Hrm. What else could produce these types of MRI results?

I had a bucketload of testing done, and my spinal came back positive, o-bands.

Le sigh!

This is coming up soon for me, will be interesting to see what the results show.

I think someone may be mixing-up the FLAIR and T1-weighted post-gadolinium images. FLAIR images often reveal many bright lesions, but post-gadolinium sequences may show a couple, if any. I've *never* seen even a single enhancing MS lesion that wasn't seen on a FLAIR sequence prior to contrast injection.

As for what else they could be - my advice is, don't try to learn this stuff piecemeal; it's too easy to misinterpret what you're reading when you take fragments of information out of context and without a firm foundation in medical imaging.

Thanks Rex.

So, FLAIR images are sufficient for seeing virtually all lesions, active or not? Is gad used only to clearly identify which of the lesions is "active" then?

The situation for my daughter is slightly complicated by the fact that she has braces, and for some reason these braces were especially problematic, according to the radiologist. Her ped. neurologist felt they got enough information to conclude their weren't lesions though, by "piecing" together the images (whatever that means ).

She won't be wearing braces forever though, so TIME will show if something crops up ... In the meantime, I am going to go with the probability that they were able to pick up on the "important" parts of her brain analysis with the images they did get.

I know they used a "FLAIR" image on her, as the neuro mentioned that . . . but do you know if they ALWAYS use that type when specifically looking for MS? So, if gad isn't used, and lesions don't show, we can safely "assume" that MS is not a imminent concern for ANY patient who has a MRI? (Not to imply that lesions might not pop up down the road ...)

Cherie

Pretty much.

As we discussed off-line, I don't know what "pieced together" means, but I do think the middle and upper portions of the brain might be diagnostic anyway, even with the braces.


FLAIR is used on virtually every scan of the brain, because it suppresses the signal of cerebrospinal fluid (CSF). What seems at first glance like an abnormality on standard T2-weighted images often turns out to be normal CSF - and that finding is confirmed by the CSF-nulled FLAIR scan. So, I guess the answer is "yes."

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Iam just curious, are you a technician or do you know how to read and MRI? Iam asking because I have a couple of questions. One being have you ever heard of anyone having been told that the second MRI (taken a year and a half after one that showed lesions) showed nothing new, but mistakenly there were new leasions?

"Mistaken" according to whom?

Radioogists don't always agree on the interpretation of a particular MRI, and you'll read more than a few anecdotal comments here from people who presume that their neurologist who specializes in MS can read an MRI better than a radiologist. I would disagree with that.

[QUOTE=kingrex;514240]"Mistaken" according to whom?

Well heres the big leap, by me. Iam just a nobody who is try to self teach (I know call me crazy) I was just wondering if they actuall compared the two reports or exams. I have both CD's and they look different to me. I don't actually have th written report of the second one Iam just going by what the doc said. The place that does MRI's is know to have made mistakes in the past, not on MS per say but other things.

I know its a leap...........

Ok, I dug out my MRI sheets to re-read what they said exactly. They did 2 reports over a year ago.

They called it "Enhanced MR Brain", at the top 'MRI/Brain Scan- Enhanced'.

Then it reads:

"The exam was done according to the tumor protocol.

Both orbits, the pituitary, the corpus callosum ventricles, brainstem and cerebellum are normal.

There was no cerebellopontine lesion detected."

Then it goes on to read:

"On the FLAIR images there are multiple ovoid hyperintensities in the deep periventricular white matter. Some of the lesions extend into the centrum semiovale. Many of the lesions have increased signal on the diffusion weighted sequence and demonstrate enhancement.

The findings may be related to a demyelinating process with lesions in the active phase."

So maybe I'm confused about what exams they actually did for me, and the results. That's what their findings were in any event.

Will be interesting to see what they have to say following this round.

Just so you and everyone else understands - the FLAIR sequence is done before gadolinium is injected. The only sequences done after the injection are T1-weighted. They described your scan as "Enhanced MR Brain", but what they meant and should have written was "Enhanced and Non-Enhanced," or simply "MRI Brain With and Without Gadolinium." Your report describes some post-gadolinium enhancement of lesions that were seen on the pre-gadolinium FLAIR sequence.

Regarding gadolinium and NSF - kidney function is checked on all patients 60 years and older, specifically the Glomerular Filtration Rate (GFR). This is basically the rate at which your kidneys will clear the gadolinium. The number is computed using the Creatinine level and a combination of other factors - age, race and sex. If you are below the age of 60, the GFR is generally not checked, as it has been shown that GFR is not a factor in renally healthy patients under 60. However - we always ask everyone about renal disease, and if you have renal disease (and in our center, asthma) we will not inject you.

So at the end of the day, the lesions were seen pre and post injection?

That would make sense to what you're saying, and what the report actually says.

The way my doctor made it sound, the dye is what let them see the lesions.