How many brain lesions on average do we have?

[0485c10]

In any case, T1-weighted imaging is what's used to look for black holes, as well as for post-gadolinium imaging.

i thought a loss of brain tissue black hole lesions had to have a corresponding white lesion on a t2 mri or the black spot on the t1 image with gadolinium could be something else?

Technologist, not radiologist.

i knew but glad you stated it definitively. Mostly only technologist state things with any certainty. those working at a level above always leave a door open for other conclusions as new evidence evolves. if a person is looking for certainty, stick with a technologist!

[kingrex]

REX,
This is great to have a radiologist on the message board!

Technologist, not radiologist. But thanks.


rex

[kingrex]

its interesting that flair takes out signals from vascular issues. i thought it showed more and more noise. but they aren't vascular noise? i have to remeber the order of this. black holes show black on a t1 mri
black holes show white on a t2 mri
and black holes show black on a flair mri.

right or do i have it wrong?(asking to be certain question mark, checking consistency of how cerebral fluid shows on different mri, not demanding/telling question mark)

I'm not clear on what you mean by "vascular noise," but perhaps you mean the flow artifacts caused by blood moving through the vessels during imaging? In any case, what I said was that FLAIR eliminates bright areas from the CSF surrounding vascular structures in the brain, but it does not eliminate our view of the brain's vasculature.

Black holes do show dark on T1-weighted images, but not necessarily on FLAIR. In any case, T1-weighted imaging is what's used to look for black holes, as well as for post-gadolinium imaging.


rex

[kingrex]

usually, huh? i have read an MRI is nothing more than a picture of the brain that is interpreted, that the definite answer can only come from biopsy or autopsy? in 27 years you have seen the resolution on the pictures getting much better, but i believe biopsy to autopsy trumps an interpretation. are you copied on biopsy and autopsy reports of any past MRI you have done, to read how close your interpretations were?

I'm not sure what definite answer you're referring to. What I meant by "strikingly bad" was that toxic exposure usually produces a dramatic appearance on MRI...more than little white dots. As for MRI's specificity, which I think you're questioning by your biopsy/autopsy references, I'd agree that MRI images, in the absence of any other clinical or imaging data, probably lack complete specificity, although 30 years of imaging experience has given radiologists a lot to go on, and surgeons are largely comfortable operating based upon MRI findings. But you're right - nothing is quite like firsthand contact with the tissue.

BTW - I don't interpret MRIs, radiologists do. I'm a technologist.


rex

[0485c10]

FLAIR is helpful in that it surpresses the signal from CSF and eliminates the imaging of the perivascular spaces (called Virchow-Robbins spaces).

its interesting that flair takes out signals from vascular issues. i thought it showed more and more noise. but they aren't vascular noise? i have to remeber the order of this. black holes show black on a t1 mri
black holes show white on a t2 mri
and black holes show black on a flair mri.

right or do i have it wrong?(asking to be certain question mark, checking consistency of how cerebral fluid shows on different mri, not demanding/telling question mark)

[0485c10]

But to the trained eye, MS plaques are usually different and tend to stand out.

Taking drugs or drinking alcohol doesn't mean that you have brain lesions. Exposure to some chemicals or chemical fumes can definitely affect the brain, but the appearance is usually strikingly bad.

usually, huh? i have read an MRI is nothing more than a picture of the brain that is interpreted, that the definite answer can only come from biopsy or autopsy? in 27 years you have seen the resolution on the pictures getting much better, but i believe biopsy to autopsy trumps an interpretation. are you copied on biopsy and autopsy reports of any past MRI you have done, to read how close your interpretations were?

[penkalet]

REX,
This is great to have a radiologist on the message board!

Thank you for your comment. Still a little too technical for me
but I am understanding better now.But yes it is the radiologist that counted those lesions, probably on the MS neuro order because he sent me to him.

Here is the copy of the result:
If you feel like it, please comment.

Thank you,
Alain

FINDINGS:
T2 lesions: Comparison was made predominantly to the study performed on 2009. Multiple some of them too small to count approximately 50 to 70
T2 lesions some of them located in the periventricular white matter and corpus callosum and most of them in the subcortical and centrum semiovale white matter of the frontoparietal lobes, some of the lesions may be
related to superimposed chronic small vessel ischemic changes.
A discrete lesion is also seen in the right central cerebellar hemisphere and left posterolateral pontobulbar junction. The lesions size range between 2 and 11 mm, the largest lesion in the left frontal centrum semiovale white matter. There are approximately 7 to 10 new T2 lesions.


T1 "black holes": There are two unchanged periventricular white matter
black holes adjacent to the body of the lateral ventricles.

Enhancing lesions: None

Corpus callosum vol.: Within normal limits

Brain volume: Within normal limits for age, unchanged.

Other: Minimal mucosal thickening of the maxillary sinuses.

