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Punctate fossi of T2 signal intensity in the white matter

  Hi, my medical records and MRI state similar things, specifically this:
  "too numerous to count punctate foci of high T2 signal in the periventricular white matter at the right frontal lobe and white matter in the centrum semiovale at the frontal lobes. Deminelating (i just msp. this word) such as multiple sclerosis or microangiopathic changes."  What does this mean is basic english? Is this common to find or normal?
  In addition, the doctor wrote in his findings "complexity and severity are high...medical decision making is high"  what does medical decision making is high means?
  Thank you,
This sort of MRI report is quite common. It means there are lots of tiny bright (white) spots scattered around a particular region of the picture. (The T2 weighted image is one of two or three techniques used for any given patient in one scanning session - there are usually multiple sets of pictures of the same areas of the brain to help interpret results).
Typically, the radiologist concludes the report with "Clinical correlation is advised." The radiologist issues his interpretation based strictly on what the picture looks like. He/she reports all the possible disease processes which come to mind when confronted with an MRI of that appearance. Because he/she didn't examine you in person, there is no way to make sense of the picture in context. That's the neurologist's job.
For example, if your symptoms and exam findings could point to MS, then this sort of report could be confirmatory (though with MS, there is no single test which is definitive). On the other hand, if you have headaches which appear to be migraines, this MRI would NOT suggest MS, but rather a byproduct of the migraines whose significance is not clear. Another alternative is many tiny strokes (again requiring interpretation of ALL data not just the MRI picture). Finally, there is ... normal. We see many scans which look like this in patients with a variety of symptoms who DO NOT have MS, strokes, or any other definable neurologic disease.
Now you understand why the "complexity" and "medical decision making" are high. That justifies the cost of the visit to the insurance company. If you walk in with a typical pinched nerve (for example) and everything is pretty simple to figure out, then the doctor doesn't need to work as hard to develop a diagnosis and treatment plan. If your case is hard to figure out, then it represents more effort on the doctor's part, and insurance companies expect that to be documented if they are to pay the higher fee.
I hope this helps. CCF MD mdf.

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