Too late for mri?

[mistelaj]

This is my third thread now and I wasn't sure if I would start a new thread or write in my older one...sorry for many threads..

I have written my story in "Can I rule out MS?". I met a new neurologist a week a ago and it was once again a big joke. He didn't do anything, just smiled and told me to take NSAID. My family doctor tried right after that to write a new referral to another hospital, but they sent it back and said that if my MRI:s are fine, then everything is fine.

My family doctor is very frustrated about the situation. No neurologist wants to help me and they do not do the LP he asked about. I don't even get help for my face pain (another doctor said it's probably atypical trigeminal neuralgia).

As I wrote in my history in "Can I rule out MS" I have had symptoms and "flares" since 2010, but 8 weeks ago I suddenly got numb in my left leg, right arm, abdomen, bladder and gut. It lasted in its extreme form for 4 weeks and after that I have had some kind of healing period with less symptoms that increase and decrease, come back when it's warm outside, when I am tired etc. I still have fumblingness and mild numbness and it feels like someone pushes my arm down when I lift it etc.

My doctor wanted a neurologist to help me....but after all this he asked me today if I want to do a new MRI if he writes a referral. I have only done 1,5 tesla of the brain and I think the spine mri 2015 was as low as 1 tesla. So I have a chance to do a 3 tesla mri...

But is it too late now?? If there were lesions (large enough to show up on 3 tesla mri) 8 weeks ago, will they still show up now...or after 10 weeks from symptoms started? Is it waste to do mri now?

Jreagan70 wrote 6 weeks ago "The timely thing about contrast is that inflamed lesions enhance for about 6 weeks. Since you just had a flare, you're in the perfect timeframe to catch enhanced MS lesions if they exist. Two months from now would be too late." I didn't really understood if it means that I was in the perfect timeframe to find lesions at all or active lesions with contrast..

[KoKo]

But is it too late now?? If there were lesions (large enough to show up on 3 tesla mri) 8 weeks ago, will they still show up now...or after 10 weeks from symptoms started? Is it waste to do mri now?

Jreagan70 wrote 6 weeks ago "The timely thing about contrast is that inflamed lesions enhance for about 6 weeks. Since you just had a flare, you're in the perfect timeframe to catch enhanced MS lesions if they exist. Two months from now would be too late." I didn't really understood if it means that I was in the perfect timeframe to find lesions at all or active lesions with contrast..

mistelaj

Not a waste to do MRI now. MRI scans can reveal non-enhancing and older lesions as well.

This info about MRI from the National MS Society may help with understanding:

http://www.nationalmssociety.org/Sym.../MRI#section-0

Hope this helps. Anymore questions, feel free to ask and we'll help, if we can.

Take Care

[Seasha]

I agree - it isn't too late! If it were me, I'd go get it done.

Good luck and hopefully with a 3 tesla, something will show up.
Keep us up to date how everything goes!

[pennstater]

I would get the MRI done on the stronger 3T machine. If you get it with contrast, any active lesion will be detected. The views without contrast will show inactive lesions.

They know now that sometimes lesions may disappear or shrink, but it is still worth checking the brain and spine. None of mine have ever disappeared.

Good luck.

[mistelaj]

Thank you so much all of you

I'll do the mri. I have to travel to another part of Sweden and it's a big thing, so I wanted to be sure. There is a 3t mri in my town, but they can only do the brain, not the spine (no good pictures), so I guess it's not a very good camera. The camera in the other town is a very good one (it's used for science too) and they told me when I called them that they'll install a new one in 10 days, probably even better. So if I get a referral I'll have the mri in the new camera if I wait until then

Just another questions. I have had many mri:s with contrast during the years and I'm very hesitant to get contrast again. Both because I have had allergic reactions to it (or some kind of mast cell activation caused by my mcas, which is not easy to treat) and because of the known toxicity....especially when I have had many mri:s with contrast already.

Is contrast only needed to see if there are active lesions or not? Will the active lesions still show up without contrast (without showing if they are active or not)?

[KoKo]

Is contrast only needed to see if there are active lesions or not? Will the active lesions still show up without contrast (without showing if they are active or not)?

