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Technical Question on MRI'S
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Technical Question on MRI'S

I know there are a few of you who are technologically advanced with this stuff. I'm collecting my doctor's chart notes, tests, etc. to meet with my old primary care physician and came across my MRI reports.

This is the technical information regarding my brain MRI. My question is they told me this was MS protocol but I don't think it is based on what I read from this forum.  Is this MS protocol?

"Saggittal T1, axial FLAIR, T2 and diffusion-weighted images were performed. The patient was injected with Gadodiamide, 0.1 mmol/kg (12 cc of Omniscan) with coronal MP RAGE and axial T1 weighted fat saturation images.

My cervical MRI is as follows:

"Sagittal T1, T2 and gradient refocused were performed. Axial gradient refocused and T2 weighted images were performed."    (Note: they did not use Gad on the cervical.)

I'm just curious.... I have found photo's that show my internuclear ophthalmoplegia. It's very slight but it's there. Has anyone else had this? Since my VEP was normal, I'm wondering if that is causing my vision issues --- eye pain, headaches, double vision and blurriness. The double vision is the left eye. They rest of the symptoms are the right eye. I need to make an appt with another eye doctor but I'm dreading starting this all over again.

I'm super surprised my VEP came back normal; the technician said it wasn't, and when testing my left eye (the eye that she said was abnormal) she asked me a couple times "Are you seeing that dot?" I was... She told me to rest that eye and open it again and I did... twice...then toward the end of the test she told me that was the best results she had on that eye and it was abnormal.

I'm doing better the last couple weeks (from my two week milder relapse) but the symptoms are progressing once again as I get closer to that time of month. This is nuts! lol ~
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1396846_tn?1332463110
I don't know how to read an MRI I am just curious if you asked for a copy of your VEP test? It will state the results on the report so it may give you some more insight.

Are you on any anti inflammatory drugs to help with the inflammation especially during your monthly cycle. Not sure if they would help but its worth a try.

Hopefully someone will chime in with an answer to your question about the MRI and give you some answers.

Good luck,
Paula
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1453990_tn?1329235026
Were your images done on a 3 Tesla MRI?  Essentially, the study looks a lot like an MS protocol.  Gradient Echo studies are done on 3T MRIs in place of Spin Echo studies on 1.5T MRIs.  Many time you will see spin echo studies listed as T2W and gradient echo are T2*.  

The typical brain sequences for an MS brain MRI are Sagittal FLAIR, Axial FLAIR, Axial T2,
and Axial T1 pre/post gadolinium.  You may also see Axial proton density (PD) and 3D IR T1 gradient echo sequences.

The main cord sequences include Sagittal T2, Sagittal PD or STIR, Sagittal T1.  Sometimes you may see also see 3D IR T1 gradient echo sequences.  

Some imaging centers may use MT-MRI (magnetic transfer) or DW-MRI (diffusion weighted) sequences.  These are non-standard, but may provide superior imaging, especially in the spinal cord.

The MS protocol can be found at: http://www.mscare.org/cmsc/images/pdf/mriprotocol2009.pdf

Bob
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1475492_tn?1332887767
It was not done on a 3 Tesla Machine. It was a 1.5T I believe... I know it wasn't a 3 Tesla machine.
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1475492_tn?1332887767
I am getting a copy for my next appt. but I haven't seen them myself. I just received "it's negative."  I'm totally confused by the results just based on the conversation I had with the technician... she told me it was abnormal.

I am also not on any medication at the moment. Not even vitamin supplements. I was taken off all supplements when my labs were good. I am negative on all test results (except for my initial physicals when I was really sick) all the CT scans, MRI's, EEG, EMG, VEP and labs for other diseases were negative ... but have so many residual symptoms something doesn't add up right so I'm going for a "third" opinion. I had an appt. with an MS specialist as my second opinion but it appears he had nothing to go physically off of with all the negative results.
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1453990_tn?1329235026
I guess I'm surprised that they did the gradient imaging on the c-spine.  Maybe the slice thickness or something else is driving up the SAR.  Anyhow, the sequences seem close to what I would expect.  The important variable is the slice thickness for the brain and the cord.  

As far as the VEP, the important result is the P100 time.  It is possible to have Optic Neuritis  that was "silent."  There can be demyelination of the optic nerve, but without the typical symptoms.  The VEP is pretty sensitive for detecting demyelination of the optic nerve.  At less than 60 years old, a P100 (named for the typical max positive peak 100 milliseconds after stimulus) greater than 120 milliseconds is considered "abnormal latency."

Bob
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1475492_tn?1332887767
What does the gradient imaging do? I can't tell the thickness of the slices. Maybe it's on my MRI images? I do have the scans on disc.
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1475492_tn?1332887767
Okay, I received a copy of my VEP. This is the conclusion: The above Visual Evoked Potential study reveals normal latencies bilaterally. The latency of the right was longer and the amplitude on the left was slightly decreased compared to the right...

This is what the rest says:

VEP
Trace                        N75(ms)     P100(ms)      N145 (ms)    N75-P100 (uv)
Norm                                           3.5
Ch1:Oz-Fz: R GAvg      76.2           100.4           133.6            4.05
Ch1:Oz-Fz: L GAvg       81.6            95.7            132.4           2.58
L-R Norm                                       <4.5                                <2.9
L-R                               5.4              4.7                                 1.47

I don't expect both sides be the same. I understand that the P100 is significant if it shows greater than P120. Do you know what the N75 - P100 is (which must be the reference to the amplitude being slightly decreased)?
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1475492_tn?1332887767
Oops - typo:

VEP
Trace                        N75(ms)     P100(ms)      N145 (ms)    N75-P100 (uv)
Norm                                          3.5
Ch1:Oz-Fz: R GAvg      76.2           100.4           133.6            4.05
Ch1:Oz-Fz: L GAvg       81.6            95.7            132.4           2.58
L-R Norm                                       <4.5                                <2.9
L-R                               5.4              4.7                                 1.47

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1453990_tn?1329235026
N75-P100 is a voltage differential and has to do with signal.  Latency is demyelination. Loss of signal is related to retinal or axonal loss in the optic nerve.

Bob
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1475492_tn?1332887767
Can you help me a bit? I promise I will ask my doctors these question.

Lets see if I understand this correctly. IF I have a mild latency within normal parameters in my right eye and a mild signal loss in my left eye. Wouldn't that reflect something might not be balanced right and is causing my vision issues?

What you are saying is that there may be axonal loss in my optic tract but not likely ON. Okay. I'm fine with that. :) Doesn't it still kinda sound like I may need to request an OCT to you?
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