surprising results from MRI comparison

[doublevision1]

I got my report back this week, which compared the MRI I had done this February and the previous one done at a different facility in June 2012.

For background, this was the discussion leading up to this point.

http://www.medhelp.org/posts/Multiple-Sclerosis/not-thrilled-with-my-latest-MRI---what-to-do-now/show/2094795#post_10044893

As I mentioned, I was very concerned at how much my MRI had apparently changed in 1.5 years.

Well it seems it did not change all that much after all, because most of the lesions seen in February was there in 2012 but the radiologist missed them! Not one or two, but several!

Here's what the newest report says:

"FINDINGS:

Comparison is made to the follow up study done on the 1st of February, 2014.

Many of the focal areas of signal abnormality seen on the current study were present on the previous study including a lesion within the corpus callosum, pontomedullary junction, the temporal lobes and peritrigonal white matter of the right trigone region. There is at least one non enhancing lesion which has developed in the interval in the deep white matter of the left parietal lobe. There is also a small white matter lesion posteriorly in the left centrum semiovale which may have been present on the prior study though not demonstrated due to the scanning technique. Otherwise no new lesions are seen within the brain parenchyma and there are no enhancing lesions seen.

Imaging of the spinal cord shows an area of increased signal and diminished crisis-sectional caliber of the cervical cord entered at the C4-5 level. Subtle area of diminished signal on the right dorsolateral aspect of the cord was also present at the C6 level. Small area on the midline ventral aspect of the cervical medullary junction, seen on the recent study, was not evident on the prior study.

SUMMARY:

Both studies demonstrate multifocal abnormalities in the brain and spinal cord in keeping with the provided clinical history of RRMS. Since the study was done in June 2012, one non enhancing lesion has developed in deep white matter of the left parietal lobe as well as in the midline ventral aspect of the cervicomedullary junction. No other interval change is seen."


So, while a couple of new lesions have developed since 2012, it has not changed in that timeframe as much as it initially appeared. However, there are a bunch of new lesions that developed sometime prior to 2012 that I had no idea I had.

This experience has made me lose confidence in my trust in radiologists..... how do I know this latest report is even accurate?

Anyway, I discussed with the nurse and she said if I'm tired of doing shots I could try Gilenya. I don't care about the shots, they don't bother me at all, but as Gilenya had better outcomes in studies I'm considering switching. The down side: potential side effects, and no long term data. I tolerate Copaxone very well but at some point, god knows when,  a bunch of new lesions have developed and with some subtle newer symptoms I don't think I want to miss the opportunity to try something possibly more effective.  I don't want to make any change until I've been to Italy and back, in case I do have side effects. I will see my neuro when I return from my trip in May and make decisions then. Until then I'll read all I can on Gilenya.

In the meantime, I remain mindboggled over these unexpected results.

[Jifr]

This is part of why I recommend we, as MSers, "know thy self".   That is, know your MRI.  If you're fortunate enough to have a decent neurologist, see if they will look at your MRI with you during a visit.  Have them show you where your lesions are so YOU know what you are looking at on the MRI.  I think it's better to know what's going on in your MRI so you are not in the dark when you get results that vary so much.  Some MSers frown on this but it's the right thing to do for my person.  Not sure if it's something you would be able to do.  

I review my results looking at the screen with my neuro on every visit if i had an MRI.  I know where all of my lesions are and i know if there are new ones before i get a report or see the neuro. It makes it a lot easier for me to be or get prepared for a quality visit.

[rendean]

Glad to hear that you haven't had a number of new lesions recently but it IS  disturbing that they were missed in 2012!  I would certainly have the radiologist that compared the last two MRIs, compare any future MRIs for you  since he/she seems to be more through.

Enjoy your trip to Italy!!

Ren

[supermum_ms]

That must be frustrating to know the radiologist back in 2012 didn't pick up those lesions but i'm wondering 'if' the big picture thinking should actually be, that the Copaxone sounds like it could actually be working for you.  If at the end of the day, there are only a few changes since 2012, wouldn't that mean lesion development has slowed down in the last couple of years?

In my head is a research study where the collective DMD's studied, still produced lesions in the participants but there was a notable reduction between those on a DMD and those there were not. I can't get my hands on it sorry (i'm still looking) but off the top of my head it was something like an average of 2-6 lesions per year, compared to 6-10 for those not on a DMD.

The researchers did also note that MRI's did not always correlate to new sx's or pick up all the lesions a person had and that a persons clinical signs of stability or worsening needed to be taken into account, possibly more than the MRI results. I'm pretty sure it was a medscape paper but so far i haven't found it but i'll pass it on when i do.

Cheers.........JJ  

[karryon55]

I would be feeling a bit let down right now if I was you DV. If a radiologist missed all of those lesions back in 2012 then you really need your Neurologist to be spending the time comparing your MRI's. Although it is great news that you haven't had a truck load of new lesions from your most recent MRI.

I must be honest that I have always wondered if the radiologist is busy & have a lot of MRI's to get through & if lesions are small etc they could easily be missed. This is where I really really hope my Neuro is going over the disc himself & not just reading the report.

I think your plan of taking your holiday first & then change treatments sound well thought out.

Take care.

Karry.

[cubbiesfan918]

DV - I hope you find a resolve quickly. Although I was only on shots for 4 months, I couldn't with all honesty tell you I would want a life of it forever. I'm so happy with my switch to oral but so greatly understand your concerns with the possible side effects.

I hope you have a wonderful trip to Italy - I can't wait to see pics and hope your puppy is doing well also!

XOXO
Lizzie

[HVAC]

I go with my doctors not the radiologists for my MS and Cancer. Radiologists don't know my history.

Alex