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MRI's and gadolinium (contrast)
Today was a wonderful panel discussion with two neuros, one MS RN and the local NMSS president. All of them are women, and it was an open session to discuss whatever topics we wanted. It was absolutely the BEST MS presentation I have been to yet. The one neuro is the head of the Waddell MS Clinic at the university of Cincinnati.
Some of the questions dealt with MRI technology - strength of machines, software development etc.
There was talk about the use of contrast agents in MRIs (gadolinium) and both neuros were emphatic that timing with the contrast is everything .They talked about technicians rushing to finish the MRI's, but it is important to wait long enough for the gad to circulate and enhance active lesions.
When I asked how long that wait should be, the answer was unanimous that it should be 10-15 minutes after the injection before the next series of images are taken.
The techs have NEVER waited more than a minute or two with me - I'll be mentioning that when I go for me next series.
When I get a few quiet moments I will put together a journal entry on the past two MS talk I attended - quite a difference and lots of useful information to share.
be well,
Lulu
Some of the questions dealt with MRI technology - strength of machines, software development etc.
There was talk about the use of contrast agents in MRIs (gadolinium) and both neuros were emphatic that timing with the contrast is everything .They talked about technicians rushing to finish the MRI's, but it is important to wait long enough for the gad to circulate and enhance active lesions.
When I asked how long that wait should be, the answer was unanimous that it should be 10-15 minutes after the injection before the next series of images are taken.
The techs have NEVER waited more than a minute or two with me - I'll be mentioning that when I go for me next series.
When I get a few quiet moments I will put together a journal entry on the past two MS talk I attended - quite a difference and lots of useful information to share.
be well,
Lulu
I was posting this for another question on the forum - within the recommended guidelines adopted for 2009 for the MRI protocol there is the reference to waiting after the gad injection - they say a minimum of 5 minutes
mscare.org/cmsc/images/pdf/mriprotocol2009.pdf
mscare.org/cmsc/images/pdf/mriprotocol2009.pdf
Honestly I have to go looking to be able to give you an understandable expalantion of the difference between hyperintensities (those lesions that appear bright without contrast) and enhancing lesions (lesions that glow because of contrast).
The first explanation I found is here on Medhelp in the neurology forum ....
http://www.medhelp.org/posts/Neurology/Meaning-of-T2-hyperintense-signal-on-MRI/show/296604
"a focus of T2 hyperINTENSITY means that the signal from that area has different tissue characteristics compared to normal brian tissue. Usually this is due to an increased water content of the tissue. Pathological tissue usually has more water than normal brain so this is a good type to scan to pick this up
however it does not reveal any information about what it is although the site and pattern of abnormality does. A few focuses usually does not mean significant pathology and can be due to migraine, hardening of the arteries, high blood pressure or more rarely a demyelinating disease or vasculitis.
A person can have plenty of them and be asymptomatic "
The enhancing of lesions only occur when the lesions are new (less than about 40 days) - I can't explain how gadolinium works, except it targets those new lesions. With the contrast, even smaller, just forming lesions are more likely to be seen (enhancing on MRI).
Old lesions do not enhance. By seeing old and new lesions with the use of contrast, the doctor can track the activity of our MS and also document separation of time, if the patient is still looking to meet the McDonald criteria.
I'm sure Quix can add to this if you need more of an explanation.
I hope this makes sense.
my best,
Lulu
The first explanation I found is here on Medhelp in the neurology forum ....
http://www.medhelp.org/posts/Neurology/Meaning-of-T2-hyperintense-signal-on-MRI/show/296604
"a focus of T2 hyperINTENSITY means that the signal from that area has different tissue characteristics compared to normal brian tissue. Usually this is due to an increased water content of the tissue. Pathological tissue usually has more water than normal brain so this is a good type to scan to pick this up
however it does not reveal any information about what it is although the site and pattern of abnormality does. A few focuses usually does not mean significant pathology and can be due to migraine, hardening of the arteries, high blood pressure or more rarely a demyelinating disease or vasculitis.
A person can have plenty of them and be asymptomatic "
The enhancing of lesions only occur when the lesions are new (less than about 40 days) - I can't explain how gadolinium works, except it targets those new lesions. With the contrast, even smaller, just forming lesions are more likely to be seen (enhancing on MRI).
Old lesions do not enhance. By seeing old and new lesions with the use of contrast, the doctor can track the activity of our MS and also document separation of time, if the patient is still looking to meet the McDonald criteria.
I'm sure Quix can add to this if you need more of an explanation.
I hope this makes sense.
my best,
Lulu
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I'm still confused (lol) so why did my MRI done without contrast show at least one marble sized bright glow and another couple of smaller ones, if its only with use of correctly timed gadolinium that they will light up and show them selves? How did some of mine light up or should i say why did anything light up?
