Aa
What else would T2 hyperintensities be?
I've got until May to ponder my various bits of data, and one that's really bugging me is the differential interpretation I've gotten about my MRI results. To recap:
"Several" foci. Three were specifically described-- two that were 3 mm and one that was 3x5. All periventricular. The others that I see--and I'm seeing these accurately--are one in U fibers and one in cerebellum, but they are punctate, and it's *possible* they're artifactual. There's another one at the posterior left ventricle that's actually another 3-mm one. What I wouldn't give for a 3T MRI right about now. No enhancing lesions. No spinal lesions on 1.5T.
Neuroradiologist conclusion: the 3x5 at least is gliosis, can't exclude MS.
Neuro 1: 3x5 is especially "worrisome," but she never actually looked at the film.
Neuro 2: Dismissed entire MRI, 3x5 just "normal," no big deal; have T2 hyperintensity as ventricular "caps," he says just nothing, wouldn't even pay any attention to it.
All spots are visible in axial and sagittal views.
So...I'm 39. No hx of migraines. Am I old enough to have the bright T2 signal around the tips of my ventricles? Am I old enough to have WM spots that are just age related? What else could these spots be? I've seen them all...they're really there, but is it just "normal" for a 39-year-old woman to have these things in her brain? I'd think that the neuro is right, but I've got two other MDs who took the seriously. Very confusing.
I'm trying to determine in my own (spotty) mind what's relevant to my symptoms and what's not. So...if my MRI is normal for my age, I'd like to know that. Couldn't get a straight answer from Neuro 2 on that exact question before I fired him.
Gracias,
E
"Several" foci. Three were specifically described-- two that were 3 mm and one that was 3x5. All periventricular. The others that I see--and I'm seeing these accurately--are one in U fibers and one in cerebellum, but they are punctate, and it's *possible* they're artifactual. There's another one at the posterior left ventricle that's actually another 3-mm one. What I wouldn't give for a 3T MRI right about now. No enhancing lesions. No spinal lesions on 1.5T.
Neuroradiologist conclusion: the 3x5 at least is gliosis, can't exclude MS.
Neuro 1: 3x5 is especially "worrisome," but she never actually looked at the film.
Neuro 2: Dismissed entire MRI, 3x5 just "normal," no big deal; have T2 hyperintensity as ventricular "caps," he says just nothing, wouldn't even pay any attention to it.
All spots are visible in axial and sagittal views.
So...I'm 39. No hx of migraines. Am I old enough to have the bright T2 signal around the tips of my ventricles? Am I old enough to have WM spots that are just age related? What else could these spots be? I've seen them all...they're really there, but is it just "normal" for a 39-year-old woman to have these things in her brain? I'd think that the neuro is right, but I've got two other MDs who took the seriously. Very confusing.
I'm trying to determine in my own (spotty) mind what's relevant to my symptoms and what's not. So...if my MRI is normal for my age, I'd like to know that. Couldn't get a straight answer from Neuro 2 on that exact question before I fired him.
Gracias,
E
E,
I can understand that there are some very bad MS neuros. One MS neuro back in May actually told Craig that he can't have MS because his calves aren't weak (they are tight all the time). He said that the thighs and feet and ankles are weak, but not the calves, so no MS!!! And his office is full of awards from the local MS society.
I do not know where you live...is Indiana close?? Or somewhere near where some of the recently diagnosed forum members live? You could pm them and ask for their neuro's name.
The 3T was much clearer than the 1.5T. On the 1.5T it showed gliosis, demyelination, cortical atrophy, and multiple scattered foci. The 3T showed the lesion perpendicular to the ventricles, and subcortical T2 hyperintensities, and whole brain atrophy. It was worth it to get the 3T.
Elaine
I can understand that there are some very bad MS neuros. One MS neuro back in May actually told Craig that he can't have MS because his calves aren't weak (they are tight all the time). He said that the thighs and feet and ankles are weak, but not the calves, so no MS!!! And his office is full of awards from the local MS society.
I do not know where you live...is Indiana close?? Or somewhere near where some of the recently diagnosed forum members live? You could pm them and ask for their neuro's name.
The 3T was much clearer than the 1.5T. On the 1.5T it showed gliosis, demyelination, cortical atrophy, and multiple scattered foci. The 3T showed the lesion perpendicular to the ventricles, and subcortical T2 hyperintensities, and whole brain atrophy. It was worth it to get the 3T.
