MRI questions Quix or Others Need Help on this one

[WarKitten2008]

Hi I was wondering if Quix or anyone else could answer this this question for me.

My first brain MRI was w/o contrast no MS protocol.  I was dx’s by a nero with MS
Due to this MRI, and of course ruling out everything else in the world.

It showed a few foci in the right frontal and right parietal white matter.  They also showed on the T2 flair images.
The most prominent focus is seen  in the right frontal white matter measures 3.6 x 2.5mm.

Small foci are also seen in the left side of the pons.  Highly suspicious for a demylinating process.

Also,  a possible focus  of increase signal is also seen in right cerebellum, measures
4-5 mm.

Impressions, demylenating process such as MS or Lymes.


Now over a year later and I have just switched to an Actual MS specialist
Who order an MRI with contrast and MS protocol.

This MRI reads:

That the lesions in the right frontal subcortical white matter and the parietal lobes
Appear unchanged form the first MRI
It says no new activity is found and nothing else is seen. But does state under
Impression that it is a demylentating process.

Ok now here are my questions.

1# Im wondering what on earth happened to the lesions on the pons and the lesion
On the cerebellum from the first MRI ???

2# being the 2nd MRI was done with contrast and MS protocol, is it possible
that the pons and the cerebellum was  not scanned??

3# in the first MRI  it states a possible focus of increase signal is seen in the
right cerebellum.   Why would they state that as possible focus and then  go
on to say   seen in the right cerebellum and then even give the measurements.

These questions are really bugging me,lol and my next appt with the MS
Doc is on the 15th of jan.    He will be giving me his opinion on weather
He thinks this is MS or not at that appointment.
I just want to be prepared to ask him the best questions I can about these MRI’s
Ect. Any help would be welcome.         Thanks   Warkitten 2008

[LATW]

Any DMD's?

[WarKitten2008]

Bumping for friend that is still on vacation this week. So she can read
when she gets back.
Also anyone else that may be intrested.
                                                                Warkitten 2008

[WarKitten2008]

HI Doni and Heather.

Thanks for the replys!  Doni  your so right having a good neuro is extrememly
important and comforting. I have been studing up in here for almost a year now
and have learned a ton. Especially how to deal with the doc's testing, time lines
ect ect. had it now been for this site I would probably still be in limbo.

I cant get on here often in the next few weeks, as I am having out of town company.
maybe just alittle here and there.  I am certianly willing to help answers and or help
anyone I can.  I have pretty much  been through the mill with all of this plus
other medical conditions which I can explain at a later date with more time.
And by the way it's nice to meet you  Doni.

Heather:  Wow its nice to hear from you again. I am so shocked at our MRI
written reports. The mistakes are so blaytent.  Or lazy.  I just cant understand
this kind of stuff.  I wish I knew what kind of crieteria these raidologist go by.
if any lol.
I am so shocked at the amount of lesions the showed on the 3T. you had.
it sounds scarey, but I do agree with you from what I have learned so far
that, it not the amount of lesions, but the location,
Yeesh it make me wonder how many more I have as my MRI were done
on 1.5  yipes

Thats why at this point I have to get my neuro phyc exam I guess the doc
wants to test my cognitive functions, (concidering where some of my lesions
are at) and the fact that Im haveing some small memory issues. short term
ones.   He said he just wants a base line for comparison later.
He is also going to do the EVP again, as the last ones were abnormal.
the new ones will sereve as a base line for comparison later.

All in all he thinks that right now The MS is on a mild course.. and I have to
start excersise program at home cant afford the pt right now.

to many co pays latley,  The MS doc the uro the meds ect...... all in good time.
and and the eye doc.   So many work ups latley.  I can explain more in detail
after my company leaves from vacation,

I hope to pop in for a quick read here and there in the meantime.

Thank you all for your support and insites.  Also please excues any typo's
Talk to you all soon
                                            Warkitten 2008

[Heather3418]

Remember one thing dearheart, it's not the AMOUNT of lesions, it's the LOCATION of lesions that is the main concern..... and what symptoms you are having....are they worse or are they about the same?  An increase in lesions does not always mean more symptoms and disability. The brain and it's ability to adapt to changes, is truly remarkable.  An exciting organ that we really know very little about.  As some doctor's WILL admit.  The good doctor's anyway!

