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Not sure about my MRI of Brain and Spine...

I have been going through MS testing for awhile and had a LP done and it was normal. I have had another doctor tell me probable MS but he isn't sure and it will take years to find out. I went to see a MS specialist out of town and wont have my follow up for over a month. I am wondering if anyone can help me understand this and if it is going to finally give me a diagnosis so I can get some treatment. I have been suffering with a lot of symptoms for over 20 years.
MRI BRAIN W WO CONTRAST  Comparison: None.
No evidence of intracranial hemorrhage or mass is identified. The ventricles are of normal size and configuration. Diffusion weighted images indicate no evidence of acute ischemia.
There are multiple small foci of abnormal signal scattered throughout the periventricular and subcortical white matter bilaterally. The majority of these lesions quite likely reflect gliosis and the distribution is certainly consistent with multiple sclerosis. No mass effect or midline shift is identified. No signal abnormality is identified within the posterior fossa
Following contrast infusion, no pathologic enhancement is identified.
Expected flow signal is present in the major arterial vasculature at the skull base and within the dural venous sinuses.
Limited opacification of the left mastoid air cells is identified. The right mastoid air cells and the paranasal sinuses are clear.
IMPRESSION:
1. Multiple small foci of abnormal signal are identified scattered throughout the periventricular and subcortical white matter bilaterally. While strictly nonspecific, findings are certainly consistent with a diagnosis of multiple sclerosis. Following contrast infusion, no pathologic enhancement is identified to suggest acute/active demyelination. Otherwise, no intracranial abnormality is noted.
2. Limited opacification left mastoid air cells. This could be developmental, serous, or less likely inflammatory. Clinical correlation is recommended.                                                                                                                        
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MRI CERVICAL SPINE W WO CONTRAST
Comparison: None.

Examination is limited due to patient habitus and due to the patients swallowing during imaging.

The imaged vertebral bodies are intact and within satisfactory alignment. A degree of marrow reconversion is suspected and the patient is known to be chronically anemic. There is no marrow signal to suggest an acute osseous abnormality. The disc space heights are well maintained.

At the C2-C3, C3-C4, and C4-C5 levels, no significant abnormality is noted.

At the C5-C6 level, a shallow central disc extrusion is identified which produces mild central canal stenosis and effaces the anterior surface of the cervical cord. Cord is not compressed. No significant foraminal narrowing is identified.

At the C6-C7 and C7-T1 levels, no significant abnormality is noted.

Fairly mild facet joint degeneration is apparent at several levels.

The craniocervical junction is normal. T2 and STIR images suggest subtle, amorphous regions of abnormal signal in the cervical cord primarily at the C4 level and at the level of the C5-C6 disc. These may well relate to the patient's multiple sclerosis. Within the limits of today's exam, there is no definite enhancement following contrast infusion.

IMPRESSION:

1. Somewhat limited evaluation due to patient habitus and due to swallowing during the examination.
2. Subtle, amorphous regions of abnormal signal are present in the cord at the C4 level at the C5-C6 disc level, potentially related to the patient's multiple sclerosis. No definite enhancement is identified following administration of contrast.
3. Shallow central disc extrusion C5-C6 level producing mild central canal stenosis and subtly effacing the anterior margin of the cervical cord. Cord is not compressed. Otherwise, no significant neural impingement is noted within the cervical spine.
4 Responses
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11079760 tn?1483386130
I know it's hard to wait, but your neurologist is the best person to interpret your scans for you. For example, even though the radiologist notes that you have findings that are consistent with MS, that doesn't mean it is MS.

I am sorry for all you have been going through. Limbo is so hard! There are others here who are more knowledgable than I am about MRIs, so maybe they can give you more insights.

Keep us posted on your follow up appointment.

Cheryl
Helpful - 1
1 Comments
Thank you my follow up is in August I know the first doctor was not sure if it is MS so it's a very nervous waiting game now. I just want some kind of a diagnosis so I can get on with my life and hoping to be able to drive again. Thanks for responding.
987762 tn?1331027953
COMMUNITY LEADER
Hi and welcome to our little MS community,

MRI speak is a pain, they're not that easy to interpret and most of the time they confuse lay people more than shed enough light on exactly what's going on.....MRI's are only one diagnostic piece of the diagnostic puzzle when it comes to diagnosing MS, you don't mention what your symptoms are but your symptom type and pattern, abnormal neurological signs etc are all important clues on whether neurological conditions like MS are possible or not.

To me your brain MRI isn't particularly screaming MS of 20 years, you do have an undisclosed number of non specific periventricular lesions, which is one of the specified Mcdonald diagnostic criteria locations. MS would be on your potential causes list because of that lesion location but within your MRI report it mentions you have a history of chronic anemia, and small vessel ischemic brain lesions are associated with some types of anemia, so it's possible that these MRI finding are more vascular than demyelination.

Your spinal MRI apparently wasn't very good, it definitely does happen more often with spinal MRI's but first time i've seen a patients habit of swallowing as a reason for poor quality scans......the part about the "Subtle, amorphous regions of abnormal signal are present in the cord at the C4 level at the C5-C6 disc level" is as clear as mud, my interpretation is that the radiologist can't clearly determine if there are multiple cord lesions or not.

