Question about MRI's

[Jenny3838]

I am still trying to understand the diagnostic nature of MRI's. We all know that your lesion load has nothing to do with symptoms, so why do they make such a big deal about a new lesion showing up if you are on a DMD, claiming it is not working. And the other thing that I do not understand is from what I've read when someone is SPMS they do not develop new lesions on their MRI, so why is it considered a good thing if you are not developing new lesions. JUst Curious.

[0485c10]

I am still trying to understand the diagnostic nature of MRI's. We all know that your lesion load has nothing to do with symptoms, so why do they make such a big deal about a new lesion showing up if you are on a DMD, claiming it is not working. And the other thing that I do not understand is from what I've read when someone is SPMS they do not develop new lesions on their MRI, so why is it considered a good thing if you are not developing new lesions. JUst Curious.

I told you you are a woman after my own heart with these questions. I was diagnosed unexpectedly and at a bad time based upon the my presenting symptoms and a single MRI. Having an instrument background, my first thought was not that I have to learn what MS is.....

My first thought was I have to understand how an MRI works, what it measure and how what it measures means I have MS. Then I have to understand what MS is...

So questions on MRI was very big for me during the first3-4 years. Then I got the book "MRI Atlas of MS Lesions" And that pretty much statisfied my questions about the MRI. The next few years I focused on MS --and questions of SP-RR transitions as you posted in another thread. I'm late stage RR, not yet SP. First used Betaseron now using Tysabri.

I'm without time right now, kind of hammered too from the new bottle of wine i bought, and it is so pleasant I don't want to stop drinking it this evening

Will respond in the thread after I get done with the hangover in the morning--but will also leave my email in my profile if you want to start a dialog, just identify who you are in the subject line because I delete email without opening that I don't recognize. Tell me something about yourself too & I will reciprocate.

Lynn

[Jules A]

These are good questions and imo when there are numerous lesions the chances of accurately counting all them on a MRI and then comparing that number to another MRI taken on a different date is sketchy.

For myself I want to monitor both lesion load and symptoms. Since my MRI reads "numerous" lesions I don't get caught up in the count focusing instead on active lesions and my physical progression. Now if all the sudden they saw a huge one that wasn't there before or an alarming increase in numbers I would consider changing my dmd.

Since as you pointed out in the progressive forms of MS lesion loads don't necessarily increase that is also something to keep in mind if your disability is increasing.

[Jenny3838]

Hi Lynn,
I will e-mail you; mentioned that in the other thread. Thanks so much. Wish I could join you for some wine, but unfortunately too much gives me a migraine.

I'm without time right now, kind of hammered too from the new bottle of wine i bought, and it is so pleasant I don't want to stop drinking it this evening
Lynn

[Jenny3838]

Thanks Jules,
I kind of agree with you about that too. I was actually shocked when I had my followup MRI, 6 months after my first that the radiologist stated in the report that he compared lesion by lesion and found no change. And I have multiple lesions too.

These are good questions and imo when there are numerous lesions the chances of accurately counting all them on a MRI and then comparing that number to another MRI taken on a different date is sketchy.
For myself I want to monitor both lesion load and symptoms. Since my MRI reads "numerous" lesions I don't get caught up in the count focusing instead on active lesions and my physical progression. Now if all the sudden they saw a huge one that wasn't there before or an alarming increase in numbers I would consider changing my dmd.

Since as you pointed out in the progressive forms of MS lesion loads don't necessarily increase that is also something to keep in mind if your disability is increasing.

[Mrs.Bones]

I think the reason they place such importance on MRIs and lesion load is the fact that it is one of the very few tests that can show change in a concrete, hard copy, write a report , print it out kinda way.

WE know when we have changes in function or feeling,etc. This is one of those few ways doctors can measure it. It doesn't always correspond with what we feel or how we function but it is the best they have at the moment. Good doctors take both into account and treat accordingly.

Those with SPMS can still have the occasional relapse during the transition, relapses may mean lesions, so again there's that change.

[todays child]

Will respond in the thread after I get done with the hangover in the morning--

I hope you're not feeling too terrible. These are great questions and as a newbie I would love any and all information you can share.

Thanks!

[0485c10]

I deviate from the questions in your post, to write how I understand an MRI works...its just to make sure we are communicating the same thing...

I wrote this a while ago, so there may be some in it that was pertinant in another thread.....

Lesion Types.. 2 Measurable - 1 Unmeasurble...The purpose of the dye they inject during the MRI scan is to find currently active lesions. The dye shoudn't be able to get into the CNS system from the blood,there is a blood-brain barrier(bbb) that prevents that from happening, except with an illness. So the T1 lesions, the MRI measures dye, only shows where there is currently active breach in the bbb - currently active damage going on.

Then the other 2 types of lesions the MRI measures, well one isn't really a lesion, just by comparison of past scans a lesion WAS there.

