Just got my brain mri

[scott54321]

Hi everyone,


Just found this board and need help. I just got my mri's done. Unfortunately, my doctor won't see it until Monday afternoon. I see a few white spots, and was wondering if this was ms. Could I post a picture of the mri on here, and see if anyone could tell me? If so, how do a put a picture on here?


Thanks

[HereIam]

Hi Scott and welcome,

It is torture to wait for test results when on a journey for medical answers. We all know that and have been there, done that and HATE IT. You have my sympathy.

However, I'm afraid you are going to have to wait and NOT PANIC. There are many "white spots" on the brains of all people, and many represent a big fat nothing, so don't drive yourself mad about that.

None of us a neurologists or even play on on TV (at least I don't think so), and the only one qualified to read your MRI is the neurology and radiology teams.

Please let us know what you find out on Monday and until then, remain well and enjoy the weekend if you can.

[mjan]

Hi there Scott and welcome to MS World!

Only a MS neuro can diagnose MS after ruling out other diseases, along with a clinical exam, MRI, often a LP for example.

You could get a copy of the radiologists written report from the MRI. However, remember they are ONLY giving their "impressions" and not a diagnosis. Who ordered the MRI?
And what are you symptoms?

Hang in there.. the waiting is difficult but we'll help you get through it. Sometimes, rather often I am afraid, you do not get a definitive diagnosis right away.

Warmly, Jan

[Just a small town girl]

As everyone else has said, you'll unfortunately just have to wait. I found it somewhat comforting to make a set of three lists of questions for my neuro when I was in the never never land between the time when my neuro-opth told me my MRI needed to be rechecked by a neuro because it potentially indicated MS and when I actually got in to see the neuro (about 4-6 weeks).

I made a list of questions for if she diagnosed me with ms, if she said it definitely wasn't ms and if she wasn't sure one way or another. After I made each list I figured out what I would do in each event and it made things a bit easier knowing I could live with whatever she had to say.

I HATE the MRI reports because sometimes they are so off it's not even funny. The first and last MRI report that I will ever read said that I had new activity and additional lesions in areas that I'd never had lesions before. When my neuro and I sat down and compared the current and prior MRI we found that all my lesions had shrunk, grown less intense or disappeared and there were no new lesions. I spent more than a week freaking out about whether I should change my drug, etc. all for nothing. But to each their own. If you decide to read these, don't rely on them too much.

I hope that your appointment goes well. We'll be thinking about you.

[scott54321]

Thanks guys. Still waiting to hear from the doctor. With all the symptoms of extreme leg weakness, loss of balance, lack of coordination, can't concentrate, bad short term memory, and depression, I'm very worried. About fourteen years ago I had the spinal tap done. The results were negative for MS, but it said insufficient something. I didn't know if that meant that the sample they took was insufficient for the results, or the specimen was insufficient for ms. The doctor said I didn't have it, so I guess it was the latter. The waiting is the hardest part......sounds like a song.....

[HereIam]

Have been thinking of you, have you heard anything back on your MRI's?

[kingrex]

I HATE the MRI reports because sometimes they are so off it's not even funny. The first and last MRI report that I will ever read said that I had new activity and additional lesions in areas that I'd never had lesions before. When my neuro and I sat down and compared the current and prior MRI we found that all my lesions had shrunk, grown less intense or disappeared and there were no new lesions. I spent more than a week freaking out about whether I should change my drug, etc. all for nothing. But to each their own. If you decide to read these, don't rely on them too much.

I was going to let this go, but it's always bothered me to read how the neurologist found all these lesions which the radiologist supposedly missed. FWIW, radiologists are trained to read x-rays, CT, MRI, PET, Ultrasound and other imaging modalities. Neurologists rotate through radiology during med school and occasionally during early residency, but that's generally it. And what they do know about radiology, they learned from a radiologist!

