One radiologist--who read three of my scans--wrote just three or four sentences, not giving sizes except to say "small" lesions, nor locations except to say "scattered" and "in the deep white matter." On the first scan, done to rule out a hearing-nerve tumor, he wrote a somewhat longer report detailing what all he DIDN'T find, all I think relating to the possibility of a tumor.

The report of the other scan I had, read by a different radiologist, did specify number and sizes but was worded in an ambiguous (to me) way so that you couldn't tell whether he saw two lesions or four, whether the largest were 2 or 4 mm. Immaterial anyway, since they were nondiagnostic.

Rex, I may have asked this before, but what does it mean when they write at the end of the report "Electronically verified by So-and-So, MD", a different person from the one who wrote the report?

Nancy T.

Hi Nancy,

When one radiologist signs-off on another's dictation, it could mean two things. It could mean that an attending radiologist dictated the report but was not available to review it in its final form, so another radiologist is signing-off as a proxy. This is rarely done, as it effectively transfers the liability to the second radiologist, who didn't even interpret the study. I don't know of many radiologists who would like to accept the liability for another's reading, should any problems later arise. Perhaps some group practices work like this, but I don't know of any myself.

More commonly, the term applies to cases where a resident or fellow has dictated a report. In Florida, a resident or fellow cannot sign-off on a report; an attending radiologist must do so. At teaching hospitals, residents and fellows usually dictate in the presence of an attending radiologist, with whom they have studied the case prior to the actual dictation. The attending then signs-off in the electronic radiology system, often remotely via the Internet.

What sort of facility is generating these reports?

Rex--thanks for the information, that's interesting. I had guessed maybe it was a kind of teaching thing. But those MRIs were done at a regular hospital, not a teaching hospital. Without digging them up, I know at least two of the scans I had, and possibly all three, had that "electronically verified by" line, with different doctors' names, although the one who wrote the report was the same.

I do know that the neurotologist, when I first saw him three months after the rule-out-AN scan was done, asked me for a copy of the MRI report, I think wanting to see who'd read it, and nodded and said "he's a good radiologist" or something like that.

However, both the neurotologist (when he ordered a temporal-bone CT) and the otoneurologist that he trades patients with (who ordered my next MRI) specified that a particular radiologist they apparently know and like was to read the scans they ordered. These were done at standalone imaging places, but I guess they both like the same radiologist.

Nancy

My studies were done at a major hospital near detroit, William beaumont hospital.
Pat

Although lesions may be caused by many things, the MRI remains a standard disgnostic tool to detect lesions. And, afterall, this disease is "multiple" "sclerosis", or evidenc of multiple locations of scarring [lesions]. Since there are numerous causes of CNS lesions, from migraines to aging, it is critical that an LP be performed. Lesions without the presence of oligoclonal bands, indicating immune involvement, could be caused by any number of events. And an exacerbation isn't necessary to detect oligoclonal bands in an LP....the immune system in a MS patient is always active.

I, too agree that the old hot bath test should be resurrected. The people who survive hot baths should doubt a dx of MS, and search further for a proper dx, IMHO.

They do still make a pretty big deal about temperature sensitivity, at least my doctors have.

With all due respect Barbara, I do not agee that a LP is necessary for a MS dx. It is just ONE of the means of getting a dx, and it carries a low but serious risk.

This is a paper put out by the NMSS, last update in Feb/06:

http://www.nationalmssociety.org/pdf.../diagnosis.pdf

I had a LP back in 1991, and refused any further testing after that very difficult ordeal; not even a MRI. The LP did not confirm MS for me, but I have since been dx with MS (by history and a MRI).

An LP should be a last ditch effort for dx, IMHO.

Cherie

With all due respect, Cherie, I do not agree with your not agreeing with Barbara..:D :p

An LP is just as necessary as an MRI, EPs or any other DX tool, for DXing MS. What one tells you the other doesn't, and visa versa. Actually, to me, a LP, showing O-bands, is more definitive of MS than a MRI showing lesions.

