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MRI of the head questions
Hello,
Great community.  Just a couple of questions, just trying to understand things a bit better:

1. How long does a MRI of the head without contrast take when the MRI is following the MS Protocol? And how do you know if the MRI is following the protocol (will it say it on the report?)?

2. Will "new/active" lesions ONLY appear when a person has an MRI with contrast?  If yes, why would a doctor order a MRI without contrast for someone who is currently experiencing symptoms?

3. Do lesions eventually disappear with time if someone is asymptomatic for many years? Or will they remain on the brain/spine forever?

Thanks-Dean
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572651 tn?1333939396
1)  A brain MRI is going to take 45-60 minutes usuallly, but that also depends on the machine and the software being used.

The order from the doctor should state to use MS protocol.  You might or might not see that mentioned in the report.

2)  new/active lesions show up whether you have contrast or not.  They will be visible regardless of contrast.  The gadolinium used as contrast will only cause lesions to enhance if they are less than about 40 days old.  This indicates a breach in the blood brain barrier.  

3) lesions will heal sometimes, particularly early in the disease.  The body is pretty amazing how it takes care of our injuries.  - think about how the body heals wounds with scabs.  Lesions also heal thanks to the wonderful body, but the repair job is never as good the original layer of myelin.  

Lu

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572651 tn?1333939396
if you want to read the MRI  protocol, it can be found at

http://www.mscare.org/cmsc/images/pdf/mriprotocol2009.pdf



FWIW - I have never had a radiology report list the number of lesions that I have,  Every radiologist seems to do their reports differenlty.
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1453990 tn?1329235026
It really depends on the machine, software and the sequences used.  3.0 T machines take less time for similar sequences.  I had an MRI with contrast on a 1.5 T machine this past Wed.  Even using Classic Spin Echo T1W (slow) 12 min sequences I was in and out in 45 min.

Bob
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956292 tn?1334058469
Hello,


COBOB or LuLu
I hope you do not mind jumping in on this post but I do have a question regarding this. I have gone for second opinion and my new doc is stating my last MRI done without contrast is Highly suggestive of MS....ALL my MRI's were done w/out contrast by old neuro..(He just dx. me w/ suspected TN and put me on Trileptal.)

My question is this: If I have MS will this MRI with contrast only show enhancing lesions because I am in a flare OR can this reveal lesions MISSED on old MRI's (I have 20 lesions at last count and my old MRI's seemed to have never changed or so the reports say) He is also sending me for spine MRI and Spinal Tap Those were never done either.

Jibjen
again sorry to highhjack your post dean520
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572651 tn?1333939396
The use of contrast really confuses the heck out of everyone, at least initially.  It often feels like it is a very important test that has to be done, but in reality it isn't essential.


Without contrast :  If lesions are present and going to be visible by MRI, whether they are new or old, they are still going to be visible.  Note that not all lesions are visible to the technology we have or have in use now.  

Lesions can and do sometimes heal and those lesions are the ones that may come and go on mri imaging.  The repair job to the lesions is not perfect but can be good enough to hide the damage to imaging techniques.

With Contrast:  The lesions enhance with the use of gadolinium if they are newer than 40 days or so.  Lesions that are older than that do not enhance.  

This is useful when the doctor is trying to demonstrate separation in time.  The old lesions will be visible but not enhance.  The new lesions will be visible and enhance.  The difference between having old lesions and new lesions like this is enough to satisfy the requirement that disease activity has taken place over different time periods.

It is absolultely not necessary to use contrast to see lesion activity.

I hope this helps - let me know if you have more questions.  I'm sure Bob can lend a more techical tilt to this answer if you want to know more.

best,
Lulu



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956292 tn?1334058469
Hi,

Thanks, I think I understand..If I am right, it will show him the new ones that were maybe missed before w/out the contrast..to prove there were newer ones..so as to say my old MRI's kept saying no change...? or just the fact that the lesions I have are MS lesions?

I read the Health Pages Quix wrote so I am getting it somewhat


I guess in my case it makes sense for what he is trying to distinguish...
Jibs..
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572651 tn?1333939396
No, the new ones would have shown up, whether you have contrast or not.  The contrast has absolutely nothing to do with whether they can see these lesions or not.

With the contrast agent,

If your MRI was at least 40 days ago, the lesions that were there should have been seen, but that depends on MRI strength, imaging technique, software and the person reading the test.  

I know it can be confusing - just don't try to make too much of whether you have contrast or not.  
best, L
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956292 tn?1334058469
Hi,

Got Ya... I am just getting anxious.. I'll leave it up to him to sort out ;o)

Thanks
Jibs
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572651 tn?1333939396
oops - it appears I missed completing a sentence/thought about contrast.  I'm not sure where I was going with that, so you can just fill in the blank! LOL

It's hard not to be nervous - everyone knows that we seem to get one big shot at getting it right with the neuro to start with and can't help but be anxious that everything is done correctly.

-L
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Thanks for the additional info .
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1045086 tn?1332130022
Hope this little demo works out as I plan it to.

old MRI
   x    x
      x
           x

new MRI
  x    x
      x
  x        x

Contrast isn't necessary to see that there is a new lesion but it looks the same (in terms of brightness) as old lesions.  What you do need is a copy of an earier image to compare the new one to.

If contrast is used and the new lesion appears brighter than pre-existing lesions it indicates the blood brain barrier was broken recently (about 40 days or less) and allowed the contrast to pass into the brain and "light up" the newly damaged area.

If contrast is used and the new lesion looks no brighter than previously visible lesions, the new one has probably been there more than six weeks.

Contrast will not show pre-existing lesions now that didn't show in the past.  A bigger, better MRI magnet or software program could but it wouldn't need contrast to do so.

If he is just looking for a change (any change) there is not much point to being injected with a potentially nephro toxic drug (JMO).

Hope my mock MRI worked and helped a little.

Mary
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Thanks
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956292 tn?1334058469
Hi,,It did..Thanks also.

I guess I have been trying to rack my brain in wondering if the contrast will be to late as my last MRI was done in Jan 2011..when you say (40 days or less) I guess I have no place trying to figure this out as he is the specialist and I should be greatful HE is giving me more answers than my other doc...My hope is wether the contrast is needed or not he gets what he needs from this...

Thaks for your time and patience...

I am new to this with a probable MS dx. I have tons now..

JibJen

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1453990 tn?1329235026
kind of -- Sort of.  Lesions the MRI can image show up on T2 and FLAIR.  Post Contrast enhancing lesions show up an T1 sequences.  So the lesion that showed up on a T2 and enhances on a T1 is a new/active lesion.  That is all contrast does in terms of demyelinating lesions.

Bob
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956292 tn?1334058469
Thanks alot for your input...Boy can this stuff dirve you MADD.. I go Wednesday for MRI with and without contrast and also of spine. This guy is doing things right ;o)

Wish me luck

JobJen
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After reading this 'protocol' info, I am wondering if anyone has ever asked a radiologist to 're-read' an MRI and to submit a second report following MS protocol?  I have asked at my neuro office if i could possibly get an appointment with a radiologist because  the MRI and report seem vague to me, i get no solid answers from neuro, and in a support group another neuro acknowledge that he generally "goes by the report' and often doenst look at MRI himself.
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