How long does an MS plaque stay visible on MRI ?

Would an MS plaque on a 1996 MRI  WITH contrast still be visible on a 2008 MRI ?  If so, how would their appearances differ, especially if the 2008 MRI was WITHOUT contrast.  I guess I want a basic understanding about the demyelinating process and how and when are they seen on an MRI.  Do old plaques have a discrimminating appearance compared to new ones ?

[Deb61]

I can't give you any medical expertise, but I can tell you what I've noticed from one MRI to the next.  The new lesions will enhance with contrast and appear as white spots on the MRI.  The old lesions will sometimes be there and sometimes not.  Some of my old lesions after several months have grown and sometimes they appear to have completely disappeared.  As far as that many years, I have no idea about whether it will still be there that long afterward.  

I forgot--how come you couldn't have your MRI with contrast?????

Here's a really good article about MRI's and brain lesions:

http://spinwarp.ucsd.edu/NeuroWeb/Text/br-840.htm

It says that enhanced lesions are present 8-12 weeks after they appear.  

Deb

[tot_teacher]

Thanks for the post.  I'll check out that article.  I was unable to have contrast because when I showed up for my appointment they kept asking me whether I had my bloodwork done (to check liver/kidney function prior to contrast).  Obviously they lost my paperwork and were unwilling to order the contrast without it.  Meanwhile, since I'm not "dragging a leg behind me" my neurologist I just saw in Chapel Hill doesn't seem to believe I need one.

History of probable MS plaque 1996
Questionable areas on MRI (withOUT contrast) in 2008
Visual scotomas in both eyes
Dizziness/Lightheadedness when overheated
Eye pain (upon moving R/L up/down)
Late afternoon fatique
Double/Blurry vision
etc. etc. etc doesn't seem to be enough.

Insert frustration (here)     =)

Thanks for listening!

[Deb61]

I can see why you're frustrated!  I remember when you talked about your vision problems and the scotomas in your eyes, double/blurry vision, with pain on movement.  This is enough of a concern to warrant MRI's with MS protocol.  My first MRI, on a weak open bore machine with no contrast was considered bogus by my neuro.  He didn't even bother to look at the MRI report.  

Did your current neuro indicate when he was going to order a follow-up MRI?   If you aren't going to be follow-up with an MRI within the next six months, I'd see an MS specialist or different neuro.  Your current neuro sounds lackadaisical and/or incompetent.  My current neuro says that contrast is needed to monitor lesion activity.

Deb

[tot_teacher]

The whole reason I went outside my small town for my neuro appt was hopefully to bypass all this and see a neurologist who would have the experience and knowledge to navigate such a complex and MISUNDERSTOOD disease.

I knew I was in trouble when my PCP told me you can't diagnose Optic Neuritis on an MRI because it's not visible on one !  WHAT ?!  

I end up with a neuro ( even though at a huge teaching hospital ) who is probably 28 year old and all he did was test my arm/leg strength and asked some questions.  He did order some bloodwork (because they lost my notes from my PCP referral) which again, was all negative.  He assured me I had nothing neurologically wrong and sent me home.  After he perused the rad's half-a**ed MRI report from the MRI without contrast which had "thick" slices.

I see my PCP in November for my annual physical and will wait til then to speak with her face-to-face re: where do we go from here ?  I hope she's at least read up on MS a bit before then.  If anything, I think I should at least see a neuroophthalmologist to look further into the scotomas.

Thanks again.
- Alisa

[lbradley35]

To: tot_teacher,

I totally agree with Deb.  You need contrast to see the lesions and if the doctor is to lazy to order it....then I would move on.  This is your life he is messing with and MS is not a fun disease to have especially after multiple exacerbation's.  I have had to leave a neurologist due to his incompetent/lack of care for my disease.  I have permanent damage due to staying with him so long.  My fault!

I now see a MS specialist and she has helped make my life better by new medications(Tysabri) she has placed me on and the frequency of my visits and MRI's. I was diagnosed at age 25 and I am now 39 years old. On my last MRI in March 2008, the old lesions could still be seen and the contrast made the new lesions really standout. The numerous amount of lesions I currently have (from going without treatment) has caused me to have bi-lateral brain damage - all within a two year time period.

