proper mri protocol

[marymoto]

hello i just wanted to let everyone know that i was back to see my neuro today and i have more faith in him he seemed to take more time with me today. i talked to him about my pituitary mris not being the proper protocol to check for ms. lesions.so he was shocked that i had never had one done to look for ms. after he diagnosed me with the benign ms on the last visit. anyways i showed him the only mri report that ever showed ms lesions from 2006 he said they are the right kind of lesions but there would have to be nine of them so he is going to send me finally for the right mri. he said if i do have lesions i need to be treated so he is going to put an urgent on this mri.

[marymoto]

hi thanks for your insight i really appreciate your opinion. sorry i took so long to respond yes the old mri only showed the two lesions they were six mm  i am hoping this one next week shows the proper amount and this guy diagnoses me properly.it Also talked about blood degradation products  i am not sure what blood degradation products are?

[Audrey_M]

Re: Proper MRI protocol

You posted to this question citing the McDonald criteria. I get really frustrated with how vague the radiologists reports sometimes are. It's also very difficult to find an informative website that goes into detail explaining the components of the CNS within the brain and their functions.  Do you know of any that you can recommend? I was told by one neurologist that the lesions are not in places that would correlate to my symptoms. I think this might be helpful to a lot of us.

There's one webpage that I found:

http://www.mult-sclerosis.org/centralnervoussystem.html

but it is not specific enough for me to be able to correlate things.

For me, combing two radioligist reports: Flair images shows numerous small scattered areas of incresed signal intenisty in the cerebral white matter bilaterally, but most are noted in the subcrtical white matter. The lesions range in size from a few mm to 7 mm with the largest located in the superior left frontal subcortical white matter. Small foci are seen in the left occipital lobe. A smal focus of increar flair signal is seen in the genu of the corpus callosum and on the undersurface of the corpus callosum. No contrast enhancing lesion is demonstrated.

Looking at the disk, I can see numerous lesions, but I do not know exactly what it all means, nor can I differentiate between the various slices/slides to know if I am seeing the same thing from a different angle or if this is in fact something different.

I have an appointment with a new doctor who specializes in demyelinating diseases and will ask her to go over the MR images with me.

[Mike_Shuswap]

This sounds like a step in the right direction. Hopefuly his 9 lesion statement was just talking off the top of his head.

I have over 9 lesions, but some of them are unspecified. The only person who ever mentione 9 lesions was a radiologist, never a neuro.

Anyway, I'm glad your neuro is going to rush the correct mri for you.

Good luck

Mike

[Karen99]

I've had definitive MS for almost ten years now and still don't have 9 visible lesions.  

I hope this neuro is better at treating MS than he is at diagnosing MS.  

That being said, at least he is pursuing the subject and at least dabbling in listening.  Next comes the thinking part.  (might be a challenge)

How does one go about educating a neurologistt in the McDonald Criteria without offending them?  

[Quixotic1]

I just read your journal and you already have evidence of Dissemination in Space - meaning you have evidence that the disease has hit at least two separate places in the CNS.  You have optic neuritis and an eye movement disorder.  These are separate cranial nerves in the brainstem and could only be explained by two separate lesions.

Therefore, your neuro does not need to count lesions to fulfill the diagnosis.

I'm glad he is paying good atention to you, but he doesn't understand MS.  You are suffering terribly, so there is NOTHING AT ALL "benign" about your disease.  So he doesn't understand how to use the McDonald Criteria and he doesn't understand how to categorize someone's stage in it.

Phooey!

Quix

[Quixotic1]

I am always frustrated when I hear another neuro say that a person needs "9 lesions" to be diagnosed with MS.  There is one situation in which the McDonald Criteria state that 9 or more lesions can be used to help diagnose MS.  This is when there is not enough evidence in the patient's history and their exam to show that the disease has spread out in space (also called Dissemination in Space).  What this means is that there is only evidence of ONE place in the nervous system that has been damaged - like there is ONLY optic neuritis, or there is ONLY vertigo, or ONLY double vision etc.  Then the neuro can look to the MRI to give evidence that more places have been hit with the disease.

Here is a quote from the HP on the McDonald Criteria.

"What Provides MRI Evidence of Dissemination in Space?

This is the description of a postivie MRI for the purposes of showing that there has been "dissemination in space."  This would be needed if there is only evidence on neurologic exam of one clinical lesion.  There is only one abnormality that points directly to a damaged area in the CNS.  This is also where the misunderstanding about always needing 9 lesions on the MRI.  (Sometimes you do, but not always.)  In general lesions should be larger than 2mm in cross-section.

    You need to have 3 of the following 4 things:

•1 (one) contrast-enhancing lesion of the brain or spinal cord.  If no enhancing lesion, then need 9 T2 hyperintense lesions in brain or spine.

•1 infratentorial lesion or a cord lesion (this means under the tentorium, which is the membrane on which the larger cerebrum sits.  Below the tentorium is the cerebellum, brainstem and spinal cord.)

•1 (one) or more juxtacortical lesions (this involves nerve fibers - called U-fibers - that extend from the white matter in the subcortical area through the boundary with the cortex of the gray matter)

•3 or more periventricular lesions (these are lesions sitting adjacent or very close to the ventricles)"

So you need three of the bulleted items.  Notice that only one of these is the "9 lesions" bit.


http://www.medhelp.org/health_pages/Multiple-Sclerosis/Diagnosing-MS---The-McDonald-Criteria-Revised-2005-CHART/show/506?cid=36

So, Mary, do you have evidence of more than one place that is damaged?  Where are your symptoms?  And where are the abnormalities on the exam?

This is exactly the kind of misunderstanding the neurologist often has who is not committed to learning about MS.  They hear a little bit of info and they run with it and fail to understand what it is about.

Quix

[marymoto]

hi he said he is ordering the mri as urgent so i hope it is not to long yes i am kind of sad that he is a lesion counter i hope next tinme he diagnoses me properly instead of the benign ms stuff thanks for your message wobbly take care

[Wobbly]

well, I'm glad you feel better with this Neuro and he is listening to you and sending you for more MRI with proper protocol... too bad he is a lesion counter??  Not  sure about that one..

seems to me you have enough?

let us know how things go...how long will it take to get this MRI??  
take care
wobbly
dx

[tonyad]

   Glad you are feeling more confident in your Neuro But I have to say.....
No, No, No, on there having to be (9) lesions! Incorrect answer.  He is a lesion counter and that does not hold true.
  
    If you look in the health Pages, you will see info in there that discounts that theory.
You could always copy some of that info to share with him if needed.
Anyhow, Again, have a wonderful time on vacation.

~Tonya