Elaine
Hi, Elaine--
I hope that you and Craig are doing OK.
Thanks for your response. I don't think I have nine, although I haven't bothered to count them up. It's more like seven, I think. And only three are >/= 3 mm.
Our MS neuro here booted AMERS who had lesions AND a + spinal tap, and my spinal tap was normal. It may very well be that I do NOT have MS, but it's just very hard to get a grasp on the relevance or irrelevance of these lesions with the conflicting opinions I have. And yes, my clinical picture is suggestive, but I can't actually even get two neuros to agree on some of the outcomes of their own testing.
Craig had the 3T MRI, yes? Did that reveal any further information that was useful?
Thanks!
E
I hope that you and Craig are doing OK.
Thanks for your response. I don't think I have nine, although I haven't bothered to count them up. It's more like seven, I think. And only three are >/= 3 mm.
Our MS neuro here booted AMERS who had lesions AND a + spinal tap, and my spinal tap was normal. It may very well be that I do NOT have MS, but it's just very hard to get a grasp on the relevance or irrelevance of these lesions with the conflicting opinions I have. And yes, my clinical picture is suggestive, but I can't actually even get two neuros to agree on some of the outcomes of their own testing.
Craig had the 3T MRI, yes? Did that reveal any further information that was useful?
Thanks!
E
Hello!! Your MRI is NOT normal. Craig has T2 hyperintensities as well as a lesion perpendicular to the ventricles. Having nine T2 hyperintensities is one of the diagnostic criteria for MS so they are not normal. Especially with neuro symptoms.
Can you find a good MS neuro??
Elaine
Can you find a good MS neuro??
Elaine
I have two sons on the spectrum.
A T2 hyperintensity in this case means that on the T2 flair images, the spots are brighter than the background. "Hyper" in general in imaging means "brighter compared to surrounding tissue."
"Enhancing" means that images taken after they inject the gadolinium show hyperintensity that compared to T2 flair differ...i.e., they've taken up the gad because they're "active demyelination" and thus they show up when that is injected. There sometimes will be a circle of hyperintensity where there is enhancement.
All axial and sagittal means is from the top (along the axis) and from the side (sagittal). It's not meaningful in any other way; it's just a point-of-view for taking the picture, like profile vs. full frontal. I actually think of "axial" as coronal, but then, I work with penises, and we use that differently.
A lot of white spots you'll see on the MRIs are either artifacts (i.e., just some weirdness because of angle or the way the image was captured, like reflected light in a photograph) or not anything to worry about. For example, I've got some calcifications on mine that are not meaningful, even though they look kind of impressive.
WM=white matter (axons). Quix has a detailed post on MRIs that is very useful. But in a nutshell, older citizens have these and they're age related, not "disease" related.
I personally don't consider any spots that I see that the neuroradiologist didn't note. He's looked at thousands of these things, compared to my much lower count (I've looked at a lot of them, but not for specific training). So...I'm not picking out spots that haven't already been noted by a professional, and I wouldn't go there. If you have spots that you want to ask about, try to make an appt with someone knowledgeable who reviews MRIs with patients and do that. It's the best way.
Of course, I say that, but having done that myself, it's gotten confusing because what one MD has said was informative, another has dismissed entirely--he says they're real lesions, but that they're not relevant. My problem arises not from knowing artefact from real foci, but from determining whether or not the foci are relevant. A real PIA, honestly.
E
A T2 hyperintensity in this case means that on the T2 flair images, the spots are brighter than the background. "Hyper" in general in imaging means "brighter compared to surrounding tissue."
"Enhancing" means that images taken after they inject the gadolinium show hyperintensity that compared to T2 flair differ...i.e., they've taken up the gad because they're "active demyelination" and thus they show up when that is injected. There sometimes will be a circle of hyperintensity where there is enhancement.
All axial and sagittal means is from the top (along the axis) and from the side (sagittal). It's not meaningful in any other way; it's just a point-of-view for taking the picture, like profile vs. full frontal. I actually think of "axial" as coronal, but then, I work with penises, and we use that differently.
A lot of white spots you'll see on the MRIs are either artifacts (i.e., just some weirdness because of angle or the way the image was captured, like reflected light in a photograph) or not anything to worry about. For example, I've got some calcifications on mine that are not meaningful, even though they look kind of impressive.
