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  #1  
Old 02-03-2012, 07:35 PM
NeoGeoH NeoGeoH is offline
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MRI Question

My wife had a Brain MRI w/ contrast that showed no legions. She had a cervical and spine MRI w/o contrast to ensure she had good CSF flow and no structural issues. Can a Cervical and spine MRI w/o detect MS legions? Or does it have to have contrast to do so. I am asking as I forgot to ask the doc when he went over her results as I was so focused on her possible structural problems that might be causing her numbness and tingling in her left foot and hand, and well as her headaches and neck soreness.

Thanks!
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  #2  
Old 02-03-2012, 11:37 PM
0485c10 0485c10 is offline
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Easy one. The contrast is used to show if lesions are active. The contrast will ONLY show active lesions, without contrast both inactive & active lesions show.. The lesions that are missing with the contrast are the ones that were not active.

But on top of that spinal tissue is denser than brain tissue, which causes the dye to not be picked up reliably in spinal tissue. So if the contrast is used in a spinal MRI and nothing enhances, that does not mean that there are no active lesions, it might mean that the dye didn't get picked up in spine tissue. I had 1 doc order order a brain & cervical spine with & w/o contrast and the thoracic spine without contrast.

And i had another doc order contrast on the entire brain & spine.

The cervical spine picks up the base of the brain, so that is why I think he ordered the contrast for the cervical spine, not for the neck,which is spine tissue, but for the base of the brain.

i don't think the contrast was needed and when any substance is put into the body there is a risk of a reaction, why use more when its not needed? IMO

Did she get a brain MRI only with contrast? That i might ask the doc about, because that might miss inactive lesions...lesions that were active and now are in the process of healing. Funny, I'm not concerned about the spine being done without contrast, I would be more concerned that the brain MRI wasn't done w/o contrast.
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  #3  
Old 02-03-2012, 11:56 PM
MarkLavelle MarkLavelle is online now
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Quote:
Originally Posted by NeoGeoH View Post
Can a Cervical and spine MRI w/o detect MS legions? Or does it have to have contrast to do so.
An MRI without contrast can still show MS lesions. The response to the contrast just tells them whether those same lesions are 'active.'
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  #4  
Old 02-04-2012, 06:09 AM
NeoGeoH NeoGeoH is offline
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Thank you all for the feedback. So if I understand a MRI w/o contrast will show lesions, and an MRI w/contrast will show active legions, correct?

I guess that is all good news as she has had a brain MRI w/contrast (in Dec 2011), a brain MRI w/o contrast and CINE flow (in Dec 2011), and a cervical and sine MRI w/o contrast and CINE flow (in Jan 2012). All MRI's reported no legions. Plus a CAT scan (in Dec 2011) that showed nothing abnormal as far as lesions were concerned. What they did who was a mild Chiari and a very small cavernous malformation. We initially thought the Chiari was the cause but subsequent CINE flow MRIs and examination by a neurosurgeon who specializes in Chiari ruled that out. Her cavernous malformation was review and discussed with a vascular neurosurgeon who said it was so small and in in such a location that even if it was 10 times the size it still wouldn't be causing problems. All good news too, as usually surgeons want to cut you up to try and solve your problems.

We will stay on the hunt and hopefully figure out what is going on with her, or at least continue to find out what ISN'T wrong with her. In the back of my mind I have this feeling that when this is all done, we won't be able to put it down to anything other than perhaps stress and anxiety. I only say this as that tends to be a trigger that makes things worse for her. She is a 4th grade teacher and there is a lot of stress and anxiety in her job. Plus some issues we have with our daughter don't help he stay relaxed either.

Again, thank you for your input. I truly appreciate it.
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  #5  
Old 02-04-2012, 09:57 AM
Tinkerbell65 Tinkerbell65 is offline
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Another thing to consider: the lesions may still be too small to be visible on an MRI.
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  #6  
Old 02-04-2012, 01:19 PM
NeoGeoH NeoGeoH is offline
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Uggh. I was trying to stay positive! Lol. No worries. Thanks for the feedback.