Hi mistelaj

From my understanding, I would say yes, probably, to both of your questions (I'm not an expert though!).

MRI scans taken without the contrast agent will show both old and new active lesions (but won't be able to distinguish the old ones from the new inflamed ones).

On MRI scans taken after the gadolinium is injected, only the active, inflamed lesions will show up due to the contrast dye penetrating the leaky blood vessels, which are caused by inflammation of the plaque.

This info is from an article in the National MS Society Magazine Momentum:

A contrast-enhancing agent, such as gadolinium, is injected into a vein in the arm. The agent travels through the bloodstream to get to the brain, where it can provide doctors with more detailed information. For example, if someone develops a new MS plaque, the blood vessels within that plaque often become leaky. “When that happens, gadolinium can leak out of the blood vessels into the plaque. That’s how we know that the plaque is new,” says Dr. Reich. “In our lab, we have also discovered that gadolinium can sometimes leak out into the layers of cells and fibers that cover the brain, called the meninges, and that this leakage also indicates that inflammation is going on.”

http://www.momentummagazineonline.co...stifying-mris/

Hope this helps!

Take Care

[mistelaj]

Thank you KoKo That was really helpful! Take care!

[mistelaj]

Oh, bad luck again The camera in the other town has no agreement with my county, so I have to pay for everything if I want to do it...and I can't do that. There is a 3 tesla in my town, but they say they can only do brain and cervical spine, not t-spine (but I think they'll see the upper part of the t-spine, like t1-t4).Is it unusual to have lesions on the t-spine? Are c-spine lesions more usual? If I have cervical spine and brain done here in my town the health insurance pay for it.. Maybe I can afford only a t-spine mri on my own after that, in the other town..

[KoKo]

Is it unusual to have lesions on the t-spine? Are c-spine lesions more usual? If I have cervical spine and brain done here in my town the health insurance pay for it.. Maybe I can afford only a t-spine mri on my own after that, in the other town..

mistelaj

I think for diagnostic purposes, the brain and cervical spine MRI's are most common. I never had a thoracic spine MRI. The brain and cervical spine images had enough evidence for diagnosis.

This is the Cleveland Clinic Mellen Center for MS's approach to MRI of cervical and thoracic spine (although neurologists elsewhere may have different approaches):

Q: When should an MRI of the cervical or thoracic spine be obtained?

A: We recommend an initial cervical spine MRI with and without contrast in patients suspected of having MS when the head MRI gives equivocal results. Spinal MRI provides increased specificity in patients with an abnormal brain MRI or increased sensitivity in patients with a negative brain MRI. This is particularly true with older individuals and those with numerous risk factors for non-specific white matter changes associated with hypertension, smoking, diabetes, high cholesterol and age over 55. Also, if symptoms or signs could be explained by spinal cord disease, then spinal cord MRI is required to rule out non-MS cord pathology. Additionally, some typical MS patients also have concurrent spinal cord compression that may affect their management (e.g. cervical spondylosis).

We will obtain thoracic spine imaging when there is a specific indication (for example, thoracic myelopathic symptoms, mid thoracic back pain, or when imaging of other areas of the CNS do not show demyelinating lesions in a patient strongly suspected of having MS). Due to potential issues of artifact and patient motion, the quality of scans is particularly important with spinal MRI, and higher field strengths (1.5 or higher) are preferred for the cord.

https://my.clevelandclinic.org/-/sca...ion.ashx?la=en

Take Care

[mistelaj]

Thank you again KoKo I guess it's very unusual with only lesions on the t-spine and no lesions at all in brain or c-spine... I got my referral today (brain and cervical spine in 3tesla) and I'll do the mri in 4 weeks from now (longer waiting times during the summer, but they'll call me if they get any cancellations). My doctor still wants someone to do an LP on me (I think he is frustrated) and probably he'll try with another neurology clinic after the summer holiday and when the mri is done! I strongly believe that my symptoms since 7 years are caused by some kind of spinal cord involvement, but if it's ms or something else and if I ever will have an answer......no idea But next step is 3tesla mri