in the periventricular white matter".

Now question:  After 3 or 4 weeks of being fine below the waist last wednesday I had another "attack" if you will of inability to hold myself up.  It is getting better.  Would it be useful to have another Brain MRI w/wo contrast?? Or wouuld this not show anything that wasnt there before.  Im not sure if there had been more on the first time if possibly they would have started to "reabsorb" or whatever they do and were not seen do to lack of contrast.  

Does this make sense?  Any insight appreciated, another appt with new neurologist this am.  No lesions were seen on cervical which was also done without contrast.  Thoracic was done w/wo contrast and still not lesions.

Any as a side note how long do people think these radiologists spend looking at these films??  

And I have read the health pages about MRI's and lesions and gadolinium, just need more clarification, thanks:o)

missy

[Lulu54]

I think your question has to do with the use of contrast - let me know if I'm interpreting that wrong here.

Contrast's sole purpose is to help the radiologist/doctor see ACTIVE lesions - ones that are new or formed in approx. the last 30-45 days.  Those active lesions are visible with OR without a contrast agent.  When contrast is used, the active lesions enhance (or glow!) The old lesions appear the same, regardless.

I hope that is the clarification you were looking for.

my best,
Lulu

[missy142]

Lulu,
But are they always large enough to be seen without contrast?

thanks
mary

[sllowe]

Hi Missy,

I don't think we've met yet. Hello, and welcome!

Sometimes it depends on the machine, the software used, the radiologist, etc.   BUT, if the lesion is seen, and it is active at the time contrast is given, it will appear "enhanced" or lit up on the pictures.....

Lesions do come in all sizes and I'm sure smaller lesions are harder to see, but like you read in the HPs, the machine does matter..

ttys,
shell

[CheeserNurse]

Hmm...so what if you have lesions that don't 'enhance??' Can you still be Dx with MS?? My neuro told me, the OLD neuro who I will never go to again from all my issues I have with him, but he told me that since my lesions that were found and other areas of suspect lesions didn't 'enhance' with the contrast, then I couldn't possibly have MS...there are other issues with him, but what is the research on that??

[Lulu54]

missy,
the punctate lesions as I understand them are small - like pinpoints and very small.  someone correct me if I'm wrong.


There is debate on when lesions become visible.  They're pretty sure that for every lesion visible by MRI there are usually a whole bunch more that aren't visible. I hope that makes some sense.

be well,
Lulu

[missy142]

Shell,

Sure we've met im the girl with all the spine problems, you've answered me several times before:)  I took my pic off maybe that it.

Anyhow think I found my answer. No lesions on the thoracic MRI. The T7/8 herniation that in the past was said to be pressing on the thecal sac is not its pressing on the spinal cord.  I also have cervcial herniations pressing on the cord.

So i believe my puzzle is solved, just found out today.  I will be back to my neurosurgeon next week.  All of my thoracic vertebrae are also degenerated of course but mildly if that makes a difference.  

Im very upset about having a thoracic herniation with cord compression even though the compression is "mild".  It doesnt matter I literally look like i have cerebral palsy when I walk, thats how severe the muscle weakness is.  I almost fall to the ground when it is severe. I have pain right below the sternum wrapping around to the back where your bra would clip.  it is everyday now.   Im quite scared about this and the prospect of what may happen if it doesnt get better on its own, but we will see.  When herniation cross over into spinal cord problems, myelopathy its not good.

thanks for the input,

missy

[missy142]

Lulu,

Thanks, I am having the brain MRI dont with contrast if insurance approved, i discussed with neuro today, although I believe I may have the answer to my problems.  I wrote a PM explaining it and just explained it to shell in this post briefly.

tanks again!
mary

[sllowe]

You see, I'm easily confused! Knock that off! I'm only kidding......  

My gosh, what a mess you have going on there.  I am glad you have some answers now, but sorry for the pain this is causing you.  Funny how they describe some of these findings as mild isn't it.... When they in fact wreak major havoc on your ability to get your body around.....

Hope your appt. goes well next week...

Be careful getting around,
shell

[shoshin]

So far as I know, the gadolinium doesn't have anything to do with the size of lesions. So it won't help see smaller lesions. What it can sometimes do is see *newer* lesions that aren't visible without the contrast. Or mostly, it can show that lesions that are visible without contrast are new because they show up brighter with contrast. If you're not dx'd, this can help with that if some of your lesions light up and some don't because it is evidence for dissemination in space or that the lesions started at different times.

The contrast can only get into the brain when the blood-brain barrier is compromised. I think this is usually associated with acute attacks because this is also when all the messed up immune cells can get into the brain and wreak their havoc. The gadolinium is apparently only taken up by lesions that are actively inflamed.

sho

[shoshin]

PS for CheeserNurse: You can certainly get dx'd without enhancing lesions. I've never had one.

Apparently, the lesions usually only enhance for a short period of time so it's kind of cr*pshoot if you happen to hit one unless maybe you're having a lot of acute attacks.

Anyway, there definitely is no requirement that you have an enhancing lesion to get dx'd.

Also, like Lulu said, it seems that there are lots of lesions that just can't be seen with current technology. And there seem to be other things going on in MS other than the white matter lesions that the standard MRI picks up (like lesions in the gray matter, damage in normal-appearing white matter or NAWM, axonal damage and atrophy).

Some people are even definitely dx'd with MS based on clinical evidence without anything showing up on the MRI.

sho