Radiologist Neurologist question??
 

I was dx with MS in Jan 2010....at that time my Brain MRI report said a few non-specfic small white matter T2 hyperintensities, none on the corpus callosum. But when my Neuro looked at the MRI disc, he said approximately 10white matter lesions consistant with MS (even one on the corpus callosum) .....that is when he diagnosed me.

On Tuesday this week, I had another brain MRI....and the report says...there are a few small foci of T2 hyperintensity within the subcoritical white matter of the cerebral hemispheres bilaterally. These lesions are not specific for MS, but it would be difficult to totally exclude demyelinating disease. These findings can also be seen with chronic ischemic white matter disease. Chronic migraine headaches could have this appearance as well as vasculitis.

My Neuro has not seen this MRI disc yet.

My question is: How can the Neuro be so sure my lesions are MS....when the Radiologist say these lesions are not specific to MS.
(the two MRI's were done at two different MRI facilites with different Radiologists reading the scans.)

Do you believe the Radiologist report or the Neurologist interpretation??

I can't believe this-I am having the same problem so I have chosen "None of the Above" LOL and have researched as to who has years of research into MS or MG etc and so I am going to my state's University hospital and both neuros of MS and MG have highly rated BIOs recommending them to be MY doctors. I've decided I want a SPECIALIST in the field to treat me. Too much confusion by regular docs-basic neuros included!!! I go Nov 16th and will let you know what the "experts" say-that's my recommendation after years of waiting for regular docs to try and figure it out. Now that I'm losing vision/bladder/bowels/and am an inch away from an electric wheelchairs...I say Enuf is enuf!! I want a decision!! Go, Tresa, GO!

They're probably both right. Ask them to have a conference and come up with an answer that will help you. If they don't know....then, say so..:mad:

(((((Daisey)))))

OMG Sally! You're asking two medical professionals to say, "We don't know," about something? We'll have peace in the Middle East first, I bet.

If I am not mistaken, the Radiologist job is not necessarily to diagnose, but to provide information of what he reads to the Neurologist who then has the responsibility and authority to actually diagnose based on the MRI.

In addition, I would suspect you must have other symptoms and signs of MS other than just an MRI to support an MS diagnosis as many people are given a confirmed diagnosis of MS with a clean MRI.

If it were me, and I have come not to trust medicine or neurologists after 10 years, I would go with what the neurologist diagnosis. JMHO

Years ago, before I even knew the word MS, the radiologist said "classic migraine lesion pattern" then went on to be wordy with other stuff and said "demylination disease unlikely, but should be ruled out by neurologist." now, my MD at the time, only got the part of the report that said "classic migraine" and I was labled a whiner with a headache. Given a lecture on how migraines dont cause drop foot, nor would a migraine cause the optical stuff I complained of. Fatigue was put down to being a prison employee, a full time mom, and so on. Fast forward 6 years later, a move to a new town, and the local MD said "I think you may have MS" and into the scanner I went. The radiologist said something about white matter lesions and had a list of possible causes including migraine, drug abuse, enviornmental exposures, and last on the list was demylinating disease is a consideration, but due to the patients age, its unlikely" My current MD wanted to get to the bottom of it, and did a thorough search.

After exhaustive tests, it was concluded I didnt have 99% of the things that would cause this lesion pattern, including migraine syndrome. Local nuero got involved only to tell me "you are too old to have MS" and was dismissive. My MD didnt like those answers so off to the MS clinic I went, and they said "oh yeah! you have MS, you have it so clearly based on your MRI and sx, we dont need a spinal tap." so...how is it so many folks can lay eyes on the same MRI and draw so many different conclusions?

Welcome to the wonderful world of MS. I sit in the MS chair and so many times say " are you SURE I have MS?" to which their response is "we are VERY sure!" We dont just hand out that title because its easy. It changes many things in your life including the ability to get a job, insurance, benefits, and such, and we would keep you on limbo island if we had any hesitation. So...I must really have it.

Hang in there. :hug:

Thanks guys!
yes, it is amazing how doctors can look at the same MRI and see different things.
My neurologist is wonderful, and after I was dx in Jan....I did not want to believe it, so I went to a comprehensive MS clinic about 2 1/2 hrs from my home. He agreeed with my neuro, and said he saw lesions on the MRI disc consisitant with MS too.
I do know that the Radiologist report is just a small piece of the MS picture....but they have ALL the training to read theses MRI's, so it just doesn't make sense.

My neuro exam:
1-hyperactive deep tendon reflexes
2-positive babinski
3-positive hoffmans sign
4-absent abdominal reflex
5-positive rombergs sign
6-Ataxic gait
7-nystgmus
8-optic neurtis
9-delayed SSEP (evoked potentials)
10-Vit D defiency


When I read that list, I guess I shouldn't question my dx. I am however trying to get disability.....and I am afraid they will see the Radiologist report and question my dx and not award my disability.

I would believe the MS Neurologist over the Radiologist since it is their job to recognize what is MS, the Radiologist just gives their impressions of the entire MRI. My Neurologist does his own reading of the MRI and shows it to me on the monitor, all radiology is digital. I know I have MS so I am not looking for anything additional.:)

Oh yea...I got sx that just go on n on-demylineating lesions(over 18) at last count-now too numerous to count-small brain tumor, skull thickening, brain atrophy advanced for someone my age, frontal lobe seizures that radiated in a pattern of encephalitis that centralize in autonomic system area or something to that affect-I lose total body proprioception, have +4 hematuria of kidneys, blindnessattacks, blurred vision, dbl vertical vision, body paralysis due metabolic whatever, lung disease(minor), now loss of bladder/bowel sensations. Basically, since Graves Disease in 80's after 8 years Docs found out my body reacts to levothyroxin as if it is a poison and so my immune system goes into attack mode. So I have a high toxicity to Synthroid which I cant live without...so....now I also have lupu, MG occular and general, and major MS symptoms. Very complicated especially when you add on the DID diagnosis. Ok craig, what;s the DID!!!??? If you guess it right, I'll confess.
:D:o:p;):confused:

MS is a difficult disease to diagnose, and as posted above, not given out willy-nilly.
My neuro, who is well-known for his specialty in MS, looked at my newest MRI and said, "If I didn't know your symptom history, looking at this MRI, I wouldn't be sure if you had MS or not." But based on that plus symptoms that he's tracked over the last 20 months, he knows I do have it.
It also depends on the type of MRI machine. Some are more sensitive than others, and lesions will show up more in the more sensitive machines.

Back 5 years ago, the first neuro I saw said, "Migraines," and handed me meds for that. Made me sick as a dog; I found out what a migraine felt like, cause the meds gave me them. It took me 4 years before I got a "probable" MS diagnosis. And that was after years of symptoms...
So be patient. Make sure your doc is an MS specialist, if possible. And keep notes of symptoms/appointments so you have a record for yourself of what's going on.

Tresa,

I don't know what DID is but I learned way back as a kid that I NEVER admit that I "DID" it. Clue us all in on this one, please.