Starting a topic because this has been bugging me for a while and can't seem to find much info out there.

I struggled for a long time to get a diagnosis because my MRIs remained stubbornly negative for years despite multiple attacks of ON and 6 months of L'hermitte's in 2004, plus all the general paraesthesias we all know and love. I did not get lesions showing up until 2010 and when they did, they were whoppers (half my left optic nerve and C2-C7 contiguously).

I was recently hospitalised after complaining of severe lower back pain and left leg numbness/weakness that quickly progressed into foot drop and being unable to walk, which gradually resolved over a week or so. MRI showed it wasn't a disc problem, but it also showed no lesions, at which the neuro's response was basically 'idk lol guess there's nothing going on there'. Now due to my past experience I believe this was a relapse, and it certainly presents like one. Except there was no MRI evidence.

I guess my question is, how common is this? Is it possible this is just how my body does it? That some time in the future I'll get my routine scan and bingo, big new lesion somewhere? It's all so confusing

how strong was the MRI machine that they used to look for lesions?

1.5 Tesla is, I think, the lowest Tesla strength for MRI machines. I think the last MRI I was in was a 1.5 Tesla and it didnt see anything lesion-ish, but I wasnt exactly in there looking for lesions (doctor specifically wanted to see if I had a disc problem) They didnt use contrast for mine. That MRI did show some arthritic changes on my 43yr old spine tho.

The other MRI's on my spine that I had were 3.0 Tesla (well, at least one of them was) and they were able to see "something" on it without contrast. I was supposed to have contrast, but they screwed up the IV so I had to go back a week later for another MRI where they didnt screw up the contrast. That had a "nice" glowy lesion light up on it. Well, actually two.

I think my first MRI on my brain was a 1.5 Tesla and I had contrast for it and all it showed was little non-specific white "dots".

I'm with your Doc Bort, IDK?? I do know that you can have MS and symptoms of MS without lesions showing up...IDKW..

It was a 1.5T machine. I have read that spinal lesions can be difficult to detect at that strength. I have no brain lesions, just the cervical spine and optic nerves that, as I said, took a very long time to show up.

I am seeing another neuro for a second opinion in February, so I suppose I might consider requesting a scan on a 3T machine. I don't think I would be able to get that bulk-billed though, so would probably be several hundred out of pocket. Worth it if I can get some answers though.

Hi Bort,

The MRI, regardless of strength, does not always match up to how the patient is feeling. You can feel fine and the MRI will show new/more/active lesions, you can be having a relapse and the MRI will show no changes. Sometimes, for some people, the MRI does match up.

It's always best to treat the patient, not the MRI.

Bort, I was diagnosed with MS and no lesions. When those lesions first showed up, IDK. My first MRI was in 1985 (diagnosed) and I never had another MRI until 2004. The MRI in 2004 showed numerous spinal cord lesions, so I am not a believer in the concept that spinal cord lesions are more difficult to see or that the strenght of the MRI machine can make a difference on what is or is not found.

I know the newer, stronger MRI machines have better resolution and quality but the older machines can still show lesions...if they are there. The early MRIs would pick up abnormalties even without contrast and the reason I needed to go back in for a repeat MRI of the brain. What the first brain MRI showed the second one confirmed there was nothing of concern. One of the first things my neuro was looking for was a brain tumor.

I've had several MRIs and have also had some interesting interpretations of them. Things like, "There has been no change. There are new lesions here, here and here...", and my all time favorite, "There's nothing significant going on at this time."
To that last one, I respectfully say, "Perhaps according to the MRI, but I can assure you that what is going on is quite significant with respect to the impact it is having on my life."

I think that in a lot of cases, there is too much reliance placed on the MRI and not enough emphasis/concern directed toward dealing with actual symptoms; and the effct that they have on the lives of those who suffer them.

With love, Erika

The MRI is just another DX tool and thats all it is. Having multiple MRIs in a short time, is a waste of money. The Docs and Med Centers don't mind wasting it, but I do.

Next year your lesions may show up. Take a breath and have your Doc treat your symptoms. That's what we all do.

Good wishes

I'm so with Sally on this. MRI is only diagnostic, there does not have to be an absolute correlation between symptoms and lesions. You definately need a doc who is experienced with MS, so they will treat your symptoms. I can understand why they would want an MRI if you are having a drastic change in symptoms, but I also think that's like chasing a train with a tricycle. They know the damage is done, pinpointing the location only confirms their clinical suspicions. You are already diagnosed with MS, is it really necessary to confirm a new lesion when you are experiencing symptoms? Treat the patient, not the scan.

MRI examines differences in tissue density. This is why new lesions are detected with contrast. They have a different tissue density than old lesions. A new lesion starts with demyelinization (the injury to the nerve), and then your body needs some time to heal and create scar tissue over the injured area, which then has a tissue dinsity that is more easily detected on non-contrast MRI's.

I'm glad you are seeing a new neuro. Remember, doctors are not God's. They are people that WE HIRE to perform a service, just like a lawyer or mechanic. If they are not doing the job we are paying them to do, we can fire them and hire someone who will. A good question to ask the new doc would be something like, "What is your philosophy on treatment?" "Do you treat the patient first, or wait for the scan to show something?" Remember, new events may not show up on an MRI, but the damage and progression can be cut short if the patient is promptly treated. If you do not like the answer, feel free to begin interviewing someone else for the job. It is their privilege to treat YOU, not your privilege to be their patient.

Good luck!

Tammey

I have no visible brain lesions on my MRIs, just on the spinal cord, yet I have MS symptoms that are clearly the result of brain lesions. I just don't think everything shows up.

Well said Tam, thanks.