MRI's, Lesions, & Symptoms

[Quixotic1]

MY QUICK AND DIRTY EXPLANATION OF HOW MRI'S SHOW LESIONS IN MS

The Life History of an MS Lesion

MS does it's damage by causing the nerves in localized areas in the brain and spinal cord to lose their protective sheaths, called myelin.  At first, when the myelin is being attacked, the body brings a higher blood supply to the area to fight the attack and the area becomes iswollen and inflamed.  These areas now become "lesions."  At this point, when they are inflamed and blood engorged,  they are called "active lesions."   At first the nerves, themselves,  haven't changed much and they appear (and have the same density) as the healthy areas around them.  The body attempt to repair the damage that is being done and sometimes these areas re-myelinate.  They may disappear from the next MRI.  They aren't perfect in their function, but the area may return to a normal appearance.

If the nerves do not remyelinate and the damage continues, for a long time the lesions sit as scars.  These scarred areas have damaged and dying cells in them, the blood supply shrinks, and the areas become more dense  - more dense than the normal brain around them.  These are the classic MS plaques and are considered old lesions. They show up as the bright areas most of us have seen in pictures and on our films.

If the attack on the myelin sheath is too strong for the immune system to repair, more and more myelin disappears and the area of nerves eventually dies.  Then it contracts and scars.  The blood flow is decreased to that area and the body tries to reabsorb the dead area.  It becomes "less dense" then the surrounding normal nerve tissue.  After a longer time - probably years - the scar can reabsorb completely and the area becomes "empty."  It's called a black hole.

How the MRI Shows These Different Stages of MS Lesions

When you image these lesions with an MRI you can see different things, depending on the technique, the age (stage) of the lesion, the power of the MRI, and whether contrast is used.

The first MRI image is done without contrast.  This technique will show old lesions that are big enough to be seen by the power of that MRI machine.  WE KNOW that many lesions in MS are too small to be seen.  If the newer, more powerful MRI with a 3 Tesla magnet is used many more lesions will be seen (by at least 25%) than on the older 1.5 Tesla machines.  The classic old, scarred, mature MS lesion is a little bit oval, will have well-defined borders and will be in the white matter.  Characteristic places (but not the only places) are subcortical, peri-ventricular and in the corpus callosum.  The classic MS lesion will also have it's long axis perpendicular to the ventricles of the brain.  Also, important and very symptomatic lesions are found in the brainstem, the cervical and the thoracic spine.  The spinal cord ends at the bottom of the thoracic spine, so there is no such thing as a lumbar spinal cord lesion in the normal spine.

The  scarred lesions will show up as light, bright areas.  These are the classic, MS lesions or "plaques."   But, with just the regular MRI image one can NOT say if it is old and dormant or if it has active inflammation in it.

Now the very old, scarred ones that have been reabsorbed will show up as a black (empty) space or black hole.  If there are many of these empty areas the brain will contract around them eventually and show up as a loss of brain volume.  This is also know as brain atrophy.  This is particularly seen in the progressive types of MS.  In brain atrophy there will be an increased space between the skull and the brain.  Also the deep folds in the brain will appear widened.  

However, a newly active MS lesion may not show up on a regular MRI because the area of nerves, though inflamed, is still pretty much intact and has normal brain density.  On the MRI it will look like normal brain.  Without contrast it won't show up and will be missed.

When the next phase of MRI is done the contrast is in the blood vessels.   Anywhere the blood vessels are more dilated than usual,  bringing more blood to the area, as in inflammation, the areas will "highlight"  or "enhance."  They show up as even brighter than the brain around them and brighter than an old, scarred lesion.  So new lesions will show up as "enhancing," or "active".  Also, older lesions, that have undergone a new attack right around them (also called reactivation) will show an enhancing rim or ring.  When you compare the regular MRI to the Contrast MRI you can see this reactivated, old lesion.

That's how some reports can call active lesions or some report no newly enhancing lesions  (these say the same thing).  Also since some new ones heal they can be compared to old films and show they disappeared.  In addition, between different sets of MRI done after a time has passed, the radiologist can see an increase in old and in new activity.

