Brain MRI questions

Question regarding my MRI - I've had a handful now but this is the most recent due to finding lesions in the white matter of both sides of my brain.

Comments:  Multiplanar T1, T2, FLAIR, DWI and ADC images of the brain were obtained and compare to the prior outside examination from Albany Open MRI.

The corpus callosum, brainstem, cerebellum visualized cervical cord, pituitary, crainial nerves VII and VIII and intracranial flow-voids are normal.  There are no abnormal areas of enhancement  within brain parenchyma on post constrast images.  There are scattered T2 and FLAIR hyperintensities throughout the white matter with shine through on to the DWI images.  Overall, these are unchanged in size and configuation  from prior examination.  

Impressions:  Stable scattered T2 and FLAIR white matter hyperintensities.  This may represent demyelinating disease.  Howere, there is no enhancement to suggest active disease.  The scattered hyperintensities may also represent age related small vessel white matter ischemic changes.

Can someone tell me what all of this means for me?  I seem to get a major runaround!  thanks.  

[lilbit985]

Hi Missy...like you, I had a brain mri, & it showed several scatteres white matter (cerebral) hyperintensities on T2/Flair; however, the dr who read the mri stated they are non-specific. That put me in a tail-spin ! I know what those could mean, but to be vague? That irritated me so much that he did'nt say in the report ms, or small vessel disease. My dr had to call him to get the radiologist to tell him what the heck he meant ! Basically- he said they could not diagnose ms, but could not rule out either. Small vessel disease at 39 is'nt that rare, but not that common- I am sure lifestyle comes into play, i.e., smoking, high blood pressure, high cholesterol. But, I do have symptoms of ms & that is why my dr sent me for the mri in the 1st place. How old are you & what neurological symptoms do you have? hang in there- getting a dx is'nt easy, esp. w/ ms. Takes people yrs to get a dx. If you are on fb, there is a mult. sclerosis site w/ people that can give you some feedback & advice.

[Missy1018]

thanks for writing to me.  i feel like i can never get a straight answer with any health concern i have.  i was also told can't say it's ms but cannot rule it out yet.  i don't smoke, i do have high cholesterol.  in 2007 i had an appendectomy and that's when everything started.  i had instances where i could not remember simple words and i laughed at everything.  my husband thought i was drunk.  i told him i felt like the anaesthesia was still in me.  so i told the surgeon and he said i need to send you for a ct scan because that sounds like a stroke.  so the ct scan revealed in infarct in the right basal ganglia and something else(that i cannot recall for the life of me right now).  so i had numerous mris and they showed lesions and seemed to be getting worse over a period but then the last mri seemed to state they hadn't gotten worse since the mri about a year before.  well the entire thing is scary!  i do have an atrial septal aneurysm with pfo so i had to be placed on warfarin to ensure nothing more happens to my brain.  the things i feel right now are sharp pains every once in a while in my eyes or arms or feet.  very uncoordinated and lose my balance easily while my eyes are closed or if i pick up one foot i fall over.  and my bladder feels like when i need to go i cannot wait to go.  i would just really love an answer to all of this.  i'm only 45.

[Missy1018]

forgot to mention that i get awful migraines!  

[Dr Sharma]

Hi there. T2 flair hyperintensities are suggestive of a demyelinating disorder called multiple sclerosis. Apart from clinical neurological examination MRI shows MS as paler areas of demyelination , two different episodes of demyelination separated by one month in at least two different brain location. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons transmit nerve signals slower than non demyelinated ones and can be detected with EP tests. These are visual evoked  potentials, brain stem auditory evoked response, and somatosensory evoked potential. slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI and a spinal tap. Hope this helps. Take care.

[Dr Sharma]

Hi there.  This is a follow up post to my previous one. I need to clarify that I intended this as a reply for missy 1018. I have posted it accidentally to lilbit985. Could you understand it correctly missy1018?  T2 flair hyperintensities are suggestive of a demyelinating disorder called multiple sclerosis. Apart from clinical neurological examination MRI shows MS as paler areas of demyelination , two different episodes of demyelination separated by one month in at least two different brain location. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons transmit nerve signals slower than non demyelinated ones and can be detected with EP tests. These are visual evoked  potentials, brain stem auditory evoked response, and somatosensory evoked potential. slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI and a spinal tap. Hope this helps. Take care.

[Missy1018]

I had an EP which they said was negative.  I had a spinal tap and they couldn't say yes it was positive and they couldn't say it was negative either.  So the doctor said he was not ruling out MS but I'm still in limbo.  Anything else you can suggest??  Any wonderful doctors that you could recommend?  

[Missy1018]

Here is information I wanted to get to you sooner...sorry.

Cerebrospinal fluids       Tube 1         tube 4
states that Fluid WBC's 0.001 A       0.001 A
Fluid RBC's                   0.009A        0.012A
Crenated RBC Fluid       0                 40
Fresh RBC Fluid            100              60
Fluid Neutrophils            0                 0
Fluid Lymphocytes         72               80
Fluid Monocytes             28               16
Fluid Eosinophils            0                 0
Fluid Blasts                    0                 0
Other Cell Lines Fluid      0                 4
Fluid Nucleated RBCs 0%  0              0
states that CSF is negative for oligoclonal bands

An MRI on Nov. 25, 2008 states:

Technique:  Using a .035 Tesla open magnet, T1-weighted sagittal and T1-weighted, T2-weighted adn FLAIR axial images were obtained.  Following intravenous administration of gadolinium DTPA contrast, T1-weighted axial images were again obtained.