To say that the radiology reports are usually wrong is misleading and simply untrue. More likely (and worth considering) is that the neurologist is off the mark. In any case, I doubt too many neurologists would agree that the radiology reports are unreliable. There's a reason that insurance companies require a report from a trained radiologist before they'll pay for the exam.


rex

[scott54321]

Hi again everyone. Got the call from the doctor. No MS. I was so sure I had it. Now they want me to get a second opinion from a neurologist. I am mad as hell. If it's not MS, then what has mad my legs so unbelievably weak? Going to a neurologist is where this all started many years ago. He called what I had "spastic ideopathic paraparesis." This basically means he had no real diagnosis of what was going on. I really do not want to start all over again for the millionth time to only hope that this is finally be the one that fixes it. I've had three surgeries (two cervical, one lumbar) that have made no improvement in my life. I can barely walk, my wife is bipolar, I'm useless. I'm about to give up.

[onlyairfare]

scott54321, I'm sorry you are having such a difficult time with your symptoms and the frustrations of no diagnosis. Sometimes you just have to keep getting additional opinions and tests - you'll see on this board that many of us went through years of symptoms before getting a diagnosis. Keep the faith!

kingrex also makes a good point. Radiologists spend years in their residency training exclusively becoming experts at reading images, while neurologists spend some time in radiology rotations, but then learn a lot "on-the-job" about reading MRI's for MS diagnosis. They could learn from the best and do very well, or not. I am reminded of that saying "To a man with a hammer, everything looks like a nail." Neuros are looking for MS lesions, so they find them; They do have the advantage of putting the MRI and the patient's history and physical exam together with the images.

Ideally, the radiologist and the neuro would work as a team to take good care of you instead of sniping at each other about who reads the images which way.

[Flug]

Scott did you Dr. only have you do one MRI? Hey should preform a few different tests before coming to a conclusion.

[mjan]

Hugs! I KNOW you want a name to what is wrong. Many things can complicate getting an accurate diagnosis. And again, I am sorry your life is not where you want it to be..

Two of the MS neurologists told me they want to read the MRIs for signs of MS. To me, they ARE trained to look for MS lesions. However, I had lots of lesions and this renown MS neuro told me I did not have the classic lesions for MS. BUT he monitored me for awhile, thinking I may have a mild/benign MS case. He said, I never rule MS out. Hmm..

Well when I had to leave his clinic after 4 years, due to insurance changes, he told me NO, you do not have MS. I see him now at MS educational conferences.

Few years later, I see another Neuro for seizure like symptoms and he thinks I may have MS. He's the 3rd doc to say, Are you sure you don't think its MS? Does another brain MRI..same old..same old.. only I WAS in some kind of exacerabation, chalked it up to work stress. 6 weeks later, another MRI while IN the hospital, reveals NEW lesions which are the classic MS kind. So.. you never know.

This is not an easy disease to diagnose so we have a LIMBOLAND thread that is helpful and very supportive.

I also have spinal stenosis so it gets confusing which is which.. MS or my back.

Hang in here with us.. we'll help you get through this best we can. BUT..remember, the docs can only go by what they see via clinical exam and tests AT THAT TIME. Many here know things change.. and hopefully finally there is a name for it.

So I hope you get answers, however, try not to convince yourself its MS when it could be more than one thing going on.

Warmly, Jan

[Shashi]

I was going to let this go, but it's always bothered me to read how the neurologist found all these lesions which the radiologist supposedly missed. FWIW, radiologists are trained to read x-rays, CT, MRI, PET, Ultrasound and other imaging modalities. Neurologists rotate through radiology during med school and occasionally during early residency, but that's generally it. And what they do know about radiology, they learned from a radiologist!

To say that the radiology reports are usually wrong is misleading and simply untrue. More likely (and worth considering) is that the neurologist is off the mark. In any case, I doubt too many neurologists would agree that the radiology reports are unreliable. There's a reason that insurance companies require a report from a trained radiologist before they'll pay for the exam.


rex

How about when you have two radiologist who say two different things? October of last year, I had an MRI done at one hospital. The radiologist there noted five T2 hyper-intensities which were non-specific. My neurologist, an MS specialist, showed them to my on my MRI a few months later. I see them very clearly. When I asked her what they indicated, if they were non-specific, she said we haven't ruled out MS.

This October, I had an MRI done at a different hospital. This time the neuro-radiologist only noted two T2 hyper-intensities which were non-specif and not indicative of demyelinating disease. However, on this MRI, I still see all five of the spots that the other radiologist and my MS specialist saw. So, why did this radiologist not see them?

