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Quixotic 1: re MRI
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Quixotic 1: re MRI

Just a quick question,  I replied to you on the 13th, but should my NRI of the cervical and thoracic spine have been done with contrast?  Does that make a difference in finding lesions and abnormal cord signal? thanks dowma (MB)
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147426_tn?1317269232
I'm still learning alot about the purposes and advantages of all the different MRI techniques.  This is what I understand at this moment.

An plain MRI without contrast will pick up larger, old lesions.  Old means that the inflammation (and increased blood flow) has died down and they are in the process of scarring.  The older the generation of MRI machine, the less likely it will be able to pick up small lesions.  Most MS specialist believe that the great number of MS lesions are still invisibleto the MRI's imaging capablility.

When you look at the articles on MS, they ALWAYS discuss the poor correlation between where the lesions are found and where the damamge is showing up on the body.  They know where things are controlled in the body.  And there may be obvious damage in that area (eg. specific muscle weakness), but there may be (and usually isn't) no visible lesion in that spot in the brain.

Some people only have a few visible lesions (or none at all) and over the years their brain actually shrinks in volume from the enormous number of lesions that were never seen, but that scarred down and caused loss of brain matter.  A poster over on the MS Support Forum had this problem.  The MS docs keep hoping that more and more people will come to their diagnosis as the MRI's get better and better.  I think the most pwerful one currently widely available now is the GE T3 (It has the most powerful magnet - 3 Tesla)  My latest MRI was on this newer machine and finally showed a whole wartload of OLD lesions - lesions that were missed in my last three sets over the last 27 months.

Now --- When the imaging is done with injected contrast, there will increased uptake in the areas of increased blood flow - that is, areas of active inflammation.  New MS lesions which are actively demyelinating have a higher blood flow around them than the surrounding tissue.  So newly active MS lesions will "light up" or "enhance" with the gadolidium contrast.  If they are still small those new lesions will be completely missed by the regular non-contrast MRI.

The answer to your question is:  An MRI done to look for all MS lesions (old/scarred and new/inflamed) needs to be done with contrast to reveal everything possible.  If your films were not taken also with contrast or they were done on an old MRI machine (some of these machines are twenty years old and pretty primitive) then it cannot be stated that you have no lesions, only that none were seen.

Now -- keep in mind that the MRI will also show other kinds of lesions like from migrain, or stroke, or vasculitis.  Also if someone had meningitis (an infection with inflammation of the lining around the brain)  an MRI with contrast will light up those ares too.

So, to everyone in whom MS is possiblity.  The MRI to check for it should be of the brain and c-spine (and probably of the thoracic spine as well -2 of my lesions are there) and it should be done with and without contrast.

Does this answer your question?  Or did I garble it?  Quix
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Avatar_f_tn
thank you that did answer  my question regarding MRI.  When you have a chance can you read my history from the post regarding VEEG results I would greatly appreciate it.  Thanks MB
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147426_tn?1317269232
I'm sorry, I thought I did answer your question about what the VEEG could mean.  Here is the link to that answer.

http://www.medhelp.org/forums/NeuroSupport/messages/2541.html

Then you wrote more about your history, but I didn't actually see another question.  Do you want me to discuss whether I think all your symptoms seem answered by a seizure disorder?  Or whether it looks like something else?

Quix
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Avatar_f_tn
Sorry for the confusion,  Yes do you think my symptoms and VEEG results are from a seizure disorder or something else.  I am thinking it is something else such as MS.  The epileptologist do not think it is seizure disorder but haven't given me any explination about my symptoms or the results for that matter.  I am really at a loss.  What do you think after reading my history?  Thanks, MB
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147426_tn?1317269232
No, I do not think the EEG as reported could be responsible for your symptoms.

You have episodes of persisting symptoms

07/06 Chest pain, R arm paresthesias x 3 weeks

Episode of dizziness, loss of balance with brain fog x several weeks

09/06 MRI (without contrast) shows two lesions on FLAIR sequence frontal lobe

Gait problems - with hyperreflexia, spasticty in R LE

Increased motor difficulties/weakness - Dx viral syndrome & anxiety???????