The second Type, the MRI measures HiGH water content. It's an instrument, it has to measure something & it measures high water content. The thing is, the entire brain & spinal column is surrounded by a fatty substance, called myelin, that repels water. The human body is MOSTLY water(like 95%), so where that mylen is missing through a disease process, there will be a high water content, where there shouldn't be a high water content. That shows as T2 lesions.

Oh yes, for some reason, the spine does not seem to reliably show dye. So spine MRI's may only show a high water content, T2 lesions. I noticed my MRI, he ordered dye for the brain & cervical spine MRI-but without dye for the thoracic spine. The cervical spine MRI picks up a part of the brain stem.

The third type doesn't show at all. This is an autoimmune illness, damage is done, the body fixes the damage- replaces the missing fatty cells, myelin, so the MRI can no longer measure a high water content. Despite the fact that a lesion is no longer measurable with the MRI, some tissue damage remains from the time when myelin was missing..That's the third unmeassurable kind I was talking about..

There are really three types of lesions. Active T1 lesions that shows current disease process is happening.*your doc will be interested in that!* There are "in process of healing* T2 lesions. That will be of interest too, some never fully heal. And then there will be the dissapeared lesions, they are no longer measurable. They were able to heal to the point they can no longer be measured by the MRI. Being able to heal to that extent, is a positive sign for the cuuent disease progression. Alot of T1 "dye" lesions, active & breached bb lesions is a negative for the treatment being used. No treatment eliminates them, at times they are gone though,...it's comparisons of past MRI's for medication effectiveness.

MRI shows "currently active" t1 lesions, "healing" t2 lesions & now missing lesions. Three types

[0485c10]

This is a good basic article on MRI's

http://www.unitedspinal.org/msscene/...o-the-disease/

In it it states such subjects

Lesions happen 10 more than relapses
(under the Lesion Location and characteristic section)

MS inflamation leads to atrophy that would be loss of tissue.
(under the Atrophy section)

new gadolium-enhancing lesions and t2 lesions are uncommon in SP, so monitoring brain MRI's is not as useful in SP, this later stage of MS.
(under clinical implications sectiom)

And spine lesions are so symptamatic that there is not a need to do routine spine MRI as in brain MRI where silent lesions form at 10 times the rate of symptoms.
(under clinical implications section)


I'm getting confused at what I want to say. Meds can slow lesions down..and lesions are thought to cause eventual atrophy---so why not sto them if the meds are available to do it? And since many are silent to the doc and the patient, the MRI's are needed to determine if the med is slowing the lesions.

I have read the brain has all kinds of extra realestate and about 40% of brain tissue can be lost before there is irreversable disability. The brain is plastic and able to re route around damage area, until that 40% is lost then it can't any longer. This is my favorite article on that subject about the brain being flexible and able to route around damage until it can't. MS treatment slows damage in the forward direction it can't reverse damage. Its frustrating for all of us. Its taking out home owners insurance and never having a fire. We just do meds because we know it can, just like we knopw the house can start on fire.

http://www.mscenter.org/images/stori...er09lowres.pdf


I'm uncertain why this is bold? I wasn't yelling.
RE: lesion load. I haven't seen any correlation to disability either---present disability, but I have seen correlations to future disability. I even read a post from a doc that explained a theory about that.It's all theories. That the scars or lesion load cuts off blood flow to the brain tissue underneath causing this atrophy and the brain can only compensate for a certain amount of brain tissue loss(atrophy). Do the serial MRI to make sure there are no silent lesions building that could lead to atrophy. The proper med can slow the lesions, a doc has to be sure its the right med for the person.So you are right about not needing brain MRI's during SP without relapses....thats totally neurodegenerative, but when it is SP with relapses still present MRI and meds help the inflamation stage.It said so under clinical implications.
Not having lesions building up on the MRI is a good is not always a good thing!

Its GOOD IF it happens without increased disability.

Not having lesions with increased disability is a bad thing, probably a sign of the untreatable nerodegenerative phase(SP without relapses)

But if disability isn't increasing and lesions that may lead to atrophy are not happening, that is a good thing.

[Bob698]

I have read the brain has all kinds of extra realestate and about 40% of brain tissue can be lost before there is irreversable disability. The brain is plastic and able to re route around damage area, until that 40% is lost then it can't any longer. This is my favorite article on that subject about the brain being flexible and able to route around damage until it can't.

I think that's why the docs out here were so interested in me.
My crainial MRI showed a lot of damage and a lot of activity but my symtoms were considered mild and my mobility was good.
I spent several hours with them doing a debrief of the previous eight years and my activity levels. Basically, if I felt weak I'd push harder. Not an easy thing to do but I was on my own (no ins. so forget about things like DMDs and MRIs) and found that route thru trial and error. As far as I'm concerned, I was forcing my nervous system to adapt to the damage and re-route the nerve paths. The docs are still trying to figure that part out.