Finidings:  The vintricles are normal in size, shape and position.

On T2-weighted images, areas of increased signal are noted within the white matter of both cerebral hemispheres.  There is no evidence of extension of abnormal signal to the cortical surface.

There is no evidence of mass effect or extracerebral fluid collection.

There are no areas of abnormal contast enhancement.

Impression:  Areas of increased T2 signal are noted in the white matter of both cerebral hemispheres.  Differential diagnosis incldes demyelinating disease, lyme disease, white matter microvascular ischemia, history of migraine headaches, or previous head trauma.  

on an MRI from 3/17/09

Technical:  Utilizing a 0.35 Tesla open superconducting magnet, sagittal and axial recontrast T1, axial FLAIR, T2, and axial post-contrst T1 weighted images of the brain were obtained as well as sagittal FLAIR images.  Comparisaon is 11/25/08 MRI brain exam.  

Findings:  The ventricles, cisterns, and sulci appear symmetrick and non-dilated.  No midline shift, mass effect, extra-axial fluid collections or abnormal enhancement is nted.  Subcentimeter bilateral cerebral hemispheric white matter T2 signal hyperintensities are noted predominantly subcortical, approximately 6 in number on each side without significant change.  The sella does not appearexpanded.  Internal carotid artery flow voids are present at th e skull base.  

Impression:  MRI exam brain demonstrating nonspecific subcentimeter bilateral cerebral hemispheric white matter, predominantly subcortical T2 signal hyperintensity, without significant change since 11/25/08.  Primary diagnostic considerations include demyelinating disease, early small vessel ischemic disease, possibly related to hypertension or vasculitis and migraine-related changes.  Clinical correlation is advised and followup MRI examd may be helpful.

Hematology work up:

Anticardiolipin AB, IGM 25 High should be less than 12
Hexagonal Phospholipid Neutralization PR 10.2 high should be 0.0-6.1
Thrombin time 16.6 Low should be 16.8-20.6

Can you tell me what a Immunoglobuiin A, Quant, Serum test is???
mine showed 418 High normal is 70-400
Thank you.

Looking forward to hearing back from you.

[Missy1018]

I also meant to ask in hematology what does a high Sed Rate mean?  mine is 31 which should run 0-22 mm/hr.  thanks.

[Missy1018]

Can someone answer my latest questions please.  Thank you.

[Missy1018]

MRI of 6/14

Examination:  MRI OF THE BRAIN WITHOUT AND WITH CONTRAST

Clinical Information:  Multiple sclerosis.  Comparison is made to previous examination 11/24/2009 from Capital Imaging.

Technical Factors:  MRI of the brain was performed according to routine department protocal.  This included sagittal T1, axial T2 and axial FLAIR, axial diffusion, pre and post contrast axial and post contrast coronal sequences.  Contrast agent 15 ml of Magnevisit.

Findings:  There are about 30 or so perventricular and mostly subcortical white matter changes in the frontoparietal regions.  There is no significant change compared with the prior examination allowing for significant differences in the scanner technique/acquisition parameters.  There is a small focus of enhancement in the left parietal subcoritcal white matter measuring 4 mm corresponding to an enhancing plaque.

There is mild mucosal thickening of the maxillary sinuses.

Impression:   There are numerous, about 30 or so, mostly subcortical white matter changes and multiple perventricular white matter changes.  There is one plaque that enhances in the left parietal region posteriorly and superiorly.  Aside from the enhancing plaque there are no other changes compared with the prior study.

MY QUESTION IS...DOES THIS MEAN THAT THE DIAGNOSIS IS MS OR WHAT COULD IT BE?  Thanks so much!  Any help would be so appreciated.  

[gail09]

I had a mri,brain scan. in the letter it said, it is normal but i have, few scattered high signal changes, which were non-specific in both hemispheres; Can any one please translate in normal language please

[sennefer]

I have been misdiagnosed with any disease that mimicks ms.  Diseases like autoimmune disorder, chronic fatigue disorder, tuber sclerosis, sarcoidose (sarcoidosis), and others other a time frame of eight years.  I was originally told that my MRI revealed either demyelinating or migrainous disease.  And, in the beginning, I was told that ms diagnosis was a wait and see issue.  That was eight years ago.  Now, I am being told that they the Neuorolgist do not know what I am suffering from.  But, they have started me on steroids, which had taken before in 2010, nerotonin, klonopin, gabapentin, baclofen, and other meds.  I am back to having mri's once a year after they stopped it for a year.  Help!  I thought MS was a disease of deduction.  If the neurologists are looking for a disease which mimicks MS and none of the diseases use fit the condition, what is wrong with at  least starting the treatment using MS drugs. Any clues as to what is their hang up?