MRI of Brain - I have MS - need help understanding findings

[hotstuffmom]

What does it mean with there is a single, new focus of increased signal in the anterior margin of left middle frontal gyrus.  There are periventricular, deep whit matter and subcortical parenchymal changes.  The other periventricular deep whit matter and subcortical changes are similar with lesions right and left body, frontal genu of corpus callosum, posterior bodies trigons of lateral ventricles, right deep white matter, subcortically to precentral gyrus.

[jensequitur]

I'm not sure why neurologists always schedule you for a brain MRI when you show progression, even if the problem isn't obviously in the brain.  Looks like you've got some progression in both brain and spine.

I have spinal lesions, which cause leg weakness, weird paresthesia in my knees, and some stiffness and lack of control.  I also get myoclonus in them, especially in the mornings.

[hotstuffmom]

Yes, the Radiologist compared this MRI with the one I had in 2008.  

I have had multiple MRI's of the spine; the MRI scan of my cervical spine demonstrates a disk herniation of right C5-C6, with spinal cord compression, mild.  T2 signal of spinal cord demonstrates a fairly focused lesion.  Assessment:  Right C6 nerve root impingement syndrome, secondary to diskogenic stenosis at right C5-C6, with spinal cord compression and abnormal spinal cord signal, with findings of myelopathy.  I had C5-C6 fused in 2005.  

[jensequitur]

Did the radiologist compare your last MRI with this one?  If so, it sounds like you have a new lesion.

You're having trouble walking, huh?  Yeah, me too.  Have you ever had an MRI of the spine?

[hotstuffmom]

hello everyone, and thank you for your responses.

I was diagnosed with MS in 2005

I have not discuss my last MRI with my neuro, I am waiting to get an appointment with him.  I had an appointment with him in November 2010, and he states that my walking has worsen.  He wanted me to get another MRI just for a comparision to the one I had in 2008 and the one I had in 2005.

I am just trying to understand what the results are showing.

Below is what my lastest MRI shows:

MRI OF THE BRAIN WITHOUT AND WITH GADOLINIUM -- 1/24/11
History: Multiple sclerosis; follow up; headache.

Technique/findings:   Axial diffusion weighted images, axial T2 weighted, FLAIR, sagittal T1 weighted and coronal T2 weighted images were obtained. Post Gadolinium enhanced images in axial, sagittal and coronal T1 weighted and sagittal FLAIR images were obtained.  Comparison with study of 1/9/2008.

The diffusion weighted images demonstrate subtle focus of increased signal in the left middle frontal gyrus, it is accompanied by high signal on apparent diffuse coefficient maps, this is compatible with T2 shine through.  

There are no other areas abnormal diffusion restriction. There is no evidence for acute infarct.

The ventricles, sulci and cerebellar folia are within range of average. There are periventricular, deep white matter and subcortical parenchymal changes.  There is a single, new focus of increased signal in the anterior margin of left middle frontal gyrus, best seen on FLAIR images, #19 and #20 and sagittal images #5. This lesion was not identified on previous study.

The other periventricular deep white matter and subcortical changes are similar with lesions right and left body, frontal genu of corpus callosum, posterior bodies trigons of lateral ventricles, right deep white matter, subcortically to precentral gyrus. These were present on prior study.

There are expected flow voids for the vertebral, basilar and internal carotid arteries.  No abnormal masses, fluid collections or residua or hemorrhage are present.  The contents of sella turcica are unremarkable.  The mesial temporal lobes are of normal appearance.

Post Gadolinium enhanced images demonstrate no areas of abnormal meningeal or parenchymal enhancement. In particular, there is no associated enhancement of left middle frontal gyrus, white matter signal change.

The cranio-cervical junction is normal with normal position of cerebellar tonsils.  The contents of sella turcica are unremarkable.

IMPRESSION:

1.  Single, new, subcortical white matter change or white matter lesion, left middle frontal gyrus.
2.  No acute infarct
3.  No abnormal enhancement
4.  No evidence of active breakdown blood brain barrier

[jensequitur]

Oh, yeah - meant to say that the 'new focus' means it's a new lesion.

[jensequitur]

Ooh, they've got a lot of anatomy terms there, don't they?  Usually what I do is google words like anterior margin and gyrus, and see what they mean.  You've probably started doing that already.  I recommend Wikipedia.  Radiologists don't always use the same terminology, but you can usually figure out what they mean.

Here's where you have to be careful, because researching your own MRI can lead you to information that isn't true.  Especially when they're using phrases that you don't understand.  Like 'parenchymal.'

So let's go with what we do know.  It sounds like you have several lesions in your brain.  A single new focus of increased signal is a fancy way of saying you have a white spot on your MRI.  There's something going on in the periventricular and subcortical regions.  (Periventricular means close to the ventricles. Subcortical means below the cortex.)  It also sounds like you have a lesion on the corpus callosum, and some activity around the lateral ventricles, wherever that is.

Have you talked to your neuro yet about your MRI?  Or are you waiting for the appointment?  I can't tell from what you've put down here whether your MRI was with contrast - did you get the MRI because of a flare?  

Here's a couple of health pages that will really help you understand what's going on.

This one was written by Quix:
http://www.medhelp.org/health_pages/Multiple-Sclerosis/How-MRIs-Show-Lesions-in-MS/show/23?cid=36

I wrote this one to help explain how the MRI works, if you're interested:
http://www.medhelp.org/health_pages/Multiple-Sclerosis/How-does-an-MRI-work/show/79?cid=36

Welcome to the forum!  Feel free to ask anything - I do!

[Lulu54]

Hi Hotstuffmom and welcome.  From your heading I am going to assume that the doctors have already told you that you have MS.  The locations of the lesions they have mentioned in this report are classic for MS.  

Rather than focus on the lesions and the amount of them, please remember that it is just like real estate .... location, location, location..... makes all the difference.  The brain is enormous - if you could unfold in you would be shocked how large it is.  And a majority of that brain is unused territory.  

We don't feel the effects of those lesions on our body unless they are in the perfect spot - we can have a boat load of lesions and never be affected by them.  Or we can have a few tiny lesions that reak havoc and make our lives miserable.  

Maybe when you get more comfortable here you can share more of your story and how you came to know that you have MS.

In the meantime, welcome again.  I hope you find this forum useful.

be well, Lulu