Types of lesions

[CtResident]

Okay, correct me if I am wrong. On an MRI, if the lesions are "ovoid", that is from MS. If they are "punctate", that is from migraines?

Are there other types/shapes/sizes? Is it entirely possible to have both of the above? Because I do get what I personally term migraines, but I haven't ever been to a dr. for them, nor do I take anything other than OTC meds for them.

Could I have both lesions on an MRI? (I am presently undiagnosed with MS.)

Thanks,
Sniffly Suzanne

[Quixotic1]

That's exactly what it boils down to.  That and the professional opinion of your neurologist.  My neuro is far better than the neuroradiologists (who specialize in imaging the central nervous system).   He pointed out areas on my 1.5T spine image that he was suspicious of and each one of them ashowed as a lesion on the 3T film and each one was missed by the radiologist.

They are like all members of all professions varying from extraordinarily good , to okay, to medicore to stupid.  Some are more conscientious in their review of films and some see things and patterns that others miss.

A difference in the reports is sometimes prompted by the amount and detail of the "clinical history" put on the MRI request.  The more info , the more likely the radiologist will look for signs to substantiate it or rule it out.

Much of medicine is more an art than a science.

Quix

[SOONERMOM]

So does it really boil down to the Radiologist's professional opinion?

My first MRI said "lesions not classical for MS", the second 2 months later said"multiple sclerosis is most likely, pattern & appearance on FLAIR suggestive of MS type lesions, etc".  My Neuro said there were no changes of my lesions, same number and size.

Thanks,

Stacey

[Quixotic1]

I must have been misleading in my description.  MS lesions can be of any size, shape and location.  And Heather is completely correct in her post.  When I was talking about the "classic" ovoid lesion, I meant just that.  It's suggestive of MS, but not nearly all MS lesions are ovoid.  And some migraine lesions are larger than punctate.

It's just that some docs assign "arbitrary rule" to what they will accept fro one type of lesion or another.

Yes, you can have lesions from different causes in the same brain.  A person with migraines and MS who's in their 60's will likely have some MS lesions, some migraine lesions and "age-related" UBO's.  And, for the most part the doc's can only guess which ones are which.  I'm sorry if I made it sound more scientific and definite than that.

Heather's "Dawson's Fingers" are the one's that are referred to when they say that MS lesions are typically "ovoid, well-circumscribed and perpendicular to the ventricles."  The "fingers" radiate outwards from the ventricles.

And yes, the "Radiology Assistant" site is great!

Quix

[Heather3418]

The word "punctate," means small.  Now that can be from migraines but can also be seen in those with MS.  Not all MS lesions are more than 3mm in size.  Some start off small, only to increase in size.  They can literally change day by day.  If you were to do an MRI of a person with known MS every 24 hours, you would see the changes occuring right before your eyes.  It's amazing.

I have circular shaped lesions and ovoid shaped lesions.  I also have lesions that have been described as "Dawsons Fingers."

So while some radiologists say they must be a specific shape and location to be from MS, I for one believe that they can be anywhere and be of several different shapes.  Remember this is only my opinion after having dozens of MRI of my 12 year course with this disease called MS.

Heather