MRI report Quix or anyone who knows MRI's??help

MRI OF THE BRAIN WITHOUT AND WITH IV CONTRAST
INDICATION: Reported diagnosis of multiple sclerosis several years ago. New onset of left eye visual disturbance and left leg difficulty.

TECHNIQUE: Multiplanar and multisequential MR images were performed through the brain without and with the administration of intravenous contrast. Magnevist 15 mL.

COMPARISON: Correlation is made with a report on unenhanced and enhanced MRI of the brain and orbits performed on 06/26/2007 at the Community Hospital of Bremen. This prior study was unavailable for direct comparison ac the time of dictation.

FINDINGS:
There is a 3 mm punctate T2/FLAIR focus in the centrum semiovale of the posterior right frontal lobe which demonstrates minimal peripheral enhancement. Given lack of prior imaging for direct comparison, it is indeterminate whether this represents the prior reported focus of increased FLAIR signal in the subcortical right posterior frontal white matter which demonstrated enhancement as indicated on the report on the unenhanced MRI of the brain and orbits performed on 06/26/2007 or if this is a new finding.

Although nonspecific, in the proper clinical setting, this may represent a focus of acute demyelination. There is minimal ill-defined T2/FLAIR hyperintensity in the periventricular whitematter of the bilateral cerebral hemispheres however with no definite well defined focus demonstrated. There otherwise are no other definite abnormal T2/FLAIR hyperintense foci identified in the cerebral white matter.

No definite infratentorial foci are demonstrated. The orbits are grossly unremarkable in appearance however this study was not tailored for examination of the orbits and given findings compatible with right optic neuritis as reported on the prior MRI of the brain and orbits and given reported new left-sided visual symptoms, an MRI of the orbits without and with IV contrast is recommended for further evaluation.


There ia otherwise no mass, mass-effect or abnormal extra-axial fluid collection. Diffusion imaging shows no hyperacute, acute, or early subacute infarction. The ventricles are normal in size, shape and position. There are normal signal voids within the larger intracranial vessels.

There is minimal mucosal thickening in the bilateral ethmoid air cells otherwise the included paranasal sinuses and mastoid air cells are predominantly clear. The marrow signal pattern in the skull base and calvarium is within normal limits.

There is otherwise no definite abnormal intracranial enhancement.

IMPRESSION:
1. There is a 3 mm punctate T2/FLAIR focus in the centrum semiovale of the posterior right frontal lobe which demonstrates minimal peripheral enhancement. Given lack of prior imaging for direct comparison it: is indeterminate whether this represents the prior reported focus of increased FLAIR signal in the subcortical right posterior frontal white matter which demonstrated enhancement as indicated on the report on the unenhanced MRI of the brain and orbits performed on 06/26/2007 or if this is a new finding.

Although nonspecific, in the proper clinical setting, this may represent a focus of acute demyelination. There ia minimal ill-defined T2/FLAIR hyperintenaity in the periventricular white matter of the bilateral cerebral hemispheres however with no definite well defined focus demonstrated. There otherwise are no other definite abnormal T2/FLAIR hyperintense foci identified in the cerebral white matter.

No definite infratentorial foci are demonstrated. The orbits are grossly unremarkable in appearance however this study was not tailored for examination of the orbits and given findings compatible with right optic neuritis as reported on the prior MRI of the brain and orbits and given reported new left-sided visual symptoms, an MRI of the orbits without and with IV contrast is recommended for further evaluation.


2 . No other definite acute intracranial abnormality or abnormal intracranial enhancement is demonstrated.
3. Minimal mucosal thickening in the bilateral ethmoid air cells.

[LATW]

Sorry it is so long.  I sent the prior MRI to them for the comparision.  There are things on this MRI, periventricular mentioned, that was clean on the previous MRI's.  So even on the DMD's I am showing some new things.  Wish they had done my eye orbits with this MRI!!!!!

Any help would be appreciated.  My doctor is out this week but will be working on it next week.

My unofficial opinion is I am showing some new things in this compared to my other MRI.  I can post that one too if anyone wants to see it.  
Thanks,
LA

[Lulu54]

Hi LA,
at times like this I wish we had a radiologist on call - they spend years and years studying how to make these reports incomprehensible to the rest of us!  :-)

Actually, what I read here doesn't sound too bad, when it is put into the framework of having MS.  The lesion on the front right lobe, if it is vaguely enhancing, means it is aging and not active at this point.

Would having your orbits imaged for ON be worthwhile?  Would it change the dx or treatment for you?  It might be something to talk to your neuro about including the next time you have imaging done.

be well,
Lulu

Remember that the DMD's we jab ourselves with regularly are not going to stop our MS from progressing - they just slow it down if we are fortunate.  DMD's are not a cure - here's hoping we get one of those soon.  

[LATW]

HI Lulu
I doubt very much that having my orbits looked at would change anything.  I am having a horrible time with my eyes even though my eye doctor says they look good.  

I just said that about my eyes because I was already in the machine.  I have had my eyes done before when I had ON twice.

This MRI is showing more than the last one did.  I am just wondering if this report plus my abnormal neuro exam and ON will secure my diagnosis.  That is all.  

I have a pin point spot on my MRI in the my right frontal lobe in 2007. There was debate as to if that was a lesion or something to do with high blood pressure.  So not it is large enough to measure.  

I have nothing in the Peri vertricular area in the 2007 or 2008 MRI scans.  I just assume the changes mean the MS is active enough to show changes in my MRI although they are not huge.

However I am struggling physically with whatever changes or activities that are happening.  

I have great difficulty with walking.  My big question is IS this consistant with MS?  So I can put that question to rest I hope.

[Fluffysmom]

LA,

I wish I could say one way or the other.  It does sound to me that the 3mm hyperintensity in the centrum semiovale, if it is the same area as the previous in point spot, would indeed show change.  

Lulu said the vague enhancement says that it aging and not active at this point.   Was it active, growing from that pinpoint spot?  That question can only be answered by the radiologist and your neurologist.  

My guess would be that the periventricular stuff is still too nonspecific.

I know it hurts to wait.  I know you want that LOCK on your diagnosis.  You've been diagnosed for quite some time, haven't you?  Feb. 2008; wow, that's when all my stuff started.  

Take it easy, LA.  I think they should give us a diagnosis that we can frame, like a diploma.  I swear, we take enough tests to earn one!

Kathy

[LATW]

It was Feb 2008 when I was dx'd and started on Avonex.  I have had progression since my  ON first started in May of 2007.  I was tossed about by two different neuros.

So this is reliving that night mare again.  

The one thing my nuero did tell me is he was sure this is MS because of the ON and abnormal nuero exam.  My first MRI was abnormal with ON and that spot.  

Anyway.  I am miserable today.  Partly because of this and partly because I am having a lot of abdominal  pain and am waiting on my c-scan results.

I have not gall bladder, no appendix, had a hysterectomy.  So that does not leave many other things.  My iron is low so I am losing blood somewhere.  I just want to sleep.  

LA