You're freaking me out here, MRI images! You're freaking me out (not too badly, though!)

[lovemy6monkeys]

I had my MRI yesterday, and, of course, I got a CD of the images. and, of course, I looked at them last night. And, of course, I don't have the knowledge to know what exactly is what LOL So, with that in mind, I'm not stressing *too* much, but I do have some worry over one image.

The tech who did the MRI would talk to me and tell me "This series will take 3 minutes" etc. They did my brain MRI last, and when he got down to the last 2 series of images, he said "These last 2 series we will do back to back. It will take 4 minutes and then I will get you off the table." After the 4 minutes he said "I'm going to do one more series, it will be another 4 minutes." I didn't think too much of it other than maybe he saw something and wanted better images of it.

So, I come home and look at the images. To my (very) untrained eye, I think I see a spot near my brain stem/ cerebellum, which if I'm right makes some sense. My neuro has suspected all along my vertigo is brain stem/ cerebellum caused.  

I also saw what looks like the "subtle multi foci" that were noted in my last MRI in april, but were too subtle to be counted as lesions. Since I couldn't see them at all on my last scan, but I see (what I believe to be) them now, I'll assume they have gotten worse.

Those were not surprising, or worrisome to me. I was hoping something would show up in those areas to "clinch" my diagnosis.

The image that worries me is near my left optic nerve. My left eye is the one that has always given me trouble. I get the headache behind my eye that extends towards my ear. It seems like my left eye is the one that is slow to focus. I'm sensitive to light and dark, but that seems to be both eyes. The left eye is also the one with the delayed VEP results, that increased from a 8 millisecond delay to a 10 millisecond one in 4 months time.

In the image I'm worried about, there is a white oval shape right up against the outer (left) side of the optic nerve for my left eye. It is a bright white oval, not overly large. There is not a corresponding spot on the other side of the left optic nerve, or on either side of the right optic nerve. If there were another spot on the right side, I would not be concerned...but since it is only the one spot on the one side of my left nerve, of the eye that has given me trouble, it has me a bit worried.

I am trying to tell myself it is either 1- nothing at all, or 2- just a normal MS lesion. But I keep getting nagging "what if it is a brain tumor" thoughts. I know, I know, I'm jumping to worst case scenario conclusions...I'm trying not to. But, UGH!

I do see my neuro on Wednesday morning to go over the MRI. And, I'm going to ask him point blank what that spot is.I guess I'm just wondering if a bright oval shaped spot is what a normal MS lesion looks like? A lesion I'm ok with, a tumor scares me.

Oh, I did not have contrast during this MRI...would a lesion show bright without contrast?

Thanks for your help, and thanks for listening!
~Jess  

[COBOB]

When you have an active case of ON, there may be a plaque which would make an area of the Optic Nerve or Optic Tract look larger than usual. Plaques on the optic nerves seem to be hard to detect unless they enhance.  

Post-ON, my MRI show a decrease in channel diameter of both my Optic Nerve and Optic Tract in my right cerebral hemisphere.  I can still see, so that's the good news, but it is the leading reason why I have chosen to start start DMDs.  That type of damage effect the vision in the right and left eyes, since the left eye medial vision travels down the left optic nerve, but the right optic tract.  So up to 3/4 of my vision could be effected.  

Bob

[jensequitur]

That white oval shape is probably part of your eye!  Optic nerve inflammation is very hard to read.  I can pick out on the MRI the brain lesions and the spine lesions, but everything else is beyond me.

[lovemy6monkeys]

Thank you guys :-)

I'm trying to be patient, which is difficult for me. But, lots going on here to distract me. My 13-year-old and 8-year-old have decided that their life's goals are to annoy the stuffing out of each other, and take me along for the ride. We had wanted to let our youngest stay in her nursery alone until she turns 2 in April, but for my sanity we need to get our older 3 boys out of sharing the same room. So, we will move our 5-year-old daughter in to share the nursery. The 8-year-old will now share with our 4-year-old, and my 13- &11-year-olds will share. I'd love to have the kids each have their own rooms, but since the lottery insists that I must actually buy a ticket and play to claim a prize, a bigger house is not in our future.

Today we took the kids to see Despicable Me at the discount theater ($14 for all of us, not bad!). Tomorrow we will make the bedroom switch-a-roo.

I will just wait and see what happens on Wednesday. Though, the good news is I've still got my weird sense of humor about all possibilities. We have had a bit of a rough year, but the last week I've been feeling very optimistic that things are going to get much better very soon. I told DH today that maybe it is a tumor on my optimistic nerve and not my optic nerve :-)

I'll let you guys know how things go on wednesday.
~Jess

[rendean]

Jess,

Paula and Bob both gave you great explanations about your MRI films. Like Paula said , it takes lots of schooling and training to read the subtleties of MRIs. As hard as it is, stay calm and patient until Wednesday when your neuro can answer all of your questions.

BTW, if you moved during that one 4 minute sequence , it is possible it had to be redone for clarity reasons.

Go enjoy your "6 monkeys" and get your mind occupied with something else than the MRI. Scaring yourself with the "what-ifs" won't change the results , it will just add stress to your life until Wednesday...this I know from personal experience!

Have a good weekend,
Ren

[COBOB]

The Gadolinium contrast isn't really a dye.  It is a paramagnetic compund that spins faster than water in the T1 sequence (it is usually brighter than everything.)  You will see the lesion on the T2 or FLAIR sequences  and if you see the same lesion on the T1 Post GAD sequences, it means that that lesion is between 0 days and about 45 days old.  It demonstrates that you have active demyelination disease and it is not migraine or ischemic changes.

There are a lot of things that look like lesions of T2 and FLAIR, but they are not.  Lesions are very subtle and every round bright spot on T2 and FAIR is not a lesion.  Most people over count since they look at vascular sections and other normal brain anatomy that should be there.  Lesions are very thin, and one of the big problem with trying to read images on a laptop or home computer is radiologist typically use 4 displays at the same time.  They want to compare the lateral, sagittal and axial images at the same time if they can.  When the look for enhancement, they want to compare the T2 lesions to the T1 Post GAD sequences.  Not all enhancement on the T1 Post GAD is a lesion.  If it can't be seen on the T1, it will usually be written off to a UBO (Unidentified Bright Object.)

Bob

[figuerpa]

Jess,

I am not expert or no doctor but from everything I have read, Typical MS lesions are oval in shape, but then you have to understand that you will see things in the images that are normal spots depending on the part of the series taken. I have not and would not even attempt to read my own images.

There are spots on my images that are there is one image and not in another so I am guessing it is normal and nothing to worry about. Then I have a spot that stays in every image and I guess it was a lesion and I was right, my neuro pointed that out to me right away. He also told me about black spots that I would see and that I shouldn't freak out cause they are normal.

Reading MRI's take lots and lots of schooling to know exactly what you are looking at, and I am sure that not school alone will help, I am sure it is the experience that helps them learn how to read them.

Looking at my images myself I would have to say I have many many lesions but when a trained eye looks at it they say I have 2 in my brain and one in my spine.

What the dye does is highlight the areas that are active and new.  Those areas are going to show up on normal MRI's whether contrast is used or not.  So someone  having an MRI does not absolutely need to have it done with and without contrast.  The enhancement we see with contrast only denotes if the disease is in an active stage.  That can be important to demonstrate a separation of time for the McDonald criteria, but it is not necessary to actually see the lesions on the MRI pics.  I hope this makes some sense.  

Paula