Need to know how

I need/really want an interpretation of the follow part of my latest MRI report:

Similar foci of increased signal intensity on T2-weighted images are present within the cervical spinal cord.

These are extensively distributed, but appear most prominent on the left in the C1 to C3 region.

The cord appears to have decreased anterior-posterior diameter on transverse images, but this is less evident on sagittal images.

Intravenous contrast administration results in no abnormal enhancement of the cervical spinal cord or meninges.

[Quixotic1]

Hi, Guy.  I'll take a stab at it.

Similar foci (probable in comparison the the foci on the brain MRI) foci (discreet spots) of brighter areas in the cervical spine.

They are pretty widely distributed throughout the cervical cord, but appear to be more frequent on the left side in the area of the spine spanning from C1 to C3.

When the views that appear to be cross-cuts are viewed, the cord seems narrower than it should in front and back.  But, in the views that look like side-ways cuts (from top to bottom) this decreased front to back width isn't as visible.

After contrast there are no enhancing lesions seen, no evidence of new (less than 6 weeks) demyelinating activity.

NOTE:

The MRI looks at the brain and spine from three angles.  These are the major "planes" also used in 3D - viewing.  I'll try to describe them.

FRONTAL Plane - These views are as if the person is facing you.  The cuts are made side to side. Example: So the first cut would lop off your nose.  The next would lop of your face.  The next would be ear to ear. etc.

SAGITTAL Plane - In this view the person is seen from the side and the slices go back to front.  First slice takes off the arm at the shoulder.  Next the ear and down besice the spinal cord.  Then the spinal cord gets sliced along its entire length.

TRANSVERSE Plane - The cuts go horizontally through the person if he is standing so the first cut takes of the taop of the skull.  This view is also referred to as the CORONAL view as if the first slice cut right under the bottom edge of a crown.

Meninges - The three layers of membranes that surround and protect the brain and spinal cord.

Did that help?

[MCBCON]

Almost, does this mean I have lesions on my cervical spinal cord in c1 to c3 area?

i understood the views.  But, does "Intravenous contrast administration results in no abnormal enhancement of the cervical spinal cord or meninges" mean I have no problems?

[Heather3418]

May I take a stab at your question?  What your last sentence means is that no "current" disease activity lesions are seen in the cervical spine.  It DOES NOT mean however that you are symptom free.  It just means no current disease activity is seen.  What is seen is scars and these "scars" can and do continue to produce symptoms in some.  I have heard also that scars in the brain may not be causing current symptoms.  

My spinal lesion did not highlight after the administration of contrast dye on my last MRI a couple months ago.  This spinal lesion still causes problems but is not currently going through more damage at the moment.  No enhancement.  

And yes...it does mean that there are lesions seen in your cervical spine.  Correct me if I am wrong, Quix!

Heather

[Quixotic1]

I'm actually going to tweak both of your answers.

"No current disease activity" is a terrible way to describe the lack of enhancement from the injection of contrast.  It means only that the radiologist did not see any enhancement.  New (less than 6 weeks old) lesions with "active" inflammation are the ones that will light up with the contrast.

The report of the radiologist is ONLY referring to what "he" sees as activity - the enhancement of any new lesions with contrast.  He cannot - CANNOT - speak to what is going on in your body with your symptoms.  The other lesions that you have scattered in the upper cervical spine are certainly causing active disease - active symptoms.

The word "active" is being used in too different ways.

From the radiologist's view - Active disease refers to evidence of active inflammation as seen on MRI.

From your and your doc's view - Active disease are all of the symptoms and disability you suffer from the MS.  Lesions don't have to have inflammation to be causing symptoms.

It is definitely confusing.

Quix

[MCBCON]

Thank you

[MCBCON]

Shows you how messed my thoughts get sometime.

I meant to thank you and not Rena on this one.

Thanks

[Heather3418]

I thnk that Quix explained it much better than I did.  I guess you already figured by what I wrote that MS is always active.  Whether the contrast dye shows new activity or not, your symptoms can still be there.  Just as my spinal lesion does.

Michael, my spinal lesion literally causes havoc in my body.  I believe from what I read about yours, that your does too.  I feel for you buddy...I really feel for you.

Take care and have a good day...you hear?

Heather

[MCBCON]

Should I be upset with my neurolgist for not mentioning these lesions on my spinal cord to me.   Pretty much I have decided not to see him again except to get a referral to an MS specialist.  I will use the excuse that I want to see someone doing research who can monitor me on drugs that he (my current neurologist) is not able to prescribe.

He only talked about the lesions in my brain and that they are getting smaller and less pronounced on the MRIs.   He even suggested that my symptoms might be due to deficiencies in Vitamin D or B6/B12 or arising because of fever due to a virus.

I had to read the MRI report myself to discover any mention of lesions on my spinal cord.  I was only mildly surprised to see I had these lesions because of the way I have been feeling and the way my whole gait has changed.  I was however shocked that he did not mention it to me.

[Deb61]

I have no idea what this means but the part, "The cord appears to have decreased anterior-posterior diameter on transverse images" sounds like the spinal cord is shrinking/showing atrophy.  Does that sound like what it means?  Plus, you've got a lot of lesions in your neck area.

The part, "Intravenous contrast administration results in no abnormal enhancement of the cervical spinal cord or meninges," doesn't, in my opinion, add anything.  What I've read about spinal cord lesions is that these gadolinium-enhancing lesions are less likely to show up on the MRI than the brain lesions and these enhanced lesions are there only six weeks after the initial inflammation.  Some doctors increase the amount of gadolinium to enhance those (Is that safe????).  

I'm glad you're seeing an MS specialist--especially for your peace of mind, if nothing else.  It's a shame that we all have to practically turn into medical doctors to be proactive in keeping our mobility and health good. . . A good chapter for I HATE MS book???

Take care,
Deb

[Quixotic1]

Personally, I would be pretty ticked at a doctor that implied, by his silence on the topic, that my spinal cord was clear.  You have a significant amount of disease in the c-spine and it is likely quite symptomatic!  Yes, a change is definitely in order.

Quix

[MCBCON]

Thanks for telling me this.  I already came to that conclusion.  I am ticked because up to now I thought my spinal cord was free of lesions.

[MCBCON]

Had an appointment yesterday with my neuro.   We discussed my latest MRI.  I asked him to explain why he said that the lesions my cervical spinal cord were small when the interpretation from the person reading my MRI stated: “They are pretty widely distributed throughout the cervical cord, but appear to be more frequent on the left side in the area of the spine spanning from C1 to C3.”

My neuro said that he disagreed with the report and he showed me the MRI.  He pointed out the main lesion was a thin scare that only showed in two adjacent views running from C1 through C3.  And, that there were a few small other spots.  He said that with other patients with problematic spinal cord lesions he would see scares that look larger and more rounded and cloud like.  He also showed me a view from the top and pointed to it and said that how I see it as a small lesion.  When you look at it from the top it does appear as a small spot.  

He also said that when he did the neurological exam that I did not display any indication of someone with spinal cord problems.

I am not sure how to react to his statements.

[wingnut19]

bump