Have a good weekend, precious one.

Heather

[Heather3418]

Update - my radiology report was wrong also.  When I had an apointment with my Neuro on the 13th, she agreed that the report looked like it was dictated in haste and did not complete the full picture.  It said that my MRI had not changed since my MRI of a year ago.  One year ago it was done on a 1.5T machine and this year it was done on a 3T.

The lesion count went from 12 last year to 23 this year.  My Neuro did say that the 23 lesions may have been on the one I had last year, but could not be seen by the weaker MRI.  But the radiologist did not mention this on the report.  She said that 23 lesions should have be noted and commented on.  Size, location, etc., but they weren't.

She took my CD's of both MRI's (that I had brought to the appointment) and is going to be going over them with another radiologist.  I have yet to hear back from her, but it's been less than a week.

I am still amazed what the 3T picked up that the 1.5T did not.  Truly amazing and clear.

Heather

[WarKitten2008]

bump

[doni54]

Hi Warkitten,

Sounds like your appt went well and that you've found a great neuro!  I'm glad he reads his own MRIs too, and explained all this to you.  I'm glad he gave you the answer to your questions.

Hope you will stick around with us and share your experiences.  It helps so much for us to have members who are dx and can help the undx members understand some of the things that are going on with them.

Take care,
doni

[WarKitten2008]

HI All:

Im bumped this thread up to give a recap on the appointment I went to
today for a 2nd opinion on weather I really have MS.   And Well darn,
I still have it, guess its not going anywhere.
But the good thing is I have a fantastic MS specialist that is taking over
my MS care from now on.

Now to re cap on the above MRI's in case anyone is interested.

It seems the problems was with the raidologist;  first off  In the 2nd MRI
he states that he sees a few foci that are unchanged from the last MRI.

He then states, nothing else is found.

So Im wondering as stated in my first post, what the heck happen to the
ones in the pons and cerabellum right????

Well The MS doc looked at this stuff himself today. And here is what he said.

I asked him the same questions I asked above about the dissapearing lesions,
and he look it all over and compares the old one to the new, and says
ummmmm????   well the ones in the pons and the one in the cerebellum are
still there!!!!   they are just more faded now. (He dosnt know how the radiologist
missed that on the 2nd mri. (mris were done at 2 different facilities).

then he goes on to show me several small lesions in different areas and says
that alot of people get these when they age.

And then he shows me the MS lesions in my brain, also the pons and cerebellum
ones.  He also said You have more than a few mentioned in this 2nd MRI report.
there were several.  I didnt ask for a count as I know there are at least more
than 9  I didnt want to get myself up set  anymore than the 9 point.

So at anyrate, I guess he wont send me back to that MRI place again. I think he was
pretty shocked on the raidiologist report.  I am so glad that this doc reads his
own mri's  not only does he read them but he pulled me up a chair right beside him
so I could see and ask questions too.!!
He does say that the ones on the pons and the one on cerebellum are becomming
fainter on the MRI but not completly gone.  
So I hope that anyone reading this will be sure to have a nero that reads their
own MRI's and not rely on the Radiologist reports. All tho I do recommend to all
that you get a copy of that report before your next appt with the doc. So you can
ask questions about it.   Had I not had that report in hand before my doc appt,
I wouldnt have been able to bring the facts about the supposed missing lesions to
his attention.          Warkitten 2008

[WarKitten2008]

Wow Hi to everyone of you!!! Thank you for all the advice and knowledge you
have shared with me.

Yes I will certianly be asking the MS doc, to take a looksie at the pons and
cerebellum area.  

Yeesh I have had a Dx's of MS for almost a year now,  and finally was able
to get a fantastic MS specialist for a second opinion.  Im on edge waitting
for the jan 15 appointment, cant wait to hear what he has to say.

Im guessing that he is going to also say MS, but ya never know he might
put me back in limbo land, or find somthing even worse.   Grrrr I so hate
the wait.