Also, I found an online article talking about subcallosal striations in the frontal horns of the lateral ventricles being an early indicator of MS. (http://radiology.rsna.org/content/210/1/149.long) My MRI from October of last year looks exactly like this. My neurologist first thought that there was a lesion next to the ventricles on the axial MRI image, but when she looked at the sagittal images where you can see the striations, she said they were artifacts and it wasn't a lesion.

However, on the MRI from this year, which was done at a different hospital on a different machine, the striations are still there and look larger and are now on both sides and what looks like the peri-ventricular lesion is still there too. Why would an artifact carry over from one year to the next on different MRIs done on different machines?

But no one notices it and no one will look at it and tell me if it is a lesion or not or subcallosal striations or not and I keep getting conflicting reports from radiologists and doctors. I even tried to see if the authors of that article would look at my MRI, but I was told I have to make an appointment. They're in California. I live in Tennessee. It's not happening.

And I have given up.

[kingrex]

How about when you have two radiologist who say two different things? October of last year, I had an MRI done at one hospital. The radiologist there noted five T2 hyper-intensities which were non-specific. My neurologist, an MS specialist, showed them to my on my MRI a few months later. I see them very clearly. When I asked her what they indicated, if they were non-specific, she said we haven't ruled out MS.

This October, I had an MRI done at a different hospital. This time the neuro-radiologist only noted two T2 hyper-intensities which were non-specif and not indicative of demyelinating disease. However, on this MRI, I still see all five of the spots that the other radiologist and my MS specialist saw. So, why did this radiologist not see them?

Also, I found an online article talking about subcallosal striations in the frontal horns of the lateral ventricles being an early indicator of MS. (http://radiology.rsna.org/content/210/1/149.long) My MRI from October of last year looks exactly like this. My neurologist first thought that there was a lesion next to the ventricles on the axial MRI image, but when she looked at the sagittal images where you can see the striations, she said they were artifacts and it wasn't a lesion.

However, on the MRI from this year, which was done at a different hospital on a different machine, the striations are still there and look larger and are now on both sides and what looks like the peri-ventricular lesion is still there too. Why would an artifact carry over from one year to the next on different MRIs done on different machines?

But no one notices it and no one will look at it and tell me if it is a lesion or not or subcallosal striations or not and I keep getting conflicting reports from radiologists and doctors. I even tried to see if the authors of that article would look at my MRI, but I was told I have to make an appointment. They're in California. I live in Tennessee. It's not happening.

And I have given up.

To be fair, you're really not trained to read MRIs, and the 5 lesions you see may not be precisely what was seen on the earlier MRI. I have no doubt that you think you're seeing the same lesions, I just question if, in fact, you are. In any case, this is all anecdotal - there are no images to see, so your impression is all we have to go on. Just sayin'...

The truth is, it's very easy for doctors of any specialty to disagree on a case or patient. The people here regularly describe neurologists with whom they have a problem, and whose diagnosis (or lack of) has been contradicted by another neurologist. Here, the tendency is to go with the neurologist whose diagnosis most closely jibes with the patient's own suspicions. If a patient believes he or she has MS, then the "most competent" neurologist is the one who reinforces that belief. Patients rarely seem relieved to hear that they "don't have MS", and when they find a neurologist who agrees that they DO have MS, the reaction is often along the lines of, "See? I told you that other neuro didn't know what he was talking about." I don't recall anyone saying, "This new neuro says I do have MS, but I don't know...maybe he's wrong." Perhaps your 5 lesions really are 2? I hope so

That paper on sub-callosal striations is pretty old...we see a lot of periventricular signal on FLAIR images. FWIW, these papers are thought-provoking but they should not be taken as absolute truth; early on in MRI, every time we saw bright spots in the white matter, some very experienced, university-based neuroradiologists called it MS. I know a lot of papers were written at that time which seem pretty foolish today, given our current level of understanding. Like most other medical disciplines, radiology is a combination of art and science, and it's a work-in-progress.


rex

[HereIam]

Scott--this is a confusing time for you, I am sorry for that. That you have a history of back surgery makes it all the more foggy for diagnosis.

The only suggestion that I would make is to have the neuro order an MRI of your C Spine and to do another spinal tap. This would give them more information to work with.

I don't want them to find MS in you, but you need answers and I'm not sure they've done enough yet to say "no MS, let's move on to the next guess."