I was DX in 1976, with a Myeliogram(sp), showing the protein and o-bands. This shows that you have demyelinization happening. Didn't have MRIs in the old days:rolleyes:. I may or may not have had lesions, but lesions are not, in themselves, proof of MS.

The risks associated with an LP are minimal----certainly no more than taking anaesthesia during childbirth. IMHO, the more tests performed the better to eliminate potential non-MS diseases. Although MS is now treatable [in some people's minds anyway], the treatments are invasive, expensive and not without their own risks.

I'd like to know as much as possible about what's going on with my body. I had my first LP the day after my first very positive MRI, and my second some 10 years later, as part of the prelim exam for a drug trial. In spite of never having exacerbations [PP], my LPs were both positive.

If my lesions were only due to TIAs [which could be possible as I've had high BP since childhood], the treatment approach would be quite different.

A little more information never killed anyone;)

The link I provided indicated that there were several dx tools used, one of which was a LP.

Sometimes a LP is helpful, but MANY times it is not especially in the early years with this disease (it seems). I remember we did an (informal) survey of dx MSers on OBT; approx. 50% did not have O bands upon testing, or never had a LP but still had a definitive dx.

I had a terrible time with my LP, and ended up in the Brain Trauma unit (under 24 hr care) for a week. It was, by far, the worst experience in my life (natural childbirth/52 hrs of labour/drip inducement was a CAKE-WALK in comparison).

I realize I am one of the very few unlucky ones, but there is a REAL risk with this procedure. If it is deemed absolutely necessary, then I guess people have to do it. However, there are plenty of other tests that I would recommend they have done before agreeing to a LP.

As I said, in the end I got a dx without those results anyway.

Cherie

So sorry you had a rough time with the LP. Thank goodness that can usually be avoided with the skill of the person doing the procedure [neuros did mine both times], and some preventative care. Any excuse to lay around for a whole day is a good enough excuse for me!

Was the LP you had positive? With the LACK of diagnostic skills of many neuros, I'd seriously doubt my dx if it hadn't be confirmed by LP. And then reconfirmed by redoing all the tests at Mayo.

I'm just a bit cynical-----:rolleyes:

Thanks Barb.

It was performed by an Anesthesiologist (couldn't ask for a more trained professional for this procedure), but I just had a stroke of bad luck.

To be honest, I've never even tried to find out what went wrong, or why it was so serious, but I know I had to BEG for an epidural with both of my pregnancies. I swear I'd still be pregnant if I hadn't had those in the end. :D

You are right, the worst that most experience is the headache and requirement to lie around a few days. I won't go into any more gory details about my experience, but it was nothing as simple as that.

I never asked whether the LP showed the bands (I don't think so). To be honest, I didn't even know what they were looking for with that particular test :p as I was pretty incoherant before and after the test. I was in the middle of a Transverse Myelitis (spinal lesion) attack at the time.

I was dx with "probable MS" (1991), but still had to wait for another clear attack before they would confirm it. After the second attack, I had an MRI, and the lesions were visible in my spine and brain. So, at the end of the day, the LP was unnecessary.

Cherie

Mine was done by an intern. Not a good idea. The spinal tap headache went on for like three weeks and it was excruciating. They also forgot to draw blood to compare it. But, it was positive in a number of different ways.

You should wait ten years, all the while stalking that intern, and then take your revenge like a Klingon! We'll all hold him down and...well, I don't think we could pull off an LP on our own...wait - we'll catheterize him! :D

"Don't worry, Doctor...you won't feel a thing."

My first LP was done by a intern, other than he had a hard time getting fluid and it took an hour, there was no problem. This one showed high protien and MBP and no O bands. Blood tests were done with it.

The second LP was done by a neuro, I wound up back in ER with a leak and had a blood patch that made my whole left side go numb for many hours, and my upper lip is still numb 9 months later. No accompanying blood work was done with it. Protien was Low, MBP normal and it states 0-1 bands, they tell me that they weren't allowed to tell me if it was 0 or 1. Also they only checked the IgG and not IgM or IgA on the second. My neuro told me he would only check anything to do with MS and nothing else!

Pat

Too funny kingrex!