Please don't risk your health over this incompetent doctor, it is not fun waking up one morning to find out you are paralyzed on your left side.
There is no guarantee with MS you will recover from the damage caused by an exacerbation, take it from me I am living proof.

Lori

Lori

[tot_teacher]

Believe me, I intend to "keep the fire burning" under all of them.  When a neuro told me 13 years ago to ignore my scotomas because they are just signs of a migraine phenomenon ... learn to live with them   I could kick myself for believing him.  Why wouldn't I ?  ( I was only 25)  Meanwhile, my one scotoma has become 12 and my body feels as though I've got every MS symptom imaginable.

I do NOT intend to ignore ANY SYMPTOMS any longer and WILL INSIST on a proper diagnosis ( of whatever it is ).

Lori -
Thanks for your sound advice and stay well.
-Alisa

[Udkas]

Hi there,
While we are talking about MRI scans I also have a question.  My Neuro has never ordered contrast (seeing  neuro 2) but he hasn't ordered contrast either, the reason he gave me was that you need to be symptomatic for it to be of an advantage?  Usually by the time I see him it is after the event but everyone on this forum seems to have them with and without contrast? And you are all saying to Alisa to have it with contrast, I thought that there was no advantage of contrast for old lesions??  I will ask my daughters boyfriend he is a radiologist who is best friends with the MRI radiologist (Handy Ha). but she has just started dating him, don't want to overload him too much...:-)

In answer to old lesions my neuro told me that when I had symptoms 13 years ago that the machine and the pics were so crappy that they prob didn't show them as technology just wasn't good enough but they are there and he still believes they are there irrespective of the MRI results.  I wonder if they can heal like any scar over time, and become less obvious if you have no further demylination???  apparently it is all timing of the MRI, too soon, it misses them and too late perhaps they aren't as detectable.  Dunno but my MRI are clear and he says they are there., lesions that is. Scheduled for another MRI in 2 weeks.  He did say a suspicious are on last MRI but he believed that was from 13 years ago but now he says I have definately got worse!  I know I have got worse!

Good luck, keep asking questions, a good Dr should answer them or find out if they can't answer them.

Cheers,
Udkas.

[lbradley35]

Just because there is no lesion on your brain doesn't mean there are not lesions on your spine.  I would request the contrast because it really highlights the lesions. I think your doctor is doing you an injustice by not ordering contrast...its just a shot of dye and it makes the MRI easier to be read by the radiologist.

I would inquire about the MRI with contrast on your next visit.  I know some neurologist like to read their own MRI's, so I would ask the doctor who read the MRI and could you get a copy of the report.

Lori

[shoshin]

I don't think there is any advantage to contrast for old lesions, but you can have new silent lesions that aren't symptomatic so you should still have it. Are you dx'd? If not, it's especially important as lesions that enhance with the contrast can count as evidence for dissemination in time. The health pages have a lot of good info about your other questions (like why the lesions might not show up on MRI).

sho

[Udkas]

Hi from Udkas,

I think it's too late now to get it with contrast this time as it is already scheduled for a fortnights time.  He is not doing my brain this time, he did 12mths ago but he just refers to it as Transverse Myletis, and reckons that I have had another attack as he is finding abnormalities that he didn't find before, he did find abnormalities before as well.   I do get face symptoms tho, double vision, nerve pain at back of eye and burning, and some numbness,

but I must admit most of my symptoms are from the Navel down, bladder dysfunction, weakness, numbness etc., but I do get some arm weakness, pins and needles in my hands/numbness.  

My first neuro told me he thought it was MS, then when My MRI was clear 13 years ago he said I couldn't discount it out, then he told me later he thought it wasn't MS but neurological based? He (the first neuro) thought that with the amount of symptoms I had something should have shown up on MRI. But the machine was **** back then, I had Lumbar puncture that was normal, I had EVP they were abnormal, reflexes abnormal, vision field test abnormal, optic discs pale, although this neuro reckons my discs are normal  and so did last neuro but the ophomologist reckons they were pale. This neuro reckons there are lesions there, he is certain they are in my upper spine ( thoracic i think) I think this is based on my physical exam and findings.

