MRI without contrast and location of lesions

Just reading through some post and decided to pull out my mri report and I had a few questions.  If thought a remember seeing a page on locations of lesions verses symptoms if anyone has that info it would be great!  
My report stated couple of hyperintensities seen in R parietal perventicular white matter, white matter of the left mid temperal lobe and white matter of the anterior left temperol lobe.  small hyperintensities seen in the left cerebellar hemisphere adjacent to the 4th ventricle..
Impression: multiple white matter hyperintensities.  In a patient this age differential would inclue multiple sclerosis.  Consider post contrasted imageds if the possibility of a neoplasm exists.
1.  Are these common locations for MS lesions?  2.   Are hyperintensities and lesions the same thing?  3.  From what I have found online a neoplasm is a tumor.  Wouldnt they have seen this is in the MRI or would i have to have contrast to see this?  3.  So would you guys consider these result a ringer for MS?  My neuro never followed up with another MRI...he did lumbar puncture which showed what I think was 5 oligoclonal bands and started me on solumedrol and gave me diagnosis of ms.   I know I am in denial but it would make a world of difference to me if you  would give your opinion and say Oh yes, he's right those things definitely say MS .... or u didn't necessar ily agree adn would seek second opinion.  

[Lulu54]

Tammy, unfortunately there is no one who can say that the doctor is absolutely right, including the doctor himself, because the ultimate confirmation of MS can only be done post-mortem on the autopsy table.

But from everything you have described, I would agree with the doctor on your case.
If you have doubts and want to be double sure, there is absolutely nothing wrong with seeking a second opinion.  Or even a third.  

It is quite the diagnosis to live with and we encourage everyone to learn as much as the can to take the MyStery out of this disease.  Knowledge is power and this is the first step to regaining some control of your life.  


good luck in sorting it out,
Lulu

[tammy197238]

How do I take the mystery out of the disease?  I have been reading alot of information online and even got the free book MS for dummies that came with my avonex starter kit.  I havent found anything online or in book about if hyperintensities and lesions are the same thing.  I am from small town and there is one neuro office that is 40 miles away.  I'm kind of leary about asking for second opinion since i would have to get it from a neuro in the same office.    I know this sounds silly but I almost wish I would have a second attack so I could come to terms with the diagnosis and say ok...i know now this is what I have.  

[jujuminx]

I cannot help you with the medical part other than to say that based on what you wrote, I would agree with your dr.  Your emotional reaction is what I am really responding to however.

MS is a very serious disease that none of us want. Unfortunately uncertaintly is part of it. Since dx's are hard to come by (we have a lot of limbolanders here) and it comes only with eliminating a lot of other mimics, it can take years to dx.

If you have been relatively healthy and you are still young, it can take the wind out of you. Really? MS?  I don't feel like I have MS. Can't be, can't be my body is attacking itself, can it?

As Lulu said, get a second if you feel the need. You don't need to do it immediately though. Sit with it, live with it. Do whatever research makes you feel comfortable. Sometimes it just takes time for the head, heart and body to get in sync.

Hopefully, in spite of your "silly" wish, another attack may take years to come. Pray that it takes decades.  Denial is fine as long as it doesn't make you stop taking your dmd's and taking care of yourself.

Many of our members get second opinions out of their area, sometimes out of state.  The only one setting the limits is you. This is your life, take control of it.

Good luck and keep coming back here.

Julie

[Lulu54]

It seems to be that it takes at least a year to wrap your brain around having MS and figuring out how to make peace with it.  Even then, you still can have those nagging doubts and be full of questions.  I know I still am.  

We're all taking treatments of one form or another hoping that the next attack doesn't happen.  But I do understand whatr you are feeling.  Proof is so hard to come by with this disease.

Julie is right - you're the one in charge, as hard as it is to picture right now.  Take it slow and when it feels right, you will know the next step.

be well, Lu

[COBOB]

MS lesions are hyperintense on T2 and other Inversion Recovery Sequences on MRI.  Not all Hyperintensities are MS lesions.  MS lesions are only hyperintense on T1 after the administration of Gd-DTPA paramagnetic contrast if the lesions are less than about 40 days old.  This is because the Blood Brain Barrier is still leaking and allowing Gd to "leak" from the blood vessels into the brain near the lesions.

The OC-Bands indicate that your CNS is producing unique antibodies not present in your blood.  As far as I know, neoplasms do not do this.  So with periventricular hyperintensities and OC-Bands, if you have the right clinical exam and history, there could be enough there for a neurologist to call MS.