Please ask question where I haven't been clear.

Quix

[joannm41]

I was living in a home where I got very sick with symptoms from the black mold there, I had, and still have some, of the toxic mold symptoms. My MRI showed an unusual brain mass loss in the frontal lobe area, my doctor has given me every test because my symptoms mock those of MS. I don't have MS nor do I have Dementia.  Many people don't realize the seriousness of exposure to mold. I have moved but feel recovery is going to take a long, if at all.

Thank you for all of your info.  Joan

[Buffy813]

Thank you for the information, maybe I will learn how to use this site soon. Just looking for some help and answers to a 2 year old problem.

[Guitar_grrrl]

Hi, Buffy, and Welcome.  You have written your intro on a very old thread that will likely be ignored.  Won't you please introduce yourself in a new thread?  You'll get many more answers this way.  Just copy and paste into a new question.

I'm assuming you've been in touch with a neurologist?

Please have a look at our Health Pages (links on R side of page).  They're a wealth of information, and can answer many questions you may have.

Cheers!

[Buffy813]

I have been sick for over 2 and half years. Ive been diagnoised with Sensory Peripherical Neuropathy back in August of 2011. I lost my job because I couldnt see to be on a computer all day. Extreme fatique and now I have muscle loss in my left leg. Left side numbness and tingling, short term memory loss, fainting, Ive applied for disability, been denied 2 times now its in a lawyers hands. I do not have any insurance I had a MRI last week. It showed a foci with intensive T2 FLAIR in the occiputical part of my brain. Can someone tell me if this sounds like MS or not. I have been to all kinds of doctors and cant get a straight answer from anyone. Please give me some help here..

Thanks
Buffy

[FrenchChick537]

Thanks for your comments.
sorry I didn't want to go on to much for my 1st time on here so only gave a summery.
well here we go.
I was having lots of colds and viral infections/bladder infections that I thought where causing my headaches neck/shoulder pain.
I then had what I can only describe as a funny turn of not knowing what was happening, feeling out of sorts lost/ confused and distant. when I came out of this I had a numbness/tingling down my left side of my face/my left arm would not work correctly I could not hold a pen to write and my leg felt heavy. it felt like my body just would not function?
My GP  did blood work no stroke but noticed my carotid on my left side not right went to see hospital had ultrasound a slight blockage found and given Amlpodline ?  was sent for x rays on my neck/shoulder thinking it could be trapped nerves. all ruled out arthritis/old age(53 at that time)
I was signed off work as my blood pressure was up and down even on my candistartan etc.
I was sleeping(if thats what you could all it) loads but feeling fatigued all the time, could not think straight everything was hard work. Crying/angry/confused.
My legs felt like they would not rest/heavy, my ankles where stiff and I'd suffle along until I felt steady to walk as I was constantly tumbling to the left? I still can only walk a short time until I feel totally exhausted and have to rest. this could last for a few days/weeks then i'd feel a bit better but never my old self.
I then had CT scan all clear 1st MRI was unclear as I was to nervous and it was unclear to read/ neurologist who did'nt do anything but asked about my PTSD and then said possibly  Fibromyalgia or Somatization disorder

[immisceo]

The results make it seem like there is a possible issue with blood flow ('ischaemic insults" is the wording I'm taking that from) which would perhaps be consistent with discussions of mini-strokes. As they've not ruled out demyelination, any interpretation of these results will depend on clinical examinations with your neurologist.

You've not really mentioned the symptoms you're experiencing that lead to the MRIs. Certain symptoms may be pointing them away from suggesting MS. Pregabalin is for neuropathic pain, generally. Is pain something you're experiencing? This would explain why it was prescribed for you. Is the FND you mention Functional Neurological Disorder? That's not mentioned on here too often, so I can't comment with any familiarity on that one.

It can indeed be tricky to get looked at objectively for physical complaints when records list mental health struggles or traumas. Many times members of the forum have gone through a neuropsychological evaluation in order to address head-on that their issues are physical in nature. It can help take certain diagnoses off the table, or more finely focus what issues are indeed on the table.