MRI reports

[daisy.girl]

I have all the clinical symptoms:
neuro exam:
-hyperactive deep tendon reflexes -positive hoffman's sign -positive babinski-bilateral clonus -absent abdominal reflex -mild ataxia -decreased spinal mvmt -increased paraspinal spasms.
......all of which are abnormal

Also:
abnormal SSEP
Optic Neuritis
normal spinal tap
low B12 (not extremely low 308)

MRI with and w/o gad on a 3T magnet:

the radiololgist report said: a few subcortical white matter lesions T2 hyperintensities non-specfic

then, I took the MRI disc to my neurologist (he does have his own MRI facility, and reads the ones specfic to his field....I however, live in a different town, so I went to the MRI here)

the neurologist read the MRI and stated approximately 10 white matter lesions on flair consistent with MS.

Why the difference? and who is more capable to read these?
I also should mention that my neuro has his own MRI facility....and he reads the ones that are specific to his field....but I live in a different town, and had my MRI done here.

thanks,
sharon

[daisy.girl]

thank you all for your information : ) .... I appreciate it.
So much to learn about this dx, symptoms, and treatment

[shoshin]

I have had it go both ways. When I was dx'd the radiologist read my brain as normal and the neuro said there were a couple "small spots."

However, the radiology report was delayed and the neuro (not an MS neuro) told me he wasn't sure if the spots on my spinal cord were just artifacts (spots that show up as a side effect of the imaging process, but aren't real) or not. When he got the report and the radiologist said they were real lesions, the neuro went with that. He said the radiologist would not have said that if he wasn't sure.

sho

PS I think the prevailing opinion on the forum is that all good neuros read their own MRIs and don't just rely on the radiologist.

[daisy.girl]

thanks again to everyone...

if there are others of you that have had a difference in the readings of the MRI report from radiologist and neurololgist.... or that their neurologist reads their MRI.......I would love to hear about it.

[Quixotic1]

Just a quickie (yes, it is possible) here.  My neurologist found more lesions than the radiologist also.  And when we repeated the MRI on a more powerful MRI, he was right.  The lesions wer much clearer and right where he said they were.

Q

[Fluffysmom]

Hello from me, too, Sharon.

My experience was kind of the opposite; the neuro-radiologist that read my brain MRI said the many hyperintensities were "far and away most likely to be multiple sclerosis".  I started preparing myself for a diagnosis.  My primary care doctor had ordered the MRI, and told me to see a neurologist.

The first one dismissed my lesions and symptoms, said I could come back in a year for a follow-up if I felt like it.

The second one ordered most of the tests, which came back pretty much normal, so I was dismissed as having no need for further neurological work-up, despite new and worsening sensory symptoms.

Next, I saw an MS specialist, who decided on a wrong diagnosis before meeting me, pretty much, though she followed up with me until I asked too many times why more wasn't being done to find out what was wrong with me.

I most fortunately got in with an excellent MS specialist who took a careful history, did a thorough exam, looked at my MRI with me, and gave me a choice of which disease modifying drug to choose.  I started injecting Avonex two weeks later.

The point of this long story (sorry!) is that it took me almost two years from that first MRI report to diagnosis, learning all I could about MS in the meantime.  I was diagnosed with RRMS October 19, 2009 and I still sometime wonder if I really have MS, or if its from my orthopedic issues, or something they haven't figured out yet.

I've joined an MS support group, started going to Gentle Yoga for People with MS, am going to a support group potluck with a speaker from the National Multiple Sclerosis Society, signed up for a Seminar entitiled "Living well with MS:  Your quality of life counts" on March 15.

All this is making it more real.  I've given myself 17 weekly injections, which keep getting easier.  Getting support and information from the great people on this forum have also helped a lot.

I hope you feel at home here.  Welcome!

Kathy

[Lulu54]

Hi Sharon,
Let me add my welcome to the ones you already have here.  It looks like your questions have been answered.

The other point to make between the radiologist and the neurologist reports - my neuro is at a teaching university and just last month repeated to me that the radiologist reports are useless.  Most neurologists want to read their own films.  If the radiologists know that, I believe they do as little as required to be able to bill for reading them and not much more.

You are wise to get that second opinion if you need that for your own peace of mind.  It would be so nice if you can *wish* the MS away  :-)

Welcome again and I hope we'll see you around.

my best,
Lulu

[daisy.girl]

thank you so much for taking the time to answer my post.