My neuro is saying because i didn't have 'enough' inflamation in my brain thats why he is 99% sure i dont have MS. I know he cant be that sure when its the only MRI i've ever had and it wasn't following MS protocal to start with but is the consensous (sp) of this topic saying only contrast will show current BBB?
I was under the impression that what my MRI showed was some minimul 'new' inflamation (enhansing lesions) and some minimal but 'old' inflamation (none enhansing) which in my neuro's opinion is all irrelevant and meaningless. TWIT!!!
I cant help but wonder if the thoughts i've had regarding the lack of gadolinium with my only MRI is right thinking, should my brain have lit up like a christmas tree if they had used gadolinium? I'm still confused as to why or how the ones that did enhanse so i'd be greatful for any thoughts on this.
Cheers........JJ
My neuro is saying because i didn't have 'enough' inflamation in my brain thats why he is 99% sure i dont have MS. I know he cant be that sure when its the only MRI i've ever had and it wasn't following MS protocal to start with but is the consensous (sp) of this topic saying only contrast will show current BBB?
I was under the impression that what my MRI showed was some minimul 'new' inflamation (enhansing lesions) and some minimal but 'old' inflamation (none enhansing) which in my neuro's opinion is all irrelevant and meaningless. TWIT!!!
I cant help but wonder if the thoughts i've had regarding the lack of gadolinium with my only MRI is right thinking, should my brain have lit up like a christmas tree if they had used gadolinium? I'm still confused as to why or how the ones that did enhanse so i'd be greatful for any thoughts on this.
Cheers........JJ
The hardest thing for me in all of this will be remembering to MAKE the tech WAIT for that 10-15 minutes, after injection. If I remember to ask, I will tell them at the beginning of the whole series, about the wait time and if they don't do it, don't bother scanning me. Period!
I'll be sure to tell them that they are wasting my time and playing games with MY health....as my very treatment for my MS, could be dependent on that 10 minute wait.
All these people that may have had enhancing blesions to show a breech in the central nervous system,Blood Brain Barrier-BBB) that didn't show, because of immediate return to filiming. This could have resulted in someone NOT being diagnosed with MS, because they do not "meet" the criteria of showing two separate attacks over time. Do you understand what I am trying to say? I shudder when I think about those poor people...
Heather
I'll be sure to tell them that they are wasting my time and playing games with MY health....as my very treatment for my MS, could be dependent on that 10 minute wait.
All these people that may have had enhancing blesions to show a breech in the central nervous system,Blood Brain Barrier-BBB) that didn't show, because of immediate return to filiming. This could have resulted in someone NOT being diagnosed with MS, because they do not "meet" the criteria of showing two separate attacks over time. Do you understand what I am trying to say? I shudder when I think about those poor people...
Heather
I actually had a neuro appt yesterday, and was able to ask him this question. We discussed it in detail.
At his previous MS Center in Michigan, he said they were suspicious that in about 4,000 patients who had MRI over a couple year's time, none of them had enhancing lesions. That is zero MS patients with active disease. They re-looked at the imaging technique going on and found that the final set of pics was being taken almost immediately.
He says it takes a minimum of 10 minutes for the gadolinium to breech the blood-brain barrier, and 15 minutes is even better.
beeHe said the protocol was rewritten so there is that waiting time to do those final images and if contrast is given, it is useless unless there is that waiting time.
However, he did also explain (and I wish I had written this down for sure!) that patients are immediately put back in the tube and more pictures are taken.
The T2 weighted (I think that's what he said) images don't enhance, and that series of pictures can be done in this protocol while waiting out the 10-15 minutes for the contrast agent to do its job.
The technician can then take the other images --- but there is no way that any of us should be done with our MRI's almost immediately after getting the contrast agent.
Unfortunately, we can't wear a watch into the MRI to clock the timing!
The best we can do is perhaps talk to our neuros about this and also mention it to the technician and make them aware that you know that this timing is important.
be well,
Lulu
At his previous MS Center in Michigan, he said they were suspicious that in about 4,000 patients who had MRI over a couple year's time, none of them had enhancing lesions. That is zero MS patients with active disease. They re-looked at the imaging technique going on and found that the final set of pics was being taken almost immediately.
He says it takes a minimum of 10 minutes for the gadolinium to breech the blood-brain barrier, and 15 minutes is even better.
beeHe said the protocol was rewritten so there is that waiting time to do those final images and if contrast is given, it is useless unless there is that waiting time.
However, he did also explain (and I wish I had written this down for sure!) that patients are immediately put back in the tube and more pictures are taken.
The T2 weighted (I think that's what he said) images don't enhance, and that series of pictures can be done in this protocol while waiting out the 10-15 minutes for the contrast agent to do its job.
The technician can then take the other images --- but there is no way that any of us should be done with our MRI's almost immediately after getting the contrast agent.
Unfortunately, we can't wear a watch into the MRI to clock the timing!
The best we can do is perhaps talk to our neuros about this and also mention it to the technician and make them aware that you know that this timing is important.
be well,
Lulu
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