Questions?? about my 3T MRI results

[johnniebear]

I  was able to fit in the 3T with room spare-   I have wide shoulders & a belly to match.

I have my follow up visit with the MS DR next week.

Here is my findings,  could someone tell me what this all means?

MRI brain ,  the ventriicles and sulic are prominent, consistent with mild age related volume loss.  The cistern remain patent. there in no midline shift or mass effect . As noted on the outside exam, there is minimal oval punctate T2Flair hyperintensity along the greater than the right corona radiata as well as additional focus lateral to the right frontal horn more conspicuous on the proton density images.

Pulsation artifact is present on the axial FLAIR images thought the posterior aspect of the frontal horns.  ON the sagittal images, the more prominent left corona radiata lesion does appear somewhat perpendicula to long axix of the lateral ventricles,  No infratentorial lesion are seen.  There are no areas of pathological enhancement.  There is no diffusion abnormality.  No extra axial fluid collection identified.

IMPRESSION: Unremarkable contrast-enhanced MR of the orbits,  A few scattered punctate foci of T2 FLAIR hypertensity in the periventricular  white matter as previously noted on the outside report, without corresponding
enhancement.  These remain nospecific, but could  be consistent with early demyelinating disease if clinically appropriate..     INCIDENTAL PARTIALLY EMPTY SELLA    ( WHAT THE HECK DOES THAT MEAN?)


One other thing that I'm not to worried about is they found a prominent muscosal cyst in the left maxillary sinus.
There is mild fluid opacification of right greater than the left mastoid  air cells.

Thanks to all
Johnniebear

[COBOB]

By the way, my first MRI was done at an Imaging Center.  My second MRI was done at a university hospital.  The first MRI was read by Dr. XXXX, Radiologist.  My second study was read by Dr. YYY, Neuroradiologist, University Hospital.  The second report looked very different and was obviously compared against the first study.  Here is the main part of my last MRI:

http://www.medhelp.org/user_journals/show/242785/Results-of-2nd-MRI

I think I have learned that there is a big difference between Imaging Centers, Hospitals and Teaching Hospitals.  Even my Neurologist is a Neurology & MS Fellow and Professor.  This may not work for everybody, but I'm having much better luck with my care at the teaching hospital.

Bob

[COBOB]

If there were no enhancing lesions, you are correct.  New lesions enhance for about 40-45 days.

Bob

[johnniebear]

WOW..   I"m  thinking I don't know very much at all..


I had the MRI done at an  Image Center,   they were able to access the old reports from the hospital online,  so I asked how did the images compare to the old ones?  The  Answer surprised me,  they would just read the old reports.  I always thought they compare old images to new images.

I know my MS DR.  doesn't even want the reports.

I also thought is was a little lazy on there part by saying a a  few scattered punctate foci,  should they have said how many?   Atleast I learned that I didn't have new leisons oin last 45 days because they didn't enhance,  is that correct?

Pastor Dan,  I have new neighbors  right now,  hope all is well with your Flock.

thanks

John

[COBOB]

The Frontal Horn is the anterior part of the Ventricle, so anything "lateral to" is another type of periventricular lesions.  In terms of neuroanatomy, my understanding is that this area can extend into the frontal lobe.  Some symptoms associated with lesions lateral to the frontal horns are migraine, optical ataxia, and changes in executive functions.

This may be related to alterations in the  "Cholinergic Pathway" to the frontal lobe. The study I am referencing talks to non-specific white matter lesions (WMLs) and includes punctuate lesions and lesions near or below the MRI threshold that produce a neuroradiologic effect that is sometimes referred to as "dirty white matter."  

"Frontal and Periventricular Brain White Matter Lesions and Cortical Deafferentation of Cholinergic and Other Neuromodulatory Axonal Projections"  

Now that is a mouthful.

Bob

[PastorDan]

Oops, was thinking of Johnnymutt, but hey, IL's not that far from OH, right?  Peace, blessings, & all that stuff.

[PastorDan]

Bob, since we have your seemingly well-informed opinion on this thread, can you explain the meaning or significance of "additional focus lateral to the right frontal horn" in John's report?  I noticed brightness in this area on many of my slices, but it was only mentioned incidentally in the last report, IIRC.  Just wondering about this; nobody seemed concerned about it.  Thanks.

Hey, Johnnie, hoping htings are well with you & yours, neighbor!

[COBOB]

PARTIALLY EMPTY SELLA means that the pituitary is flattened out and isn't filling the Sella  Turcica.  Search "empty sella syndrome:  Not all that rare.

The interesting comment is the "corona radiata lesion does appear somewhat perpendicula to long axix of the lateral ventricles"  That is a text book location and position for an MS lesion.
Corona radiata is a portion of the white matter.

Bob

[jensequitur]

Lesions, even punctate, in the periventricular white matter, is indicative of MS.  I'm not sure what that partially empty sella means!  I'd google it if I were you...