WM=white matter (axons). Quix has a detailed post on MRIs that is very useful. But in a nutshell, older citizens have these and they're age related, not "disease" related.
I personally don't consider any spots that I see that the neuroradiologist didn't note. He's looked at thousands of these things, compared to my much lower count (I've looked at a lot of them, but not for specific training). So...I'm not picking out spots that haven't already been noted by a professional, and I wouldn't go there. If you have spots that you want to ask about, try to make an appt with someone knowledgeable who reviews MRIs with patients and do that. It's the best way.
Of course, I say that, but having done that myself, it's gotten confusing because what one MD has said was informative, another has dismissed entirely--he says they're real lesions, but that they're not relevant. My problem arises not from knowing artefact from real foci, but from determining whether or not the foci are relevant. A real PIA, honestly.
E
How do you get your knowledge on these MRI's? I have been looking at my CD and I'm trying to figure out the white spot there, the white spot yonder, and so on. (BTW, my results were "normal") But I see some things on the 271 images and I'd like to learn more.
Okay: axial and sagittal views. Is this where most (all?) spots are seen?
Explain difference between hyperintensities and enhancing?
WM spots: define please.
And so on.
Thank you VERY much!
As an aside, I have perseverating autistic girls in my house; well, it's settled down over the years. In your defense, let's just say you are, ahem, FOCUSED on something important to you. LOL
Thanks again,
Suzanne
Okay: axial and sagittal views. Is this where most (all?) spots are seen?
Explain difference between hyperintensities and enhancing?
WM spots: define please.
And so on.
Thank you VERY much!
As an aside, I have perseverating autistic girls in my house; well, it's settled down over the years. In your defense, let's just say you are, ahem, FOCUSED on something important to you. LOL
Thanks again,
Suzanne
Yes, I left you a note. Just some words of hot flash, or "wisdom," as other like to say....
Zilla*
Zilla*
I like that word, too. We have a lot of that around here. ;)
I'm feeling "Arrgh," also, but I also don't want to be having an unnecessary reaction to something if it's really really not relevant. I've put my beautiful MRI pics (well, three of them) in my photo thingie and on my sig. That's my 39-year-old brain there. :-) Pretty, isn't it? Technology is simply amazing.
Thanks for replying!
E
I'm feeling "Arrgh," also, but I also don't want to be having an unnecessary reaction to something if it's really really not relevant. I've put my beautiful MRI pics (well, three of them) in my photo thingie and on my sig. That's my 39-year-old brain there. :-) Pretty, isn't it? Technology is simply amazing.
Thanks for replying!
E
I'm sorry, I didn't mean to leave you hanging like that.
Honey -- you're 39, not 103. There is no reason for you to have a spotty MRI, especially given the fact that you have neuro symptoms. You do, don't you? I have to apologize. I get everybody mixed up.
Even so, those foci are too large to be from migraines, and you're too young to just "have them." And even if you had a history of migraines and were 103, if you had neuro symptoms, THAT would be the reason for the lesions!
Aurgh. Not you, aurgh. The secret handshake aurgh. If you haven't read my other thoughts lately (I think you have) you don't know what I'm talking about...
I'm just venting. Move on to a new neuro as soon as you've gotten all the testing you can get out of this one, honey.
Take care,
Z*
Honey -- you're 39, not 103. There is no reason for you to have a spotty MRI, especially given the fact that you have neuro symptoms. You do, don't you? I have to apologize. I get everybody mixed up.
Even so, those foci are too large to be from migraines, and you're too young to just "have them." And even if you had a history of migraines and were 103, if you had neuro symptoms, THAT would be the reason for the lesions!
Aurgh. Not you, aurgh. The secret handshake aurgh. If you haven't read my other thoughts lately (I think you have) you don't know what I'm talking about...
I'm just venting. Move on to a new neuro as soon as you've gotten all the testing you can get out of this one, honey.
Take care,
Z*
Aw, please? No, really. Am I old enough for "age-related" spots? What else would cause such "spots"? This is kind of driving me crazy (and according to neuro 2, I'm already crazy) because some people think they're relevant and others don't. I have to say, my MRI *looks* like some I've seen that are considered relevant, but I realize that such comparisons are probably not that useful.
E
E
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