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MRI's, Lesions, & Symptoms
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
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
Thank you very much from a newbie. I thought I understood what the MRI said as I did a lot of research as well, but it helps to have these terms for when I look it over again. I will need to ask my dr. on Tuesday what T! shortening is though I did ask about "late evolution of the demyelinating plaques" meant and he had stated that this meant they couldn't say how old it was - could have been there a month or 3. Again thank you.
Laney-
You should really post this as a new question as a lot of members, including Quix, may miss it due to being a very old post. If you really would like Quix to answer, you could put her name in the subject line like "non specific changes on MRI, confused! Quix?". Something like that.
I am sorry that I cannot answer your question as MRI's confuse the heck out of me, but I am pretty sure some of the members can help a little. I have not been able to keep up with the forum for a couple months now, but last I knew Quix was kind of in and out, too. So, give her some time to answer you.
I have never seen you yet, so it is nice to meet you. I do not have MS, I was dx'ed with a mimic but stay on the forum anyways. :)
Hugs,
Addi
You should really post this as a new question as a lot of members, including Quix, may miss it due to being a very old post. If you really would like Quix to answer, you could put her name in the subject line like "non specific changes on MRI, confused! Quix?". Something like that.
I am sorry that I cannot answer your question as MRI's confuse the heck out of me, but I am pretty sure some of the members can help a little. I have not been able to keep up with the forum for a couple months now, but last I knew Quix was kind of in and out, too. So, give her some time to answer you.
I have never seen you yet, so it is nice to meet you. I do not have MS, I was dx'ed with a mimic but stay on the forum anyways. :)
Hugs,
Addi
What does it mean if you have "non specific changes" on the brain? I had an mri with and without contrast done last week and the nurse left me a message to let me know the results. I had the mri done to rule out and lesions due to having a lot of recent neurological problems and a past history of possible transverse myelitis. I also have a herniated disc in the lumbar area and also one in the thoracic area. I have two buldging discs in my neck. My symptoms are tingling in my left arm and hand. Weakness in my left arm and my last two fingers go to sleep when I do anything with my arm extended out or above my head (probably related to the thoracic herniation). I do not see my neurologist for two more months! I have really felt like I am left out in the cold with my whole situation. I have continued to work through all of my problems which is extremely hard, especially with the lumbar herniation because the sciatic pain keeps my up at night. Now I get this new stuff from the mri last week and I feel even more at a loss. Please advice me on what non specific changes in the brain mean. I am truly at a loss! Thanks, Laney
I think you should deffinately think about writing a book so you can get paid!!!! I just love reading your posts!!!! Thank You!!!
Thanks from one living in limboland for it seems like forever. I was recently undiagnosed after many years. My neuro retired. I had a MRI completely free of lesions but had lesions (several) in the past especially in the caudate area. Years from now they will figure it out. I just want to continue with Copaxone because it keeps me from having so many attacks. I was told to see a regular neuro. I do not want to go through the diagnosis dance again so I am just laying low. Oh they also suggest but do not diagnose somatoform disorder. Is that why I have the lesions or those T2 really bright spots.
Do some people remyelinate better than others?
Do some people remyelinate better than others?
hi quixotic, i have been a little worried ...i have asked several times but havnt been answered...i know that not every one can be but you seem to be the leading person on here that knows what your talking about.....
ok here goes..i have ddd multi level moderate to severe and i have hypothyroid...about 6 years ago i had hyperthyroid and graves and they did the iodine thing and told me eventually would probably go hypo.....well itdid....ok so now i have pain in the butt that goes all the way down the legs and i cant sneeze or cough without being in a lot of pain in my back....and when i turn my neck one way or the other it pops and a few times i have had like a zap or pop in my head. well my daughter was here today and i asked her to feel back of my head and shew went a little ballestic and told me to get in a doc tomorrow...it is swollen in the back of my head compared to hers.....and sometimes i forget what i wanted to say and its just really driving me crazy.....noise really bothers me to....i have a lot of muscle weakness in my arms and legs and i have experienced what i found out later might have been the ms hug ...oh my thats a hard thing to deal with and also my muscles willcramp up a lot and i get off balance a lot....well i have rattled on enough and if you or someone could have the patience with me and try to explain what all this means i would be soooo appreciative.......thanks for listening debj
ok here goes..i have ddd multi level moderate to severe and i have hypothyroid...about 6 years ago i had hyperthyroid and graves and they did the iodine thing and told me eventually would probably go hypo.....well itdid....ok so now i have pain in the butt that goes all the way down the legs and i cant sneeze or cough without being in a lot of pain in my back....and when i turn my neck one way or the other it pops and a few times i have had like a zap or pop in my head. well my daughter was here today and i asked her to feel back of my head and shew went a little ballestic and told me to get in a doc tomorrow...it is swollen in the back of my head compared to hers.....and sometimes i forget what i wanted to say and its just really driving me crazy.....noise really bothers me to....i have a lot of muscle weakness in my arms and legs and i have experienced what i found out later might have been the ms hug ...oh my thats a hard thing to deal with and also my muscles willcramp up a lot and i get off balance a lot....well i have rattled on enough and if you or someone could have the patience with me and try to explain what all this means i would be soooo appreciative.......thanks for listening debj
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