I am still holding out that the numbness and tingling, her only symptoms (not counting what we believe to be non-related tension headaches) are not MS-related. In the future they may prove to have been the early warning signs or first symptoms if others crop up, but for now I am going to hold out hope for some other cause, or maybe none at all, so long as other symptoms don't crop up.
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  #7  
Old 02-04-2012, 07:42 PM
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kingrex kingrex is offline
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Quote:
Originally Posted by 0485c10 View Post
Easy one. The contrast is used to show if lesions are active. The contrast will ONLY show active lesions, without contrast both inactive & active lesions show.. The lesions that are missing with the contrast are the ones that were not active.

But on top of that spinal tissue is denser than brain tissue, which causes the dye to not be picked up reliably in spinal tissue. So if the contrast is used in a spinal MRI and nothing enhances, that does not mean that there are no active lesions, it might mean that the dye didn't get picked up in spine tissue. I had 1 doc order order a brain & cervical spine with & w/o contrast and the thoracic spine without contrast.

And i had another doc order contrast on the entire brain & spine.

The cervical spine picks up the base of the brain, so that is why I think he ordered the contrast for the cervical spine, not for the neck,which is spine tissue, but for the base of the brain.

i don't think the contrast was needed and when any substance is put into the body there is a risk of a reaction, why use more when its not needed? IMO

Did she get a brain MRI only with contrast? That i might ask the doc about, because that might miss inactive lesions...lesions that were active and now are in the process of healing. Funny, I'm not concerned about the spine being done without contrast, I would be more concerned that the brain MRI wasn't done w/o contrast.
A couple of things...yes, contrast is used to reveal active MS lesions. But it will also show any other form of enhancing abnormalities, and in this case I'm not sure the poster is sure that the patient actually has MS - something else might be going on.

Yes, contrast enhancement can be more difficult to image in the spine, and for a number of reasons. But doctors routinely order it for MS because, while harder to visualize, it certainly can be done.

The base of the brain is routinely imaged on the brain exam. In this case, as a Chiari malformation is present, I'm sure the doctors wanted to image the cervical spine to make sure that a syrinx - expanded central canal in the spinal cord - was not present, as this can happen with a Chiari.

Finally, the phrase "brain with contrast" is commonly (albeit improperly) used to describe what was actually a brain with and without contrast. The only time we ever do a brain post-contrast only is when we have very recently done a plain exam and the patient is recalled for contrast.


rex
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  #8  
Old 02-04-2012, 08:21 PM
NeoGeoH NeoGeoH is offline
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Originally Posted by kingrex View Post
A couple of things...yes, contrast is used to reveal active MS lesions. But it will also show any other form of enhancing abnormalities, and in this case I'm not sure the poster is sure that the patient actually has MS - something else might be going on.

Yes, contrast enhancement can be more difficult to image in the spine, and for a number of reasons. But doctors routinely order it for MS because, while harder to visualize, it certainly can be done.

The base of the brain is routinely imaged on the brain exam. In this case, as a Chiari malformation is present, I'm sure the doctors wanted to image the cervical spine to make sure that a syrinx - expanded central canal in the spinal cord - was not present, as this can happen with a Chiari.

Finally, the phrase "brain with contrast" is commonly (albeit improperly) used to describe what was actually a brain with and without contrast. The only time we ever do a brain post-contrast only is when we have very recently done a plain exam and the patient is recalled for contrast.


rex
Rex, you are correct in your assumption that we are not sure my wife has MS, it is just one of the many things that has yet to be ruled out. And being the wanna be detective doctor that I am, I am just trying to understand the circumstances where something like MS may or may not fit her present symptoms and test results. Her original brain MRI in December was done with contrast. Of this I am positive as she got and infection and blood clot from the IV they gave her. That MRI was the only one she had with contrast, and was actually done to check for MS lesions by her first neuro. I know that a clean MRI doesn't mean you don't have MS, but I think he had it done to make us feel better and just rule it out as a likely or definite cause at this point. All her MRI's and catscans have come back w/o any report of lesions or abnormalities save the Chiari and Cavernous Malformation, which has both been discounted as possible causes of any of her tingling and numbness.

Thanks for bouncing these conversations around, it is really helpful for a noob like me.
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