Persistent enhancing lesions?

[sardi_g]

My latest mri report noted "Some of these lesions are again noted to exhibit mild contrast enhancement...." So I emailed my neuro to ask if that meant I needed steroids. She said something like it wasn't lesions that were enhancing bc lesions don't enhance that long - which is what I thought. So the radiologist was wrong? Maybe I have an area of persistent break in the blood brain barrier.

It also noted evidence of either calcification or blood products, which I think is a normal aging process that we get prematurely.

I'll ask my neuro for more explanation on the 21st but was wondering about these "again seen 5 - 10 areas of nodular enhancement...., appreciated only on postcontrast images". Seems like nodes and lesions are used interchangeably so these particular lesions may not refer to ms lesions?

[MSW1963]

sardi_g, I can only suggest that you get 2nd/3rd opinions about your MRI results. I only consult with MS specialist for MS treatment, and I've never had anything reported on MRI reports that is as complicated. I would expect a much more thorough explanation than what you've gotten from your neuro. MOO

Take care and hope you get some answers soon.

[sardi_g]

Thank you. This was the first time on a 3T machine so maybe that's why the report was more detailed. I'll ask for the english translation when I see my doc.

I appreciate your answer and your well wishes and you take care too!

[sardi_g]

I looked at last year's mri report and it specifically said there were no abnormally enhancing lesions to suggest active disease. I asked a family member to look at the this year's scan and there is enhancement in one series. Can't find last year's scan.

It can be hard to ask doctors for more clarification, but something's not right. I'm not even sure what the final verdict is but I'm glad I posted here and got the nerve to ask more questions so thank you again for the feedback.

[MSW1963]

sardi_g, also curious how much the latest developments on your MRI/report are due to the 3T technology. I've often suspected that there must be much more going on than the current MRI technology, pre 3T, is detecting.

Do you know how familiar your doc is with 3T? Is there a learning curve involved for MS doc or do they get specialized training for it?

[sardi_g]

I like the iceberg analogy that describes MS; and as technology improves, we're going to be seeing more of what's currently hidden. The problem is: how much of this information is actionable, given the limited options we currently have. Steroids and dmd's - do I need some? Do I need to change my dmd?

"Whatever's enhancing are not lesions bc lesions don't enhance that long" I don't think that was my neuro writing that as I had emailed her office. I'm confident in her experience as well as the radiologist's, especially since there's really so little practical knowledge to acquire at this point. The rest is fascinating but soo academic.

Maybe when he said "again" he was referring to an earlier scan before last year when some lesions *were* enhancing, and now there are some old lesions re-enhancing. That's what I'd like to know. I have a feeling copaxone isn't for me. Ugh. My neuro wasn't thrilled I went off the tec. But I felt horrible. But it was working. I wish we could have more confidence in the dmd's so side effects don't become such a big factor. Now what.

[sardi_g]

Except for being embarrassed, the final verdict is positive. Everything was correct although it appeared contradictory. "Whatever's enhancing" was enhancing last year. It was easier to see on the 3T. It's just not an ms lesion. Another name for it could be 'blush' or node but it doesn't represent a break in the bbb. The copaxone's working!

Not sure I have any comments that could be helpful other than if you have questions about reports that seem to contradict, it's helpful to look at the scans first. And don't lose one like I did!

[MSW1963]

I haven't lost any of my MRI films, but my MS doc's hospital medical records department has. Very disappointing because my NOLA MRI's that I traveled to retrieve after a devastating hurricane, specifically for this MS doc, are probably no longer 'retrievable'.

Glad to hear the 'anomaly'? on the 3T image/report is not a concern to your and your doc.

[sardi_g]

Sorry about the loss of records

That anomaly is called luxury perfusion. Haha! That name cracks me up. Doesn't get more euphamistic.

What isn't funny is that my dad WHO BASICALLY DISCOVERED the relationship btw gadolinium enhancement and breaks in the bbb contributed NOTHING to my understanding of what's going on in my head. I just had to spend hours googling blush etc to find out what's going on. Basically my brain is turning to crap.

And he never cares, never asks me how am doing. I can't even mention ms in his presence. And he never gave much attention to me anyway and ignored so much that I endured growing up. And now I hate him and he has cancer and I'm a villain for feeling this way and it's gonna haunt me for the rest of life.

I'm so done with it all.

[sardi_g]

I'm going to see a new therapist that was recommended. Def hitting a breaking point.

I don't hate him but you can all judge all you want.

Thanks to those few who have responded to my crazy rants lately. It did help - esp the one about anger, but also to ms1963 for answering and offering support. This place can be so cold but I felt less alone and that helped a lot.

[MSW1963]

sardi, i googled a variety of search terms that included MS, 3T MRIs, luxury perfusion but didn't come up with anything that made any sense to me. As far as the euphemistic terminology is concerned, yah it's a real hoot. Not.

Not that your post sounds crazy in the least, but I've had my share of really really crazy rants, but thankfully it's a tolerant group here and I've found enormous support during my time here.

I found it necessary to cut my adoring but incompetent mother out of my life as a young adult. I was so young and it was such a drastic decision I'm still amazed I had the strength. It was extremely difficult but necessary in order for me to become an independent, modestly successful adult. It was made more difficult because she was an adoring parent despite her dysfunction, who's face lit up when I entered a room. It's still painful to think about.

[sardi_g]

I wish there were pm's so I could clarify what I wrote w/out bumping this post up and I don't want to post here anymore but my post was misleading bc these pockets of capillaries are *not related to ms*. It's not an ms lesion (as some lesions aren't in an ms'er) so its enhancing doesn't represent inflammation/break in bbb. These are pockets of capillaries where the contrast pooled and so showed up on T1. I never looked but if I tried to find the corresponding lesion on the t2 I'm guessing it wouldn't be there. But don't quote me on that. It's 'luxury perfusion' bc the blood isn't feeding anything. You don't need it. Like you don't need a rolls royce. :-) There's more to it but don't know and don't care anymore.

For whatever reason, sometimes parents and children don't 'click' and there doesn't have to be any blame. Not all temperaments can be reconciled. Thank you for sharing your story. I think there's a term like 'distancing without anger'. I need to do a lot of that. In spite of the family dysfunction that occurred in our family I don't think anyone doesn't love anyone (except the parents lol) - but engaging can still be painful. That really sucks about life.

Take care.