Avatar universal


Hi, I am new. I joined after lurking for a few days to ask foolish questions and because I am impressed by the pragmatic lack of drama in the responses here. My first foolish question is: can atrophy be determined on an MRI without a Pre-Ms MRI to compare too? People don't usually have an MRI in their back pocket for no reason. How is this done? I have read the space between the skull and the brain increases and I assume that would be true of the space between the cord and the spine. But people's shoe size differ so how can it be known what space is within a normal amount & what is atrophy?

I was diagnosed in 2004, 19 years after I had ON. An opthamologist told me this could be MS. It cleared up. I had no recognizable problems. I thought I dodged a bullet. In 2004, I found out I had not dodged it. I read that people who live with MS for a long time without being affected much, can just end up with some atrophy of the spine and the brain. So I wanted to know if my brain and spine MRI's showed atrophy. I did run across a poster who identified herself as a neurological nurse, on one of the boards. I did ask her how spine atrophy was determined? Brains get black holes. Was it by clinical observation of how the spine was working or can it be shown on an MRI? Is there a standard diameter a spine must have to be non-atrophied?

She said the MRI of the spine does not narrrow uniformily on the MRI, instead it suddenly narrows and widens and that shows atrophy. Does a lot of CFS fluid around the cord inside the spinal cage or around the brain in the skull determine it? What is a lot of CFS fluid? Any thoughts or experiences in determining atrophy?

Thanks. I'm curious. Lynn
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Avatar universal
Hi Lynn

I cannot answer your questions but would like to welcome you.

You will get a lot of support, help and advice here. I'm sure as the day goes on you will get answers to your questions.

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Avatar universal
Hi and welcome. I too have no tech knowledge, but I do have some thoughts, not to mention some questions.

I'm thinking that in general, you're right---For a given individual, the only sure way to determine brain atrophy is to compare old and new MRIs. Also, it is established that normal brains atrophy somewhat with age. However, radiologists are highly trained and have looked at thousands of brains and their MRIs. They know what is the normal range and what isn't, based on age.

If a radiologist's report includes a statement about brain atrophy, it is made in the context of what is normal for a person of that age, and I'm sure 'normal' means 'falls within a range' above and below which is abnormal. I guess there are outliers in everything, but that would be extremely rare.

Now here's where I'm really speculating, so I hope Quix sees this and amends what I say: I think brain atrophy must basically mean a shrinking of the gray matter, which holds the thinking parts. The white matter is basically the wiring. Of course if there's enough damage, the white matter fails to regenerate at all, and then plaques might be absorbed, leaving the 'holes' we hear about, and the matter around them contracts.

But I'd imagine if the wiring doesn't function, the gray cells they connect would also be seriously damaged and could eventually die. That's another way that brain volume could lessen.

I'm even more confused about the spinal cord. I haven't heard about that atrophying at all.

Could someone knowledgeable jump in here? Quix?

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338416 tn?1420045702
> My first foolish question is: can atrophy be determined on an MRI without a Pre-Ms MRI to compare too?

That's not a foolish question at all!

Ess is right - they do like to compare old and new MRIs.  But without an old MRI, what they do is measure the ventricles of the brain, and the space around the brain, under the skull.  They can tell if those spaces are abnormally large.  I think I've heard the words 'pixel count' being used...  Maybe they count those black pixels in the MRI.

I'm curious about this as well, because I haven't had a good MRI since 2007.  I'd like to check to see if my brain is shrinking.
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333672 tn?1273792789
I don't know the answer either, but my last cervical spine MRI says "Minimal flattening of the spinal cord suggesting mild atrophy at this level [it's unclear to me what level they're talking about] is observed. This is unchanged." So apparently they can sometimes tell without having a before picture to compare (they only had the two scans to look at, although the first one, interestingly, doesn't mention the possible atrophy).

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147426 tn?1317265632
Welcome to the forum!

I have heard only one foolish question in my life and that was "Should I put my 11 month old on cows milk?"  That one was only foolish, because they called the emergency line and woke me up at 3 am to ask it!

First, brain size does vary from person to person, but that is reflected in the size of the skull.  As the brain grows - from conception to adulthood, when the sutures close - it pushes out on the skull and causes skull enlargement.  Thereafter, the brain is at a stable size within the skull and there is a pretty predictable spacing between the skull and the brain tissue.  So, on any given normal person there is a "normal" range for the areas that show up in as atrophy.  These areas that show atrophy are the space right under the skull bones to the brain, the width of the sulci, which are the big folds in the brain, the area of the ventricles and the areas around the brainstem and spinal cord.  You should be able to judge any atrophy using volumetric calculations on the first MRI.

So you can actually look at a person's first MRI and say that this person does or does not have apparent "atrophy for age."

Atrophy for Age

Using sophisticated MRI tecniques they can actually measure the volume of either brain tissue or the volume of CSF.  In the Central Nervous System any area that does not have tissue in it has CSF in it.  Measuring the volume of the fluid is easier than measuring the nerves and other structures.  Doing this they know that a person's brain begins to atrophy by about age 40.  However the normal aptrophy of a person at age 40 is not visible to the naked eye.  It is just able to be calulated.  (Jen is correct.  One method does involve computer counting of the black pixels of certain CSF spaces.)