I think, some days that I am in denial, and other days, that the dx is wrong. I was in the medical field for 25+ years....so I know that alone makes for me questioning everything. I try to find another reason for a symptom.

for example, I have frequency and leaking urine.....I also have 5 children
                   I have neck/shld/arm tingling/achy......I do have herniated discs
                   I have visual issues........I have history of migraines

See.....I am driving myself crazy!!!

I do like my neuro very much, and he is very thorough, and has a large percentage of MS patients.

however, for my peace of mind, I am going to a Comprehensive MS Clinic 2 hours from my house for a second opinion on March 17th.

Hopefully that will be helpful,
Sharon

[twopack]

Nice to meet you RoH.  I don't think we've met yet.  Welcome.

Yup, ess is so right.  The neuro is looking at the whole picture and that is SO the RIGHT thing.

I read a book recently that talked about how radiographs are read, how much time is allotted to each, and how with the thousands of pictures being scanned (MRI produce LOTS of images) it is difficult to handle the computer well enough to actually see every image.  It's an art, not just a science.  Some radiologists report every little thing.  Some only report bare basic unquestionable findings.  

The book cited studies that indicate a rather high rate of human error.  Many times, the same doctor might report different results after looking at images a second time.  Besides, they just don't have all the corroborating info that is available to the clinician.

I had an MRI 20 years ago that was looked at by a radiologist and two neuros.  They focused on something in the brain stem area that turns out to be a probable artifact.  In all fairness, that was still very early in the years of MRI use.  

I suspect that all three were so centered on that one spot that none of them paid enough attention to the rest of my brain to notice the lesions that were actually there.  Even though the quality of the pictures was far inferior to what you would see today, my MS specialist pointed out lesions that were present then and compared them to my most recent MRI.  

Being recently diagnosed myself, I totally understand the desire to dispute the MS diagnosis now that it has been given.  There are days I am sure it is true.  Other days I am just as sure another doctor will find a "better" reason for all my symptoms.  I'm thinking something more treatable....curable.

It sounds like you have an excellent neuro working with you.  Give yourself a little time to digest all that has been laid at your feet but continue to ask your questions.  I've been told it's a continuous process.

Mary

[essdipity]

Hi again. It seems I didn't really answer your actual question.   :-)

The radiologist says you have lesions that don't particularly look like MS lesions, thus (to him) non-specific. He apparently didn't suggest what else they might be, as often happens. They are, however, located in your brain's subcortex, whch is a place MS lesions are often found.

MS lesions don't have to be 'classic' in appearance. Your neuro has seen many non-classic ones that do indicate MS. He is putting all his info about you together and deciding your lesions fit his picture of MS.

For the reasons I wrote about above, your neuro is the one to go with.

ess

[daisy.girl]

thank you for your reply.

I was Dx on 1-20-10 with RRMS....I guess I just keep questioning the dx.

I don't understand how the neuro can look at the same MRI disc and see ~10 lesions consistant with MS.

but the radiologist only sees: a few subcortical white matter lesions-non specific!!

wouldn't the radiologist say consistant with MS, or suspect?.....but to say non-specific??

[essdipity]

Welcome to our forum.

This is a good question. The radiologist receives the MRI order from another doctor, usually a neurologist. The order generally specifies what the other doctor is looking for, or looking to rule out. Often this is for insurance purposes, since insurance companies will not pay without some good reason for such an expensive test. But there's another good reason for this as well: If the ordering doctor specifies MS, then MRIs using a special set of techniques known as the MS protocol will be used. This is a very detailed kind of MRI  test.

So, that's what the radiologist knows about you, but usually that's the entire extent of his or her knowledge of your case. The tests are done, the radiologist reports on the findings, and his or her job is finished.

Your neuro, on the other hand, knows a huge amount about you. What signs have been found on a really intensive and lengthy exam. What you report about your symptoms. What blood tests and other lab work have or have not revealed, often including lumbar puncture. What the results have been of any ancillary testing, which might have been evoked potentials, nerve conduction studies, VNG, or whatever your case has warranted.

Then your neuro puts together all this information in making a diagnosis. He or also should look very carefully at the actual MRIs to form an independent judgment. Neuros should be able to read MRIs quite well--be very wary of the ones who don't even look at them. They are either lazy or incompetent or both.

And be especially wary of neuros who will not diagnose because the radiology report did not hit him in the head with MS evidence. So many of our members have had this happen.

I realize that all of this might not apply to your case individually, though it may. But we have many new members here who are so frustrated by the process, and who may not quite understand the roles of the various medical specialties.

Wishing you well,
ess