MRI "hot spots" and MS

[cerebralis]

       I experienced sudden sensory nerve hearing loss in my right ear this past summer.  I went to an ear, nose, and throat specialist (ENTS), and he had me get an MRI.  I don't know the resolutions of the MRI, but  chatted with the radiologist about it.  He said it was a newly installed machine (Jan 2009), and was much more sensative than their previous one.  By the time my results came back my hearing loss was gone.  The hearing loss has never been explained, but while scanning my head/brain the MRI picked up "hot spots".  The ENTS said that something like 1/20 of his patients get this result because of the sensitivity of the MRI, but he recommended that I get another scan 6 months later.  When I asked why, he explained that an increase in the amount or severity of the "hot spots" could be indicative of MS.
       I would like to know if he was be totally honest in saying that 1/20 patients receive a result with hot spots, or was he placating me.  He is a great doctor, but I could tell that he sensed my distraught.  I have no symptoms of MS, and I am totally healthy.  How important is it that I get another MRI?  They are quite expensive even with insurance.

[Lama Chahine, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history and review your MRI, I can not tell you what the exact implications of your MRI findings are. However I will try to provide you with some useful information.

I am not sure what is meant by the term "hot spot", this is not really a scientific term used to describe brain MRI findings. However, in general, I can assume that an abnormal signal, commonly referred to as white matter hyperintensities or "plaques" may have been seen. These can be seen for various reasons. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented. Other causes of plaques in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance.

Other causes of plaques on MRI can usually be distinguished based on history and symptoms, such as symptoms of neurologic deficit (for example arm weakness or difficulty walking etc). These can also be distinguished based on the MRI appearance. These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.

The indications for repeating the MRI depends on your exact history and the exact appearance of your MRI findings. Discussion of these factors with the physician who ordered the imaging is important, with referral to a neurologist as indicated.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[cerebralis]

Thank you!  Your response to my post gave me some perspective on the issue of MS and MRI's.  I will be calling my general practitioner to get some more input as well.