Bob

[tammy197238]

Thank you lulu, Julie, and bob for your responses.  Its not what I wanted to hear...that would hve sounded more like " I don't think there was enough for a diagnosis."  But I appreciate your honesty.  
  I'm not quite sure I understood everything you said Bob.  My PCP ordered the MRI so it was not done with contrast but showed the hyperintensities and I dont think ti was done MS protocol.  I think your saying it could be MS lesions because it was done without contrast?
I guess I really need to write down questions for my neurologist when I have my follow up in November.  I was just kind of in  a daze and also intimidated at the initial visits.  Whenn I did ask questions I didn't understand his answers all the time because it was as if he was speaking to another doctor and not me the patient who didn't understand all his medical terms.  Even though I brought my husband along as a second set of ears it didn't help because we both came away confused about things.
I am working on coming to terms with this diagnosis.  There are days when I think I'm close and then there are days when I'm so far from being settled.  There are days I'm mad and days when I'm sad.  I wouldn't blame my husband if he decided to move out because my emotions are all over the place!  Coming to this site has really helped me alot though.  It was funny tonight when he left for work he peaked at my screen and saw I was on here and said "tell your friends I said hi"
Its hard for me to talk to him about symptoms, or doubts, or sadness, or anger because he doesn't understand like someone who is going through or has gone through the same thing.  I feel like I'm boring him or I'm not coming to terms quickly enough for his liking. Well i better go to bed as 6am is quickly approaching and i've stayed up too late rambling!  Thanks for listening!

[COBOB]

Contrast is one of the most misunderstood things with MRI.  Demyelinating lesions will show up on T2 and FLAIR sequences.  If you are given Gd-DTPA, and the some of those lesions now show up as "enhancing" on the T1 sequences  (they would not have shown up there without the contrast,) those lesions are "active" and less than about 40  days old.  The only thing Gd-DTPA does is helps to show the age of a lesion.

Bob

[tammy197238]

Thanks for clarifying.  I didn't realize the contrast only showed the age of a lesion.  So the ones that showed up on mine are old lesions so I shouldnt be surprised if he does a followup mri and orders contrast that there might be a few more because the first mri only showed those older than 40 days.  thanks for your explanation I think I understand now.

Tammy

[COBOB]

The first MRI (without contrast) show every lesion that the MRI can see in T2 and the other inversion-recovery sequences.  It just doesn't tell you if any of the lesions show if any of those lesions are less than about 40 days old.  Gd shows the subset of all of the lesions that are less than about 40 days old in the T1 sequence.  Some insurance companies will not pay for Gd-DTPA (contrast) until you have lesions on an T2/inversion-recovery sequences of an MRI.  It saves them a good amount of money.

All the lesions that can be seen, will be on the inversion-recovery sequences.  Gd-DTPA spins faster than H+ protons in T1 pulse fields, so if it leaks across the BBB at an active lesion, it will be hyperintense in a T1 sequence.  That lesion should also be hyperintense in a T2 or other inversion-recovery sequence.

Bob

[tammy197238]

LOL...Ok bob your starting to sound alot like my neurologist!  I really dont know what t2 and inversion recovery sequences or subsets are.  But I think your telling me that even though my first MRI wasnt MS protocol or  done with contrast that it showed every hyperintensity or lesions that I had.  I hope Im understanding you correctly.  Sorry I'm so slow...I just dont understand all the medical terms and thats where I get lost when talking to my neuro!!  
How do you know so much!!  Your knowledge amazes me!  

[COBOB]

I used to repair, inspect and calibrate MRI, CT, X-Ray, Ultrasound, SPECT (and other nuclear medicine cameras,) and mammography when I did Biomedical Engineering for the Department of Defense. I also worked on lab equipment including chemistry analyzers, ELISA, flow cytometry, cell counters, blood gas analyzers, etc.  

I also spent 12 years as a US Navy Hospital Corpsman and I was an Enlisted Surface Warfare Specialist.

Bob

[tammy197238]

Bob,
I knew there was a reason your answers were so technical!!  I'm so very jealous of your abilities!  I'm the fix it person at our office but it is limited to changing flouresent light bulbs, fixing staplers, printers!  Lol  :)    I also work with some women who don't have alot of computer knowledge, they are in their mid fifties and we just switched to electronic charting so they think I am very talented in the computer field also.  I actually feel kind of intelligent at work....guess only I know the truth!