Once again  Thank you all for your answers, it truly helps alot to hear from
you all.  
I will let you all know what happens on the 15Th    Warkitten 2008

[sllowe]

Dagnappit! I just lost my post!

What I tried to say was this:

Yup! Pin them to the mat! I'd love to help!

These radiologists are doing a big disservice to all when they do not describe, in detail, all that is available to their eyes.

As Quix taught us, it takes a lot of hi-fi technology, and advanced software to obtain this level of imaging, not to mention the amount of money that is charged. Cliff note versions are not acceptible!

Well, this is a bit of what I thought I said in my original response... 2nd time is not a charm for me, durrnit!

Wkitten, let us know how you make out - k? Heath, hope you do too....

[Lulu54]

My first MRI reports were so much more involved than my recent followup, but neither test produced really lengthy details of what the radiologist saw.  The first was like a Reader's Digest condensed version and my one in Dec. reads like Cliff Notes.  

I suspect that not much is put into these reports intentionally.  The radiologists just read them to make sure the images are clear. The neurologist then does their own interpretation of the films.  My neuro doesn't even want to have the copy of the radiologist's report - he reads everything himself and doesn't want to be influenced by the opinon of others.

I am under the impression that a radiologist's film reading skills are much more valued by medical specialists other than neurologists.

Just my theories,
Lulu

[WarKitten2008]

bb

[jensequitur]

>  1# Im wondering what on earth happened to the lesions on the pons and the lesion
On the cerebellum from the first MRI ???

Warkitten, lesions can heal up.  It's possible that the lesions from the first MRI have disappeared because they're replaced by scar tissue.

[Heather3418]

You've given me the idea that I should do this with my lazier than you know what, radiologist.  It was one of the shortest reports I have ever received and I have 12 lesions with one I know of, showing a much greater size.  This made no sense to me, even though none of my lesions enhanced with contrast dye.  I compared my old MRI CD with the new one I just got and you can see the differences clearly.  I didn't have to be radiologist to see it, especially after looking at my scans for 13 years now.

I have a Neuro appointment on the 13th (the one year anniversary of my Daddy's death - great timing) and I intend on pining the Neuro down about the inefficiency of these radiology reports.  It SHOWS the laziness on their part, which I think is alarming.  We are the patients...it's OUR bodies that we are talking about and treatment can be changed and diagnosis' changed on the basis of a rad's reports.

Thank you so much for bringing this up to Kitten.  I will follow YOUR advice.  Whatcha say Kitten?  Let's get on board with what Shell suggests.  Sounds like a plan.

Thanks Shell and best wishes to you too, Kitten,
Heather

[sllowe]

Hey Gal,

The best advise I can give you on this is to call the facility you received the imaging from.  Ask them to please provide you with a complete comparison to your prior imaging.  Mention that there was no mention of the 2 particular areas that you are concerned with (pons and cerebellum).

Sometimes they do not mention specifics and instead say "unchanged" etc.

This is what I would do, and I did actually.  It took me more than one time around w/the radiology and my Dr. to nail it all down.

Good luck to you,
Shell

[Heather3418]

It is so frustrating when different radioligists do not describe in detail what they see, when they are comparing MRI's to old ones.  I have that happened to me all the time.  One MRI will say 12 lesions and the next MRI, the radiologist will same it appears that this MRI is baiscally unchanged, then says multiple lesions are seen.

Your lesions are still there is what this second readiologist is saying.  If one or two of your previous lesions are not showing now, that is good news.  The body was able to repair that area.  Seen by MRI, that is.

Trust me the pons and the cerebellum WERE scanned.  They is no way they can miss that area.  Your scan was done of the whole brain.  No one would ever do a partial scan of the brain.

It's best to go over this new report with your Neuro.  Trust me kitten, the MRI i had a few weeks ago, was with a vague report from the radiologist.  He just said that it appears, "unchanged" with slight volume loss as compared with last scan.

I am sure that others will be along to give you their take on this report.  But it really is par for the course for radiologists to write them up, so they sound confusing to the patient.  Once demeylination is seen on the first scan, they are less specific it seems in future scans, about describing lesions.

Heather