Mri
 

June 8th.

I can already hear the click click click!

(I'm totally ok with the MRI machine btw. I fell asleep the last time I was in it. The only part I disliked was the contrast injection. No thanks!)

Still no word on my Provincial funding (ie: if they will) for Sativex. Unfortunate, because I've been in a lot of pain the last week. :(

And as you get closer the click, click, click will get louder and then soon you'll heard the thud, thud, thud... I'm sorry you have been in so much pain.

we should take up a dontion for your mouth spray to see if this stuff works, and then petition the insurance comapnies to include it in the formulary.

I wanna try some of that stuff. :cool:

Do you have a reaction to the dye? Just wondering because I've never had any type of negative reaction to it. It's just like when I have blood drawn.....I hardly feel it and never even really know I've been given anything.

Just wondering if others have negative reactions to dye.

I have never had a problem with the dye -- however, they now have to poke me several times to find a vein. I just started having a problem with veins when I was dx.

I have a MRI scheduled for Tuesday in the morning and a appointment with my neuro in the afternoon. He should have the results already. I am nervous this time since he told me he wanted me to consider nonantrone a few weeks ago.

The room is so cold, and my veins are so horrible, I have them set an IV line before hand. That way they are not playing poke me for 20 minutes and not able to find a vein. I hate being strapped to the table while they play hide and seek with veins. its painful to keep hunting.

I am not a happy MRI person...I panic the whole time. I hate being strapped down.

They always do the iv in a separate room prior to being caged in.

I don't mind the whole MRI thing but the worst bit about mine was being told I couldn't/shouldn't swallow for the next few minutes. I had been nodding off, then the voice came over and said 'ok, don't swallow now until I say...'.
Well do you think that helped my 'not to swallow' state of mind???!! I think I had to swallow every 10 seconds AFTER she said Not to!

Last MRI - noted some Brain shrinkage
 

My last MRI they noted some "Brain shrinkage".

The radiologist wrote "moderate Brain shrinkage noted but appropriate for age and medical condition".

jackD
.
.
http://home.ix.netcom.com/~jdalton/pic049.JPG

Kitty, I don't have a reaction to the dye, it's just the idea of having another needle poked in my body. :p

Of course I don't care for the 'warm' feeling that goes through that side either when they do the injection.

two pokes now
 

In the US they have found that the "dye" causes serious health problems for those that have some kidney diseases so they now require a quickie blood test. So the total pokes is two per MRI.

jackD

Really? That's interesting, never heard about that myself. I'll have to ask them about it when I go to get this round done.

I just have to have the bloodwork done the week before the MRI.

Gadolinium -PROBLEM
 

These gadolinium-based contrast agents are used to enhance the quality of magnetic resonance imaging (MRI) and are very essential to making a proper MS diagnosis, but they have some considerable risk to a few with kidney problems.

jackD

.
.
For more information see
.
http://www.fda.gov/cder/drug/infopage/gcca/default.htm.


Early symptoms of Nephrogenic Systemic Fibrosis/Nephrogenic Fibrosing Dermopathy could include:

Burning, itching, swelling of the skin
Development of "thick skin" or "hard skin" which appears shiny
Red or dark patches of skin
Yellow spots on the whites of the eyes
Stiff joints which cause trouble straightening or moving the limbs
Deep pain in the hip bones or ribs
Generalized muscle weakness.

SKIN SYMPTOMS
The most common areas which are affected by Nephrogenic systemic fibrosis symptoms include the extremities (arms, legs, hands and feet). In some cases the trunk is also involved. The face is almost never affected with the tight and hard skin.

Symptoms of Nephrogenic Fibrosing Dermopathy usually begin with areas of thick skin on the legs. The appearance of skin may start as red or darkened patches or areas. Over time the surface may begin to feel "woody" and resemble the texture of an orange peel. It is often associated with symptoms of burning itching or severe pains in the affected areas.

In severe cases, individuals diagnosed with NSF/NFD are unable to walk, unable to extend or move the joints of their arms, hands, legs or feet and complain of muscle weakness.

NEPHROGENIC SYSTEMIC FIBROSIS DIAGNOSIS
A diagnosis of Nephrogenic Fibrosing Dermopathy/Nephrogenic Systemic Fibrosis is made by taking a biopsy of the skin. The disorder has been observed in patients undergoing hemodialysis for end stage renal disease (ESRD) as well as for those undergoing peritoneal dialysis. Neither the underlying cause of kidney disease or the duration appear to be related to the diagnosis of NFD/NSF. The reported length of times individuals have been on dialysis before a diagnosis is made has ranged from only weeks to months or even years.

NSF/NFD can progress slowly over several weeks, or develop over the course of only a few days. According to data reviewed so far, approximately 5% of those with the condition have a rapidly progressive course.

Laura, they don't need to use gad to see lesions as they are all visible without gad.

The only reasons they might want to use gad is to easily identify if lesions are enhancing/active vs. plaque, or to try to identify if you have something else going on besides MS, like a tumor or something. They can compare if there are more or less, if they are bigger or smaller, etc. even without gad.