It is now 12mths since last MRI which was brain and spine and was on a T3 brand new machine. I think at the time it was the best one is Australia! Nothing showed! This time I am having a different  machine also brand new!  My cervical, thoracic and my lumbar, not sure if I want it to show something or not!  I am confused!  Want a diagnosis but don't want it to have got worse...

MMmmm will talk to neuro about contrast and daughters boyfriend.

[Deb61]

I'm a bit loopy from medicine, but if I respond it will bump this message up.

There's no advantage for contrast with MRI's of your spine, that I'm aware of--just of the brain.  

Someone else, I'm sure will have a better explanation.  

Deb

[essdipity]

First they do the MRIs without contrast. Then they inject the dye and do the whole thing over again, the idea being to see which of the lesions are new. Only lesions formed within weeks (maybe 6 or 8) will highlight with contrast. Neuros like to see a correlation between new symptoms and new lesions, but often there just isn't any. And since there is usually quite a lag time (to say the least) between the time we experience symptoms and the time we actually see the neuro, who then orders the MRI, new lesions often get 'old' in a hurry. That's why the big majority of lesions will not highlight.

Old lesions often do seem to disappear. That's because they heal to some extent, and thus are not visible to the degree needed to show up on MRI. As Quix explains it, the healing is not perfect, though. Please read the Health Pages about this whole process. I think it will become much clearer.

ess

[Heather3418]

When an MRI is ordered when MS is suspected, it should always be done using "MS Protocol."

The MRI of the brain AND spine should be done with and without contrast.

OLD lesions can and WILL show up on MRI years later.  Mine of 1996 (5) of them are still visible on MRI today.  Those lesions are considered SCARS.  This is what is meant by Sclerosis.  It is true that some lesions will heal over time and no longer be visible on MRI.  Or they can reduce in size.  When compared with your old MRI's, it can be seen that some healing has taken place.  Healing and the ability to replace myelin happens quite often early in the disease.  As the disease, the body becomes less and less able to heal the "eaten" areas with new myelin.  Even the "new" myelin cannot do a perfect job and you may be left with a lesion that is now smaller when seen on MRI.

Contrast dye shows newer lesion activity, just as "ess" says.  She is also correct when she says that by the time we report new symptoms and our MRI's are finally set up, the lesions from that attack may no longer be visible.  

As time passes, lesions, as I said, are less able to heal on their own and are replaced with scar tissue.  The electrical nerve impulses through these damaged areas are less and less able to send the signal quickly and efficiently and sometimes, the "message" fails to get through the scar tissue at all, with permanent damage to that area.  The brain looks for another pathway to use, to get the "message" through.  Again as time passes with this disease, the brain is less able to make new pathways.  This is when you are more apt to see permanent disability.

Quix's article about lesions under the "Health Pages" in the upper right hand corner, is worth a thorough read.

Just a reminder, Multiple Sclerosis means, multiple scars.  Scars from lesions can show in your brain indefinitely, while some do show some healing or shrinking.  It's thought that the area where the old lesion is, actually shows shrinking because that specific area of neurons that has been damaged, actually dies off and is replaced with cerebral spinal fluid.  Known as a "black hole."  Actual shrinkage of brain tissue.  Once it's lost, it's gone forever.

It's all really hard to explain.  I know what I want to say, but it doesn't always come out as I intended.  Sorry if I have confused anyone.  This really is a difficult disease to describe.

Heather

[Udkas]

Thanks, I will read Quixs article.  I am only having spine done, my neuro said there was no advantage for me to have contrast? So that go with Debs comment.  I will ask and find out what the radiologist has to say when I go, my neuro seems to think it's TM that is his  opinion and he seems to be even firmer with that after this visit, he did my brain last time and my spine which was 12mths ago. this will be my 6th MRI.  I keep thinking i have just hurt my back somehow, can symptoms be worsened by twisting etc. if the lesions are in your spine? I would have thought not.  Thanks Guys, really, really, really appreciate the imput..

[Heather3418]

I forgot to tell you that my spinal lesion that showed up in 1995, stil shows on MRI today, but much smaller.  They still use the contrast on all my spinal MRI's.