10/06 Paresthesias which progressed to include all extremities, severe fatigue

MRI C-spine, lumbar-spine (Don't you remember whether they brought you out of the machine and injected the contrast?) "normal"

Lab workup for myelopathy - could you get those results for completeness? neg

Spinal tap - Did they do a complete MS panel on it? Can you get the report?

01/07 - Relapse of all symptoms, EMG neg, Increased fatigue, muscle crampy pain

01/07 2nd MRI of brain with contrast increase (in size or number??) FLAIR lesions

01/07 EEG & VEEG - mildly abnormal (I gather they have not labeled it "seizure disorder"

03/07 Rheumatology workup -neg (neg for what? What did they look for?)

Current - Severely fatigued, reduced exercise intolerance, muscle pain

Well, much of your history parallels my own. FLAIR sequence is especially good at identifying MS lesions. In the face of documented physical neurological findings (weakness, hyperreactive reflexes, spasticity) I do not understand how they can dismiss the frontal lobe lesions as inconsequential!! I had only one frontal lobe lesion and when I saw the right neuro, he thought it was very significant!! (Incidentally, so MS researchers have linked the severe fatigue to frontal lobe lesions)

Do you still have the reflexes and spasticty? Is your gait severely affected?

Do you have any reaction to becoming overheated? Hot bath, shower, weather?

If the blood work up was complete and truly negative, I don't see how they have ruled out MS. Period. Also, any MRI's that were done without contrast are suspect in my view. If they are stictly adhering to "number of lesions on MRI" to make the diagnosis, then I think you have a rigidly thinking neuro who is going to miss a lot of MS! Physical deficits count as lesions!!!! So do reported relapses!!!! It's all a matter of dissemination in time and space. Damage occuring at different times (not all at once) and in different areas of the body/brain.

I think you need to do a couple of things.

Collect all of your medical records - all of them, including copies (on disk if possible) all imaging tests and the reports. Unless you are "tied to NYU" by your insurance or employment, find another MS clinic. I'm sure New York is riddled with them. Write up a chronology similar to the one I did above, but more complete. Keep things short and to the point. Separate paragraphs for each symptom/test/problem. When you have all your records, read them carefully. I would be glad to go over things with you. When the timeline is complete and readable see a new MS specialist. I think it is ridiculous for a neuro to say "well it's not XXX." and then leave it at that. It's their job to find out what it is. You need to keep asking, If it isn't MS then what IS it??

One thing that helped me IMMENSELY. My MS neuro ordered intensive physical therapy for me with a PT experienced in MS. She knew immediately it was MS (she couldn't say so in so many words, but it was clear). She also cleaned up my gait and made walking so much easier. I was out of breath just walking into the store from close in the parking lot. She also had me fitted with a brace. Maybe your PCP could order some neurologic PT for you.

I hope this helps. Quix

You may need interval MRI's (with contrast) and they should include cervical and thoracic spine. Request that they be done on a new 3 Tesla MRI machine.
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Avatar_f_tn
hello, i have been reading your posts re MS.  Back in march 2012 i started feeling burning sensations in my breasts.  after 30 days the burning was everywhere i my body, head to toe.  Heat and strds exacerbate the problem.  i have eye issues-- floaters, flashing lights for years, and only saw opthamologists.  Currently, the doctors are dismissing MS.  Brain scan on mri fom july 6,  2012, says...."tiny non enhancing T 2 hyperintense focus seen in the subcortical white matter of the left subinsular region, which is non specific"  And  "no typical demylinating plaque identified within the periventricular and corpus callosal regions" .  i just called and found the open mri was a 1 Tesla machine.  THEY NEVER EXPLAINED TO ME ABOUT THE RESOLUTION BETWEEN OPEN AND CLOSED MACHINES.  i thought mri' s were all created equal until i saw your posts.  Hope u are doing ok and tjanks for detail.  Your thoughts on mri detail?
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