3T MRI Addendum, because MS Specialist was impressed

[johnniebear]

I had my first 3T MRI of the brain last fall at private location,  I asked them prior to the scan if they would need my 1.5T report & disk.  I was told they could obtain the data online.

Speed forward, (not to fast tho- I don't want lose my balance again)  I travel to the Chicago area now to see my Ms Specialist he said the report was no use because the private MRI just did a comparison from the hospital report.
He had his nurse call the private location & requested they do the comparison correctly. So here it is below.

My Dr reads his own MRI'S anyway,   but told me why I should go their teaching hospital and have my next MRI done in April.  At the teaching hospital they will do more slices than on the private MRI.

My next 3T MRI will include brain &Cervical.

Here's the addendum report,   If I understand this correctly  their are   four stable lesions ?

Addendum:  Images from the above referenced outside comparsion exam are provided wasn't previously available.
Please note that there are differences in technique between the 2 exams, including 2mm sagittal and axial Flair images on outside exam which result in thinner section imaging which is not typical for our demyelinating protocol.

There is a stable focus of abnormal signal just lateral to the right frontal horn, slightly more conspicuous that the previous axial images likely to the difference in slice selection.
The previously mentioned lesion along the mil left and posterior right corona radiata are also unchanged,  There is stable subtle area of abnormal signal along the left paramedian anterior genu of the corpus callosum as seen on sagittal FlAIR images.  Again although there appear to be new foci of abnormal signal on axial FlAIR image 12 of the current exam, these are consistent with pulsation artifact.   There is also a stable minimal periventricular signal along the posterior body of the left lateral ventricle on axail T2/FLAIR image 12.  Again finding can be consistent with demyelinating lesions if clinically appropriate with an overall minimal T1/T2 burden disease.


anyone have any thoughts?  
Do I have this correct that there are 4 lesions?
I have one lesion on the spinal cord around C3-4 and abnormal VEP  on the left.
I'm not on any DMD'S yet.

Thanks everyone
Johnniebear

[COBOB]

If you have symptoms, that points to a past attack (possibly very minor.) so that could move you into the realm of CIS.  By doing that, it is easier to get the insurance companies to accept paying for a DMD.  Also, if you have a second attack in the future, it would make it easier to get to a diagnosis of RRMS.

[johnniebear]

The local neuro was really a waste of time, the MS Specialists  at the teaching hospital was great.  I have to travel to the Chicago area to see him,  however it's worth it.

Even though I'm not on any DMD'S yet I still live with  some MS symptoms .  I learned on this forum it ok to challenge  the Health Care Providers when necessary, the MS Dr however went the extra mile and made the Radiologist earn his keep.


Thanks to everyone.

[COBOB]

Nice to see the doctors debating it, but I'll be most insurance plans have no debate.  Most only begrudgingly treat CIS.

Bob

[wiggles94]

Here is a great debate between two MS specialists re treating RIS:

http://www.medscape.com/viewarticle/720673

[COBOB]

There are 4 lesions and one artifact called out in the report by neuro-anatomical landmarks.  It is a good report to send to a neurologist that would know the neuro-anatomy.  They normally will wait 6 - 12 months to see if there is a progression in lesion load or a clinical exacerbation.  You have to have one attack to have CIS and the current recommendations (I think) are to watch and wait with RIS.  

If you have not had one attack, there is really nothing to treat.  

[twopack]

My MS specialist doesn't even look at the reports, especially in my case since every MRI was done at a different place using different protocols.  He reviewed them frame by frame after setting them up on side by side computer screens.  He advances one set and has his nurse advance the other on his cue while she offers a second set of eyes to identify changes.  He uses biological landmarks to keep the images in sync.

In the report, it sounds to me like he is describing lesions and asking for chinical signs that would indicate they are indeed caused by demylination.  That would seem to be an excellent approach, especially since there aren't huge numbers of lesions.

I'm not sure how many lesions there are by this report.  If you are interested in using a DMD, I would certainly start asking questions about the wisdom of waiting to do that.  More than a few people on the forum have had new and increased symptoms without evidence of new lesions on MRI.

Once again, I'm amazed that so much depends on the MRI in MS diagnosis and treatment.  I still think this type of tracking of symptoms vs. visible lesions vs. changes in lesion appearance is more like a research experiment than real science.  Hopefully, when done often enough on enough people the docs will get a better idea of the true relationship of visible lesion changes and the disease process.

That's my thoughts.
Mary

[COBOB]

No exacerbation but positive MRI = RIS
You have to get that one exacerbation to get to CIS
And two to get to MS.

[jensequitur]

No full clinical exacerbation...  meaning no relapse, right?  Hmm...  Has your doctor uttered the dread acronym yet?

[johnniebear]

I have a DX on all the paper work from my Dr.
My Ms Dr says left hold off for now and I agreed.  I haven't had a full clinical exacerbation yet.

thx

Johnniebear

[jensequitur]

I would say at least four - what they're saying is that the "stable subtle area of abnormal signal along the left paramedian anterior genu" is also a lesion, but it's not as visible as the other lesions.

Are you still waiting on a diagnosis, or are you just holding off on the DMDs?