[kingrex]

...always makes me wonder how many are from MS and how many are from other things? the longer a person lives the more other things it could be.

i was 41 at the time of the MRI. maybe 59% are from ms and 41% are from other things:stress, the 4 years i smoked, some headaches. i have always had low bp, so i don't think any are vascular. i didn't drink excessively(maybe a few times a decade after i turned 16), i only started a med 7 years ago, before that i didn't use any prescription or non prescription drugs, ice cream is/was my drug of choice.( i don't think that causes lesion, but if i drank or used any drugs that could have caused a % of those lesions)

I've been doing MRI for 27 years now...to be honest, MS plaques tend to have a unique appearance, relative to other "bright spots" in the brain, which used to be called UBOs - Unidentified Bright Objects. Bright spots on T2-weighted images tend to be either demyelinating disease (MS is one), cerebrovascular disease (stroke), migraine-related, tumor or simply dialated perivascular spaces. FLAIR is helpful in that it surpresses the signal from CSF and eliminates the imaging of the perivascular spaces (called Virchow-Robbins spaces). But to the trained eye, MS plaques are usually different and tend to stand out. The others are normally mentioned as possible, differential diagnoses.

Taking drugs or drinking alcohol doesn't mean that you have brain lesions. Exposure to some chemicals or chemical fumes can definitely affect the brain, but the appearance is usually strikingly bad.


rex

[darla7147]

MS LESIONS GOING FROM WHITE TO BLACK

SO WE WENT TO THE DR AND MY HUSBANDS LESIONS WENT FROM WHITE TO BLACK. 5 DRS HAVE LOOKED AT HIS MRI'S AND HAVE NEVER SEEN IT HAPPEN BEFORE! ANY OTHER PEOPLE HAVE THIS PROBLEM?????

[0485c10]

You might be interested in this site, if you scroll down the page

it has a section on normal aging white matter changes with the Fazekas scale.

Fazekas I &II can be considered normal in aging,

Fazekas III(extensive confluent lesions) is never considered normal.

http://www.radiologyassistant.nl<br ...p4594f74ccbf19

always makes me wonder how many are from MS and how many are from other things? the longer a person lives the more other things it could be.

i was 41 at the time of the MRI. maybe 59% are from ms and 41% are from other things:stress, the 4 years i smoked, some headaches. i have always had low bp, so i don't think any are vascular. i didn't drink excessively(maybe a few times a decade after i turned 16), i only started a med 7 years ago, before that i didn't use any prescription or non prescription drugs, ice cream is/was my drug of choice.( i don't think that causes lesion, but if i drank or used any drugs that could have caused a % of those lesions)

[kingrex]

Confluent does mean that the lesions are closely associated, but ring-enhancing refers to their appearance on the post-gadolinium sequences - the lesion shows contrast enhancement around its periphery (edge), so the enhanced portion is like a ring around it:

http://images.radiopaedia.org/images...6acb718e9d.jpg


rex

[0485c10]

I wasn't given a count, just a description of extensive damage from ms with confluent lesion and ring enhancing lesion. from what i understand confluent means they have meshed together and ring enhancing means they are forming on top of each other?

2 on the spine at last mri, 4.

from what i am understanding, a high lesion count doesn't predict disability, it just makes you believed when you complain about anything...so a person has to be very careful about complaining about anything...can't be certain what actions will be taken.

[kingrex]

Addendum

Just to follow up, what I described are two separate phenomena. For lesion counting, the use of thin sections probably increases your count, only because you will likely see the same lesion on two slices if they're thin enough. Since more and more patients seem to be seeking out 3 tesla scanners - which may use thinner sections - the problem is only getting worse.

Patial volume averaging is more likely to obscure the presence of a small lesion, and this is where thin sections are helpful.


rex

[kingrex]

Regarding lesion "count" - my guess is that the number you're quoted (and I'm guessing it's the neurologist who is giving out numbers, because radiology reports rarely give an actual count, unless it's only a few) is very often exaggerated due to technical factors. If you have a 6 mm plaque, for example, it will probably be seen on two different slices (slice = picture). The same thing could happen with a 4 mm plaque, depending on where it's located.

An MR image is an image of the content of a three-dimensional slice of tissue. Every type of tissue (e.g., white matter, gray matter, CSF, bone marrow, demyelinated lesion, etc.) has a fairly unique appearance on a given MRI sequence. The imager assigns a single unit of brightness to each voxel, which is a three-dimensional area of tissue within the image slice. If the voxel is large enough to include two or more different types of tissue, then the brightness assigned to that voxel will be an average of the tissues within it. The way to combat this phenomenon, known as partial volume averaging, is to use the thinnest possible slice thickness and the smallest pixel size available. In reality, there is a limit to how thin and fine we can practically image, so there is always the potential for some averaging.

None of this makes much difference to an MS patient, unless you're hell-bent on counting every single lesion like a Treasury agent. But when I read about someone having 60 lesions in the brain, I have to believe that this is an over-accounting of what's actually there. I'm sure there are cases, but most MS patients have nowhere near that number.


rex

[Enigma1019]

Chalk,

I love the name of your book!