In atrophy the spaces containing the CSF all widen.  This is first noticeable in MS in a widening of the space under the skull and a "thinning" of the folds, the sulci.  Later you can see obvious dilatation of the ventricles.  The spinal cord may atrophy in a wavy manner described by ess and Jen.  

People as young as early 50's should not have obvious atrophy to the naked eye.  When this is noted and is called "normal atrophy for age," I have to take exception, especially when it is accompanied by neurological problems.  The majority of people at age 60 don't have any atrophy at all to the eye.  So, if it is seen, it should be held suspect as an indication of a problem.

I used to share the impression that "black holes" are voids, but they apparently are not.  they are lesions in which the nerve fibers themselves have died or are seriously damaged.  According to Dr. Kantor and backup up by some articles I have read, black holes are lesions, some of which can heal.  the overall image of a brain shrinking from progressive loss of nerves still stands, though.

Spinal atrophy certainly does occur and some have said it is more closely related to ultimate disability than atrophy of the brain.

There are at least a dozen methods to determine atrophy - with new ways always coming up.  All are by MRI data manipulation.

There is a test called Optical Coherence Tomography, OCT - which is done on the otpic disc (through a dilated eye).  It was developed at Johns Hopkins in the last few years.  It is able to measure the thickness of the very outside edge of the optic disc where all the nerves are fanning out to cover the retina.  Via studies they determined that the thinning (atrophy) of the optic disc parallels the atrophy of the brain and/or spinal cord.  So they can monitor this parameter during a person's disease in place (sometimes) of an MRI.  It's much quicker and cheaper.

OCT then demonstrates that a person with MS has some measure of Optic Neuritis all along.  At least that is what I understood from my neurologist.  Because ON is what causes the thinning of the optic nerve and if they can use this test on all/most people with MS then that means that all/most people with MS have recurring demyelination of the optic nerve - ie . optic neuritis.  I don't think I ever had any visual symptoms, yet my OCT does show mild atrophy on the left and borderline atrophy on the right.  Weird, eh?

They have not yet shown a place for OCT in the diagnosis of MS.

Did I answer the question and should we have an HP on Brain and Spinal cord atrophy?  If so this would be a good start.

Lynn, I smiled sooo big when you praised us for lack of drama and not full of posts that sensationalize myths about MS.  Thank you!

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572651 tn?1530999357
This one should definitely be a HP - it is meaty and full of good detail, with logical explanations.  
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Avatar universal
Thanks to all who responded. It is very meaty and I will mull over the new information for a while. It would have been helpful to me if it was already a HP, when I came here.. So I do think it should be placed there for the next person who looks for that info & for me so I can find it again....

Quix you wrote that you have recently found that black holes are lesions that can heal. I would also suggest an HP about Black Holes. Since this thread is likely to go into HP,  I will add what I know about Black holes. Perhaps you can edit the Title of the thread to indicate  it includes Black Holes too or add it to the Lesion HP so it is all together..

When I was diagnosed & got my CD of my MRI scan there was an obvious dark spot on the MRI, that I assumed was a "black hole"?? My report didn't say anything about it. My report just said "extensive white matter damage consistent with MS". What I saw on the CD made me investigate much about MRI's & lesions. Ring enhancing lesions & Black Holes.

I read that there are 3 types of Black Holes you have already covered the Ring Enhancing Lesions in you HP "How MRI's Show Lesions in MS" Perhaps that to could be edited with how MRI's show Black Holes.

The three types of Black Holes are...the first two can heal. I'm not certain of the last kind.

Acute  T1 Black Holes - those are just lesion that would have enhanced on a T1 scan with Gd  dye, but without the dye they show as dark on a T1 scan.

Persistent T1 Black Holes - These lesions that show dark even with the dye,

Chronic T1 Black Holes - Theses are Persistent Black Holes that have remained for 6 months or more & are thought to be permanent.

I had a Persistent Black Hole when I was diagnosed and it was gone on an MRI 2 year later, so it never became Chronic. At least I hope it healed and wasn't absorbed, Yikes! :-o

The first 2 types of Black Holes can heal & often do. Do you know if Chronic Black Holes can heal too?

I'll add this from what I have learned about looking for  black holes on my MRI's.

A Black Hole shows on a T1 scan, but it should have a corresponding T2 highlighting lesion that highlights because of the CSF fluid there. Otherwise what looks like a black spot on a T1 scan could just be a mineral deposit. As a person gets up there in age, I believe those mineral deposits increase? The brain was a lot neater when it was younger. I'm 45 and a poor housekeeper.

As always I can be corrected and welcome being corrected if I was not right about what I understood I read.

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Avatar universal
hi llynn,

my neuro and a radiologist was able to distinguish and poinnn t out atrophy annd widening suli with out and mri from beofre Ii got sick.

Thank you for posting the explaination of types of blackk holes.
Ofically can i  be called a pea  brain:)  amo
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