MRI Results - Any Insight?

[spankyandrex]

Well, just got back from GP.  He says "no lesions on the brain, but I am not ruling out MS yet", so he is still referring me for a neurology appt. on 11/14.  Here's what my report says:  What do you think?

T2 weighted imaging demonstrates punctate areas of high signal intensity within the centrum semiovale, possibly representing prominent Virchoe-Robin spaces.  There is no evidence of abnormal enhancing lesion.  The periventricular white matter appears normal bilaterally.

Post contrast imaging is negative for abnormal enhancing lesions. The corpus callosum appears normal in width and signal intensity.  The foramen magnum and cerebellar tonsils appear normal.

Impression:  Essentially normal-appearing MRI of the brain with and without contrast.  Punctate areas of signal aberration within the centrum semiovale bilaterally, seen on axial T2 weighted imaging, may simply represent prominent perivascular spaces (Virchow-Robin spaces) and are not seen as discrete abnormalities on other sequences.  END

So, what makes me wonder are the words "may simply" and "possibly representing"?  THose words are UNSURE words, that's what worries me.  THANKS for any insight !!

[Quixotic1]

The article is interesting.  It's a couple years old, so I still need to look further and see if what they propose is verified and being used.  A lot of times one researcher will find something that is really interesting and exciting, but when they try to reproduce it doesn't turn out to be true.  I am low on "reading energy" right now, so I haven't looked further.  But, if it was me, I'd take the article (you could fib and say a family doctor friend gave you the article to show to your neuro.  That way it doesn't look like you were symptom-surfing.  Seriously, it's what I would do.) and ask the neuro what he thought of it.

Quix

[spankyandrex]

just bumping this up, wondering what your take is on this article.  Off to take dog to vet, be back later ;)  

Spanky - member of Gamma Hypo Chondria ;)

[spankyandrex]

No, I didn't think you made it up LOL!  I am beginning to know you and your sense of humor and I thought it was absolutely HILARIOUS!!!!  Thanks for posting that.  I am in the "undiagnosed and misdiagnosed" area and hope to soon...FINALLY be diagnosed with something not just "stressed out and depressed" ! LOL  

Spanky

[Quixotic1]

Hey, guys, Spanky thinks I made up HGC!  As if.  It is a well-known and highly sought after Greek House for people who think they're crazy, have been told by doctors they're crazy or are afraid they might become crazy in the future.  It also for the Undiagnosed, the Misdiagnosed and the Diagnosed, but Pissed Off!  Also for people who have lost their way, found us and like to hang out.

We have Friday night bonfires and gleefully roast nasty dismissive, dense, dumb, disdainful, dim-witted,dorky, dodos of neurologists, plus other arrogant and ignoramuses who tell us we're nuts!

Quix - Queen Mother, President and Founder

[spankyandrex]

THANKS QUIX, interesting isn't it? LOL you are too funny!

Signing off - HYPO GAMMA CHONDRIA (hee hee)

[Quixotic1]

Wow!!!!  Good work!  I DIDN'T look up VRSs and thus did not give you a totally informed answer.  I will look further, tomorrow.  No, don't stay away.  I am very impressed.  I'll try to find out a little more.  This is a whole new thing for me!  I did tell you, didn't I, that I am not a neurologist nor a radiologist.

Ooooh, you get top prize for today and honorary membership in Hypo gamma Chondria for overall brilliance!

I'll read that link tomorrow.

(laughing with delight)  Quix

[spankyandrex]

I know, I know.  But I just had to search what those words actually meant Virchoe-Robin spaces and of course the 2nd site I run into, I find this below.  I will be sure to ask my neuro about it just out of curiosity, what "they mean to him" or maybe he'll tell me.  Ok, I am staying off the computer now until I talk to my doc about getting the additional MRI's before my 11/14 appointment ;)  THANKS

Found here:  http://www.ajnr.org/cgi/content/full/23/3/376#R3

Conclusion  
We suggest that the increased number of VRSs, which resemble sandlike grains on high-convexity brain MR images, is the result of the local brain inflammation that is characteristic of MS. During the early phase of the disease, inflammatory cells that contribute to the active process of demyelination penetrate the VRSs. Their appearance could serve as an additional neuroradiologic marker in the diagnosis of the disease.

[Johnny Utah]

  Sounds like a normal MRI which is always good news. Finding the answers to your health issues often times involves normal test results. Its just part of the process to finding the answer.

  Johnny

[spankyandrex]

Yes, it helps and THANK YOU.  I appreciate your time with answering my questions, VERY MUCH!  I do have lumbar problems, that is very apparent and diagnosed, so I might as well have that done too since it's been almost 3 years.  Have a GREAT weekend!

[Quixotic1]

Hi, my gut reaction is that those tiny (punctate means tiny or pinpoint) things are probably just a normal structure as the radiologist surmised.  The radiologist HAS to hedge his interpretation of things that are that small.  Apparently, such tiny lesion-looking things are sometimes seen in that particular area of the brain in that plane.  More importantly, when they tried to visualized them with other views, they didn't show up as would scarring lesions.  MS lesions will show up in different planes and often with different imaging techniques.  So, it sounds like the MRI is normal.  

Most radiology reports incorporate unsure words, because many different process can look the same on imaging techniques - thus the famous admonition that "Clinical correlation is advised."  This means that the ordering doc should evaluate anything the radiologist says based on his/her suspicions and the problems the patient has.  Your MRI wording doesn't raise any "red-flags" for me to worry about.

If you are going to have the entire spinal column done you need the cervical & thoracic done with and without contrast.  The lumbar area does not contain the spinal cord (it ends at the bottom of the thoracic vertebra) so contrast is not typically used.  The contrast is used to look for acutely inflamed (ie. "new") white matter lesions.  There wouldn't be any in the lumbar spine.

The only reason to do a lumbar MRI is if there is a suspicion of a bony abnormality, like arthritis, which could be pinching nerves in the lower back and causing symptoms in the legs.

Does this help?  Quix

[spankyandrex]

here are my MRI results from today, it got pushed down, so wanted to bring it back up.  YOu are right, I think I am going to call my GP and ask him to order a cervical/thoracic MRI BEFORE I go to the neur on 11/14 so he has all the info before I go in his hands of my whole spine and brain and we can go from there.  This time, I will ask for my cervical and thoracic, hell, I might as well have lumbar done too lOL to be done WITH contrast as if I understand it right, lesions are better seen on the spine with contrast.  THANKS