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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
I have had 2 MRI's and my last one was to exclude demyelination,
I have also been having they think mini strokes,
I have been off work for 18months now as I cannot function with day to day life as I used to, all this just came on when driving one day. but my GP said a lot of the symptoms have been since I had an incident at work involving a gun shooting incident with myself and colleague. I have PTSD from this.
We have paid to see another Neurologist and have shown him my MRI results and info from GP, he said it was nothing in my mind but could be FND?? My GP is flabbergasted by both Neurologist answers and thinks they have pre-diagnosed me on this.
1 Neurologist has given me Pregabalin to take, if its nothing then why this medication.
We are in desperation, as I just want my life back.
Below is the impression from my MRI.
Multiple subcentimetre bright signal foci in the cerebral white matter* on T2 and flair sequences. These foci are of non-specific clinical* significance and might represent chronic focal ischaemic insults but* possibility of demyelination cannot be entirely excluded.* A correlation with clinical presentation is suggested.
I have also been having they think mini strokes,
I have been off work for 18months now as I cannot function with day to day life as I used to, all this just came on when driving one day. but my GP said a lot of the symptoms have been since I had an incident at work involving a gun shooting incident with myself and colleague. I have PTSD from this.
We have paid to see another Neurologist and have shown him my MRI results and info from GP, he said it was nothing in my mind but could be FND?? My GP is flabbergasted by both Neurologist answers and thinks they have pre-diagnosed me on this.
1 Neurologist has given me Pregabalin to take, if its nothing then why this medication.
We are in desperation, as I just want my life back.
Below is the impression from my MRI.
Multiple subcentimetre bright signal foci in the cerebral white matter* on T2 and flair sequences. These foci are of non-specific clinical* significance and might represent chronic focal ischaemic insults but* possibility of demyelination cannot be entirely excluded.* A correlation with clinical presentation is suggested.
I was reading your comment and found it interesting. I am 30 yrs old and having MS symptoms. Supposed to have had a stroke when I was little and had an mri and cat scan of brain with 1 lesion in one place and went for mri of brain with 1 lesion in another place. Been to 2 neuro's saying that it was just a stroke but totally not understanding why they would come and go. Duh, being through this for 2yrs and no dx yet! Do you have any advice for me?
Many Thanks Kyle! I did not take notice of dates, until it was to late. Want to keep people informed. Thank You, Jeannie
Hi Calming - Welcome to the forum. The thread to which you responded is a little old. Some of the posters may no longer visit. I just don't want you to think they were ignoring you :-)
Kyle
Kyle
Firstly, your story surely struck my Heardcord. I have been a nurse for 30+ years and have done extensive research on fungi and mycotoxins. Some researchers have published papers stating that fungi and mycotoxins are the cause of multiple sclerosis. I myself, have been exposed to fungi at the workplace when they started mold remediation. Been to several physicians and they are puzzled and literally fed up with me. Finally, got an MRI of the brain that showT2 hyperintense lesions within the white matter in both a perventricular and subcortical distribution. My family physician referred me to a Neurologist, which I will see next month. I took it upon myself to do a mycotoxin urine test and sure enough I am positive. Mycotoxins will demyelinate the Central Nervous system. The brain is 60% fat and mycotoxins like the brain. Took my mycotoxin urine test by calling EHAP Labs.
2012: Can you give me your opinion please I would so appreciate it. Multiple area of abnormal increased T2 and flair signal present in the strip white matter. There is periventricular predominance and demyelinating disease is suspected. Chronic microischemia changes not totally excluded. There is mild atrophy of the corpus callosum. No lesions are identified in the posterior fossa.
Diffusion weighted sequences appear normal. The ventricles are normal size. No mass or midline shift. The cp angles are clear, the craniocervical junction appears unremarkable.
IMPRESSION: Nonspecific white matter signal abnormalties in the cebral hemispheres. Demyelinating disease is favored over chronic microischemia changes.
2005:Flair and T2-weighted images show several small foci of hyperintensity in the cebral white matter. These are most prominent in the peri-atrial areas. This is not a specific appearance in a patient this age, ddelineating or chronic ischemic change might be considered.
IMPRESSION: Multiple areas of T@ hyperintensity in the cerebral white matter as described.
Why can't they we understand this, we have the problem. I realize if any of you would help me with this, it would be just an opinion. Thank you so much!
Tags: MRI Brain question
Diffusion weighted sequences appear normal. The ventricles are normal size. No mass or midline shift. The cp angles are clear, the craniocervical junction appears unremarkable.
IMPRESSION: Nonspecific white matter signal abnormalties in the cebral hemispheres. Demyelinating disease is favored over chronic microischemia changes.
2005:Flair and T2-weighted images show several small foci of hyperintensity in the cebral white matter. These are most prominent in the peri-atrial areas. This is not a specific appearance in a patient this age, ddelineating or chronic ischemic change might be considered.
IMPRESSION: Multiple areas of T@ hyperintensity in the cerebral white matter as described.
Why can't they we understand this, we have the problem. I realize if any of you would help me with this, it would be just an opinion. Thank you so much!
Tags: MRI Brain question
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