Amorphous basically means the radiologist saw vague unclear shape or form, so it's not clear enough to say what this is but from the similar type of wording throughout ie "potentially related to the patient's multiple sclerosis" he/she has the impression that your brain and spinal MRI's are from an already MS diagnosed patient and he/she is assuming spinal cord lesions...

'IF' these amorphous regions do end up being determined too be spinal cord lesions, when combined with the periventricular brain lesions, you would theoretically have the MRI evidence to meet the Mcdonald diagnostic criteria for MS but keep in mind it's possible with unclear scans for this to be a system error and not really there.....

My lay persons interpretation is that you 'may or may not' have MRI evidence that would be suggestive or consistent with MS....your brain MRI is clear but there wouldn't be enough with just your brain MRI to put MS at the top of your potential causation list, your spinal MRI will likely need to be redone to have clearer images of these amorphous regions and determine if it is consistent with MS or not. Please keep in mind that there is a lot more to dxing MS than just a persons MRI evidence and seeing an MS specialising neurologist in a few months would be in your best interest at this stage!

Hope that helps........JJ

  

Helpful - 1
1 Comments
I have a huge amount of symptoms.. Loss of vision I went to the eye specialist and he said I had Optic Neuritis. I have a lot of numbness and what feels like bug biting me all over. My head goes numb and right side of face. I have a feeling of some type of chest pain kind of like a spasm like my chest is being squeezed really hard and it happens daily. Been to ER and they said it wasn't heart related. I am having more problems with memory loss and I forget where I am going and don't drive anymore. I can't stand or walk well I fall down a lot and have been accused of being drunk or on drugs because I can't seem to get my words out as I am thinking them.. Everything is jumbled up. I have heat intolerance I get sick, weak and pass out in the heat. I feel tired and weak all the time and push myself just to walk to the bathroom and mailbox because I am so exhausted. I have bowel and bladder problems. I was tested and it shows dysfunction in both and not sure why.  When I stand it feels like ants are eating my feet and stings until my feet go numb. I always feel dizzy even if I am sitting down. I get feelings someone is zapping me with a bug killer in my limbs.. I used to have anemia issues and went in for iron through the i.v. and the hemotologist said I am no longer anemic I am checked every six months by that doctor and the last year he said it was good and I got no iron so not sure why they say that I am having anemia as far as I know it was taken care of. I could go back and be checked again. The eye doctor did say I have thinning in my eyes and lots of damage. I did some steroid treatment. I had a evoked potential and waiting on results with follow up. I had some blood tests and waiting on results at follow up. Thank you for the reply to help me better understand. I just want to feel better and hopefully get help so I can live my life again without being sick all the time.
5265383 tn?1483808356
Even when it seems like the MRI is a shoe in to a general radiologist (I met McDonald Criteria in 2013 within a few months of my first relapse), it is completely up to the ms neurologist.

Mine felt my lesions were too small and non-specific despite meeting dessimination in space.  When I had an increased lesion count over a year, they were subcortical lesions which are not particular to ms.

So despite meeting criteria, and a bunch of relapses, my diagnosis took 3 years.  I actually was tentatively diagnosed December 2015, then my LP was clear and he promptly ruled out ms again (unfortunately he had already ruled everything else on the planet out).

Took another year and in input from other specialists before he finally dxed me.

The amorphous region on your spinal cord might be considered a lesion, in which case that would possibly move an ms diagnosis.  OR your neurologist would suggest it's an artifact, which it very well could be.

It's a long and frustrating wait, for sure.  So sorry you're going through this, KDD :(.

Helpful - 1
1 Comments
What is a McDonald Criteria? I have never heard of that. It seems very difficult to find out what is going on. I just hope they find something and help me feel better soon..
987762 tn?1331027953
COMMUNITY LEADER
The Mcdonald criteria is basically the MRI diagnostic evidence you need to meet the criteria to be diagnosed with MS, there are 4 specific lesion locations and you need at least 2 out of the 4 locations, so theoretically IF you have both periventricular and spinal cord lesions this would be 2 out of the 4 and meet the Mcdonald criteria...

Having a preexisting dx of optic neuritis (ON) would be evidence of a prior attack, having ON and an MRI with brain lesions actually increases your risk of developing MS. You mention experiencing "a feeling of some type of chest pain kind of like a spasm like my chest is being squeezed really hard....it wasn't heart related" you could be describing the 'MS Hug', this is a tight banding or squeesing type of feeling that partially or fully surrounds the torso.

The Hug is often caused by the intercostal muscles between your ribs spasming, these intercostal muscles naturally expand and contract whilst breething, but when they spasm or lock down in their contracted phase your rib cage is unable to do what it's suppose to do, hence the tight restricted feeling.....both the MS hug and neurogenic bladder/bowel dysfunction are associated with spinal cord lesions, so it's definitely possible that those amorphous areas are actually spinal cord lesions.

I definitely think you need to see an MS specialising neuro, make sure you have the reports from the urologist and ophthalmologist with you when you get another opinion in regards to MS but please keep in mind that there are similar neurological conditions to RRMS that will still need to be considered if you have bilateral ON and do have multiple spinal cord lesions.

Your close to knowing what's going on, please hang in there and let us know what happens but in the mean time if you need any questions answered please just ask away, no topic is off the table here...

Hope that helps........JJ    

  
Helpful - 1
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