[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.

Thanks for the clarification, Rex.

I've run into a number of people who felt that they may not have gotten accurate results because gad wasn't used, and to be honest, I wondered for a long time if my original MRI showed everything that was going on at the time. I haven't had a MRI since then, and there were only 2 - 3 brain lesions (he pointed them out on the image, and the radiologist's report endorsed that), but I am having another MRI (with gad this time) some time in the near future.

Most of my damage is in the spinal cord anyway, but I also had lots of bulging discs. I think the reason she is going for a MRI with gad this time (in the spine), is to try to differentiate between that damage and the MS lesions.

BTW, do you know if spinal lesions might show up bigger if the MRI is done during the flare up? That seems to make sense to me, but I'm wondering how big of difference, i.e. double the size, there might be depending on if someone is in the midst of a flare.

As far as my daughter, I don't know what the ped. neuro meant by "piecing together" her MRI results. I envisioned that they got images from many various angles, and between all of them she felt she had enough information to determine if there were lesions present.

My daughter is still having neurological problems, but much improved from a few months ago. I won't be getting her another MRI unless things change substantially in time, and I do believe that lesions that weren't visible during the first neurological event, can crop up some time down the road. What I've found though is . . . every ADULT that I polled a few months back, who had a clear MRI to begin with, always had MS lesions the next time a MRI was done. The lesions showed up within 12 - 18 months in every case (that a person had another MRI that early on . . .).

Thanks for sharing your expertise.

Cherie

I don't get the impression that you're having new or exacerbated symptoms. If not, then there are only two reasons for prescribing gadolinium:

1. The neurologist is ordering it as a routine protocol; or
2. He/she doesn't really understand where gadolinium is indicated

Don't laugh - you'd be amazed at how many order gadolinium in cases where it will contribute nothing (e.g., a routine cervical spine in a patient with tingling in the hand and no previous history of surgery, a lumbar spine to r/o a herniated disk, etc.)

I don't know the answer to that one.

I'm too.

NP, and I wish both you and your daughter the best.

Well, I think it's mostly to do with my numb hands and feet, as well as the sensation changes (much stronger sensation of numbness, vertigo, etc. that are associated with certain "positions").

She has been calling that a "like-l'hirmettes" symptom, which I guess could be true whether the l'hirmette's is caused by MS, spinal cord compression, or whatever. She's been blaming the MS though, yet we are aware that I had several bulging discs on my last spinal MRI, 6 yrs ago. I think she just wants to see if anything can be figured out by using gad to differentiate between MS and any other spinal cord issues.

The other thing is that I have large spinal cord lesions, which MAY indicate NMO/Devics, vs MS. When they did the MRI in 2003, I didn't have gad, but they were really focusing their attention on the spinal cord anyway (which doesn't require gad if the spinal lesions are big enough). I got the dx based on my large spinal cord lesions, which were obvious and correlated directly with my symptoms/history.

There were only the few brain lesions, even that far into the disease process (12+ yrs), so at that point they considered Devic's anyway. However, it didn't matter much then, because NMO/Devic's were just considered "bad MS". Since then they've determined that it is actually a different disease process which requires different treatments (immunosuppressants vs. immuno-modulatory drugs).

I don't take any of the meds anyway, so unless they had to react without my consent one day, I would just carry on as I have been doing. Perhaps she wants to know though, in case Rituximab or something else might be advisable in an emergency.

As far as gad in the brain, I am (ALMOST!) 50 now, so maybe there could be various other reasons for lesions there (aging, stroke, etc.). Perhaps she is hoping that gad might give them a bit more information in that regard.

On the other hand, it could be that she is just following her usual protocol . . . and I WILL ask her to explain her reasoning before I use the gad. I have SUCH difficulty with procedures, treatments, drugs . . . she seemed very dubious about the idea anyway.

Thanks for the well wishes for my daughter. That WAS scary, but to be honest I was most interested in trying to rule out other potentially worse options ...

Cherie

Yup.


Nope.