MRI reading

[Bjonathan14]

Hi there,

I'm new to this, so any advice would be appreciated.

I've had symptoms progressing for 15 months now. Began with severe pain in left side of face, felt like a terrible ear ache. Saw seven different specialists (from ENT to incurious disease) with no answers. Finally saw a neuro who prescribed physical therapy. The PT helps with strength, but over the last  8 months, many new symptoms have shown up including:

Severe tigtness and cramping in left arm, clenched fist at night
Tingling and numbness in left fingers
Tingling on tip of nose
Muscle spasms and cramps in left leg
Problems with balance, knees buckling
Dizziness
Extreme fatigue
Presence of babinski reflex during neuro exam

A MRI was done15 months ago which was negative. It was just repeated this past week, and several lesions were found. the report lists "possible MS" as a cause. My pain specialist (medical director at a highly reputable pain rehabilitation hospital) has no doubt it is MS. But my neuro doesn't think so. He says none of the lesions lit up wit contrast and the pattern is not characteristic of MS. I can certainly respect that,but this doctor has bee less that impressive. He didn't even read the MRI report until I was in the room. Even then, he didnt read all the way through it. He forgets which blood tests he has alread ordered, and just seems not to pay much attention to me at all. I would be happy if it wasn't MS, but he is unable to give any suggestions as to what else it could be.

My question is this: when my most recent MRI was done and the dye was injected, the radiologist did not wait at all before she started the new scans. She told me after the injection, "you'll be out of here in five minutes" and I was.  Is this enough time for the dye to take effect and show the brighter lesions? I felt like that was awfully quick and I, wondering if it could be the reason none of the lesions lit up.

Thank you very much for your time.

Regards,

Bri

[Lulu54]

there is a sense of timing for the contrast agent to infiltrate the blood brain barrier.  It takes the 5-10 minute mark to fully circulate, and you can read that in the guidelines.

As for not enhancing lesions, that means only that there is no new (less than 40 days or so) activity going on and all of the lesions are older or aren't there at all.  So please don't get hung up on whether they enhance or not. That in itself doesn't mean much in the bigger picture.

you are definitely not alone - there are lots of folks here going through the same steps and doubts.

[Bjonathan14]

Thanks you all! I found a new neuro, who was highly recommended, but of course there's about a six week wait to get in. But the appointment is set. My impatient self really has to get used to what seems like a constant waiting game.

I do appreciate your feedback! It's nice to feel not so alone.

Regards and best wishes to you all!

[maxthecat43]

The timing for the contrast was fine.  The only reason your lesions didn't light up, is because they weren't "enhancing" at that time.  You definitely have signs consistent with this disease.  Please find another neurologist.  Keep searching, until you have answers that make sense.  

Unfortunately, the ability to read an MRI is something of an art.  If you current neuro isn't as skilled, or is perhaps lazy (how it sounds) he/she may have missed something.  I have personally been to five different ones.  The first one, and the third one were like the one you describe.  Good luck.  I hope you get the answers you need.

Tammy

[saucygrl]

I use acupuncture to help my symptoms and it really helps.  I agree with JJ...wobble as quickly as you can for a second opinion.  I was not happy with my first neuro even though he diagnosed me a month after having the worst flare I'd had.  I honestly felt like he just wouldn't listen.  The second one listens to me and I'm so much more comfortable with her.  Life is too short to try and live with a doctor you have doubts about!!

Good Luck!
Chris

[supermum_ms]

Oh brother, run from that stupid jack a$$ as quickly as your wobbly legs can carry you, TN not "associated" with MS, since when? Please find another neuro!! I dont mean to be pushy, no thats not true, i take that back i've heard far too many stories over the years to trust, blindly. Try reading "Lies my neuro told me" it'll make you laugh and cry but maybe it will give you more incentive to why your neuro's MS knowledge can be important.

HUGS...........JJ

PS dont mind me, its time for my nap lol so slightly off kilta lol

[TLC_31]

In any of my five MRIs, I have not had a significant delay after the dye was injected. The technician injects me, puts a few things away, rolls me back in and starts again. Blood circulates throughout the body sometimes several times in just a minute or two.

I can understand why you would doubt your neurologist, but the MRI technician (or radiologist?) did nothing wrong.

[Bjonathan14]

Oh yea, and I will request a copy of the report to check where the lesions are located.  Thanks!

[Bjonathan14]

Thank you so much JJ. I will check out the other posts to look for optimal wait time with the contrast. I am definitely going to get a second opinion. I am seeing the pain rehab specialist tomorrow and she has a few neuros she is going to recommend. I feel fortunate to have her on my side--she is fed up with my current neuro as well. It's so disappointing to have symptoms that greatly impact my life, and have a doctor who just blows them off as if  they are not important.

I've said so many times before---i really don't care what they want to call this, I just want to get treatment and relief that works. I am starting accupuncture therapy tomorrow,so we will see how that works out.

The face pain and tingling was diagnosed as TN months ago, but the doctor insists it isn't associated with MS, although I've done plenty of research that says it can be a symptom. He also hasn't done anything to treat it long term. I currently take Baclofen for muscle spasms, and that is it.

Thanks again for your response!

[supermum_ms]

Hi Bri and welcome to our little MS community, if you havent done so yet, please have a read of our health pages, you'll find them just to the right of your screen. I'm pretty sure there is one that mentions an optimum time frame between contrast and repeat MRI's, if there's not i'm sure we have talked about it on the forum. At the top of your screen you'll find a little window labled "search this community" so if you type in eg 'MRI with contrast', it will bring up every thread we've discussused so you might also find something helpful there too.

Off the top of my head, i do remember there was some research on this, 10-15minutes is ringing bells but i'm not exactly sure of the exact time that is recommended, though i'm absolutely positive there is a wait period. Its possible that nothing light up because the contrast didn't get there yet, possible but difficult to prove without another MRI at the right time a new lesion is developing, it can be hit and miss.

Whats important is that in a 15month period you have developed 'more' lesions, having at least another clinical attack, and if that was around 8 months ago its more than likely that they wouldn't light up because they would be too old for that now. To be honest I really believe you'd be better off getting a second opinion, preferably with a neuro that specialises in MS.

You are highly suspicous for MS, i'm truely sorry but you are, i suspect you might even have enough clinical and MRI evidence to meet the time and space element in the Mcdonal criteria (thats a health page you might wish to read), do you actually know exactly where your lesions are? Often the report will state this and considering it mentions 'possible MS' it might hold more clues as to where they are located, size, shape etc so its worth getting a copy if you havent already got one.

HUGS.........JJ

PS your face pain and tingling etc sounds like TN (trigeminal neuralgia)