MRI question

[Carlyle]

Hi,I think I heard something about contrast awhile ago.Does anybody have any information on this?Im going for a mri this week.thankyou

[Boudreaux]

I do not get the contrast since, in my limited understanding, it only shows active leisions. I have had new findings on MRI's that I didn't have any symptoms from so I figure whats the point since I've read that contrast agent can be harmful. Thats my .02.

[ru4cats]

Hi,I think I heard something about contrast awhile ago.Does anybody have any information on this?Im going for a mri this week.thankyou

Usually for an MRI for MS, gadolinium (contrast) is injected into a vein to pick up any active lesion activity. It is added after approx. 40 minutes of plain old MRI pics. Gad causes active lesions to light up like a Christmas tree. Some centers require an IV be placed in for the later addition of the gad; some places just inject it like a shot. If you are older than 60 (?) you are required to have blood drawn to see how your kidneys are doing. Gad has gotten some bad press lately on possible damage it causes to organs. You might want to check with your neurologist so see if you need the contrast.

Don’t know if this answers the questions you had. Hope it helps.

[Daisycat]

I could be wrong... but I thought contrast was for them to check to see if any lesions are "active".

Again I could be wrong hopefully someone with more knowledge can tell you.

[Jules A]

I could be wrong... but I thought contrast was for them to check to see if any lesions are "active".

Again I could be wrong hopefully someone with more knowledge can tell you.

That is my understanding also and fwiw my MS specialist, well known east coast teaching hospital, continues to order it so I continue to get it until something earth shattering leads me to believe otherwise.

[pennstater]

There have been studies that show that gad can cross the blood brain barrier.

My neuro said if I don't have any new symptoms or worsening of existing, the next one may be without contrast. If he sees any new lesions without contrast, will discuss if I want another scan with gad to see if active.

I already told him if there is a new lesion, but I am not having symptoms, I don't see the point. I am not going to do IV solumedrol for something that has no new symptoms.

[IntoDust]

The contrast is very important for baseline MRI’s as they are looking to determine that the lesions are of different ages. It’s also important to rule out many other causes for the symptoms. They’re looking for more than enhancing lesions with contrast. For example, some diseases such as sarcoidosis will show leptomeningeal enhancement which you won’t see in MS. Abscesses will have complete ring enhancement where MS lesions tend to have incomplete enhancement and show an “open ring sign”. Contrast is very helpful in differentiating these lesions.
I have had 2 baseline MRI’s of my brain, so for my last scan I asked if I can have it without the gadolinium. My reasoning was if anything was new, it was new and it didn’t matter if it was active now or was active 9 months earlier. It would be enough to determine that my lesions are of different ages. My neurologist agreed and my MRI showed new lesions that had formed since the last scan.
The long term effects of gadolinium are just now being researched and I prefer to err on the side of caution. I figure the last thing I need is a build up of a possibly toxic substance in my brain as it has suffered enough damage.
Also, it cut the amount of time I was in the “magnetic coffin” down by 15 minutes.

[Daisycat]

The contrast is very important for baseline MRI’s as they are looking to determine that the lesions are of different ages. It’s also important to rule out many other causes for the symptoms. They’re looking for more than enhancing lesions with contrast. For example, some diseases such as sarcoidosis will show leptomeningeal enhancement which you won’t see in MS. Abscesses will have complete ring enhancement where MS lesions tend to have incomplete enhancement and show an “open ring sign”. Contrast is very helpful in differentiating these lesions.
.

How can they tell if the lesions are of a different age? I understand how they can tell if one is active versus not active , but knowing that one is a year old and another is 3 years old is something I do not understand.

[KoKo]

How can they tell if the lesions are of a different age? I understand how they can tell if one is active versus not active , but knowing that one is a year old and another is 3 years old is something I do not understand.

Daisycat

When you get MRI's, there are reports that should have any significant lesion documented, size and location.

Say in 2017 your MRI showed no lesions in your cervical spine.

Then, in 2018, the MRI showed an active lesion (new) in a specific area of your cervical spine. That would be documented on your MRI report.

So, then in 2019, the MRI would now show that same scar (old), same location, and it would be about a year old, according to the documentation on your previous MRI report, which said it was new in 2018.

Of course tracking the age of a lesion can't always be an exact science, but pretty close if the lesion is found while still active, and the MRI's are annual or semi-annual.

Hope I didn't confuse you with my explanation!

Take Care

[Carlyle]

Lot of information I thank all who responded,the tech afterwards gives me a water bottle and tells me to drink lots of water to help flush out the contrast.

[pennstater]

IntoDust -

Good point about baseline.

I was diagnosed because I had non-enhancing lesions in both brain and cervical spine whic satisfied the disemination in space criteria.

Along with one enhancing lesion in both the brain and c-spine in that baseline MRI, it then satisfied the disemination in time criteria (having ruled out other causes). The non-enhancing lesions were evidence of a prior event, while the current enhancing (active) lesions were evidence of a subsequent event.

So without the contrast, I would have been waiting for a later MRI to show changes for a diagnosis.

[IntoDust]

So without the contrast, I would have been waiting for a later MRI to show changes for a diagnosis.

Thats what kept me in limbo for so long. Besides the location of my lesions not being “typical” initially, I never had any react to contrast. But I went from 2 to 12 in 5 months. Part of that was due to having my second scan done on a 3T machine, but I can’t imagine that the original scan missed 10 lesions. My next MRI showed 17 even though the report said 11. So that’s a big increase in 15 months.

Oh, another point about contrast that I forgot: If you are in an active flare, new lesions may not show on the T2 scans for a few weeks. They may show on T1 as black holes, but they’re not really areas of old, burned out lesions at his time. The T1 will pick up the edema and show it as a dark spot. It’s only with contrast that you’ll see some very new, active lesions.

[ru4cats]

Also, it cut the amount of time I was in the “magnetic coffin” down by 15 minutes.

LOL, "magnetic coffin"! Love the very apt description. I'm stable, so no new trips to the "magnetic coffin" for me unless I have new symptoms! Yay!

[Jules A]

Also, it cut the amount of time I was in the “magnetic coffin” down by 15 minutes.

LOL, "magnetic coffin"! Love the very apt description. I'm stable, so no new trips to the "magnetic coffin" for me unless I have new symptoms! Yay!

That is a fitting term! My neuro still orders them q18 months due to the chances of activity that isn't showing with symptoms.

[Carolinemf]

“magnetic coffin"

Yep.Very colourful and apt.
Claustrophobia . Use everything available to stay calm.
I still climbed out once - in a panic.