MRI question
 

Hi,

Thanks to everyone who has been so kind in responding to my questions. I really do apreciate it. I just got a copy of the radiology report of my most recent MRI. This is the one that my neuro-opthamologist read and called to refer me to a traditional neurologst for evaluation.

My first MRI in 2005 was normal, my 2nd in 2/11 was normal and now this one seems to show some lesions. I have been having double vision since 2/11 and all of my blood work has been normal so far.

This is what the radiology report says...

0.3cm focus, 0.6cm focus (both present since 2/11) and 1.3cm lesion which is new and is enhancing--the other two weren't enhancing

Impression:
1. There are both enhancing and nonenhancing T2 hyperintense white matter lesions, 2 lesions, nonenhancing are stable since February 2011. Dominent lesion, enhancing, is subcortical in location and enhances with contrast. MRI findings are most typical of sequela of multiple sclerosis, however do not meet the diagnostic criteria for multiple sclerosis (McDonald criteria)

It's like they're saying it looks like MS but then they're saying it doesn't meet the diagnostic criteria which is confusing.

If anyone can shed any light on this, I'd appreciate it. (I know we're not doctors but I appreciate any and all feedback!!!)

Thanks,
Bets

Here's the Wikipedia link that explains how the McDonald Criteria works.

http://en.wikipedia.org/wiki/McDonald_criteria

This link explains in a little more detail:

http://www.mult-sclerosis.org/DiagnosticCriteria.html

Hi Bets. Sorry you are having issues that might be MS, but you have come to the right place to ask questions and get a ton of support from great folks. The diagnostic criteria links Kitty posted are a good start.

I am not a doctor or medical professional, so take my words below for what they are...free information given to you on the internet by an unknown source...so listen carefully to your doctors when you talk to them because they are the experts you are paying for expert opinions. With that said...

What the MRI report appears to be saying is that you have two "non-enhancing lesions" that were there in the 2/11 scan, so I am not sure why they would say that scan was "normal" if you had two lesions visible there. Non-enhancing just means that they don't get brighter on the MRI after the gadolinium (Gd) is injected, which typically means there is not active demyelination occurring in those lesions at the time of the MRI.

The report indicates that a new enhancing lesion showed up in the new scan, which means you have a new lesion visible in an MRI separated by more than 3 months from your first MRI. The enhancing description means it was active at the time the MRI scan occurred based on getting brighter after Gd was injected.

What the report conclusion seems to be saying is that the lesions reported on the MRI are most consistent with MS, but that the MRI findings alone do not meet the McDonald criteria that Kitty linked to. There are two parts of the McDonald Criteria, the lab results/MRI scans and the clinical symptoms.

Keep in mind that the radiologist may or may not be aware of your clinical symptoms, so they are most likely referring only to the definition of how an MRI "abnormality" is determined (see Kitty's second link). Mimicing the words of my neuro when I first saw her, the radiologist is saying you don't have enough lesions or lesions in the right places to get a dx on the basis of the MRI results alone.

It is up to your neuro to incorporate the MRI results with your clinical symptoms and see if the combination of the two gets you over the McDonald criteria threshhold for a dx. Use the links Kitty provided to help you understand the criteria and do a search for "multiple sclerosis" and "MRI" to educate yourself about how radiologists and neurologist read MRI scans. Then you can go to your neuro with an understanding of what they tell you and can ask informed questions about what you are told.

Unfortunately, in my case, when my neuro told me I didn't have enough lesions of the right type or enough in the right places for her to give me an MS dx, I had never heard of the McDonald Criteria and I thought it meant "the MRI doesn't look like you have MS". Instead, what she was saying was that I didn't have enough lesions in the right places to meet the McDonald Criteria for a dx. Two years later, more lesions showed up, I met the criteria, and she shocked me by telling me I had MS.

Good luck and let us know how it goes.

TxBatman (Bill)

I haven't read any of your other posts. Maybe I should have before I commented. I only have one lesion so because MS is 'multiple' sclerosis, my definition I don't meet the criteria either. My neuro has me listed on 'clinically probable' MS. She treats me jsut like she would treat a patient that has RRMS so I am happy. I do meet enough of the other criteria, lab, smptoms that we are sure this is what I have.