I am having my first one ever with gad, and only because they are looking for another problem. I am going to clarify with the neuro that it is absolutely necessary though, as I don't want to use it if it is not.

Cherie

I've never had a blood test before an MRI with dye. They always ask if I've ever had a negative reaction to it.....but that's it.

The obvious question is "When was your last MRI?".

This policy of requiring a blood test was not adopted until 2008. The FDA letter stating they had found this problem and some screening should be done is dated 2007.

I hate to say this but I think the problem may have been more with one or two brands. That really bothers me because it brings up the old problem of "Is the generic as good as the original?".

jackD

:confused: I'm confused... I had non-contrast and contrast MRIs done originally. The non-contrast MRIs came back 'normal', while the contrast ones came back showing the lesions.

Hmmm .... that's interesting.

I had always thought that they used gad to spot the active lesions, and apparently they do, but when I asked the pediatrician neuro why they opted not to use gad with my daughter, she said they don't need to. She went on with an explanation about "flair images", blah, blah, blah . . . but I didn't really believe her ... :cool:

I came back and researched whether all lesions would show up, and found this:

"The Need For Contrast
For the most part all visible lesions can be seen without contrast. They show up as T2 Hyperintensities just like all lesions. The problem is that the neurologist can't tell if a lesion is old or new . . ."

(^I'll send you the link to the above, which I believe is a fairly reliable source^)

So, it "seems" they should basically all show up without gad.

Try asking your neuro, Laura . . . I know I'm going to ask my MS Specialist next time I'm in.

Cherie

I'm willing to bet, as well, that the machine, radiologist etc all factor into the 'outcome' of the 'results' on paper when looking at MRIs too.

Wouldn't surprise me if our MRI machine here should really be in a museum. :rolleyes:

Oh . . . one of those gerbil powered ones!?! :wink:

Still . . . I'd be curious what your (or any neuro/MS Specialist) has to say about this, if anyone has the chance to ask.

Cherie

Made it through the MRI with contrast without any problems. I had my appointment with my neuro four hours later, and the good news is that I do not have any new lesions. So he did not schedule another apointment or MRI for a year. I have been having then every 6 months.

Congrats on no new lesions, Barb!:)

Laura - so funny/strange to hear how long you have to wait for an MRI. The most I've had to wait is 2 days to get an appointment!!

Jack - I've had 6 MRIs since January 2008, all with GAD, and have never needed a blood test or anything extra. (Sheesh, I've had a lot of MRIs!:eek:)

~Keri

My GP actually ordered this MRI. She wasn't satisfied with the amount they scanned initially. They want to scan the brain stem area as well this time.

I have to be there for 2:30pm, to begin testing at 3pm... which basically has me out of commission for most of my work day :p Sigh.

Oh yeah, by pure (?) coincidence my neurologist called today for me to go in for a check up.

I hate how ominous the secretary sounds when she leaves a message on my machine too. Like the place is a dismal trap or something.

To be honest, I think they're onto me. I never did tell my neuro I stopped Copaxone. I will when I see him though. I'll refuse other DMDs as well. I don't think he'll be happy with this, but hey, it's my body!

I chuckled because Shared Solutions called me as well today and left a message (all while I was working).

Hi Laura and Cherie. As an X-ray tech and MRI tech-in-training, I can tell you that there are definitely lesions that are silent without GAD. What the GAD shows is lesions that are currently in an inflammatory stage.

People with SPMS or PPMS can still get new lesions (and they're active) but usually not inflammatory so they don't usually light up with GAD.

The presence of GAD enhanced lesions usually indicates the likelihood that DMDs or steroids would be of use.

I have personally seen a young (20's) patient come in suspect of MS. No lesions on original scan. GAD was injected and her poor brain lit up like a Christmas tree. Poor thing. At least she got her diagnosis.

Hope this helps.

so, let me see if I understand. You can have lesions that DONT light up or show until you use GAD? Does this mean the lesions that show up without GAD are just damaged areas? old inflammation areas?

Thanks for the explanation. :cool:

Very interesting, Weeble!

Crazy that a pediatrician neurologist, and that doctor (who wrote that article I quoted) both said the lesions would show up anyway.

I'm going to contact a friend who is a radiologist/technician, and talk to my MS Specialist ... to see what their take on it is. I was very surprised when the ped. neuro said it wasn't necessary, but I didn't trust her anyway. In fact, the last thing I said to her was "If my daughter never has another issue, I guess I'll never see you again . . . and if she does, I won't either". :D

Cherie

How did you know that the enhancing lesions were in fact MS plaques? If I saw a case in which the T2 and FLAIR-weighted scans were clear and the post-gad sequences demonstrated multiple enhancing lesions, I wouldn't be thinking MS; certainly, not before I had ruled out some other, really dastardly stuff.

I have been receiving MRI scans every six months for a couple of years now. for a while it was every 3. I was a mess. I have had GAD for each one. I have routine blood tests done every six months anyway, so I guess they are looking to see if my kidneys are happy then.

I hate shooting the tube! They told me if I dont have new lesions this time, I may get to go to one year at a time.

WAY TO GO BARB! WOO HOO! :hug:

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 :rolleyes:).

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."

.

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. :cool: