New MRI Report is Confusing

[polopuppy]

Hi Everyone,

I just received my newest brain and spine MRI report today. It has me rather confused and I thought maybe someone here can add some clarity. I do have a message in to my neuro but haven't heard back from him yet.

The issue is with the section about the spinal cord lesions. I was found to have the lesion at T3-T4 last June. In the report, it states that there are additional lesions in the spinal cord but then indicates that they are not new. If they weren't there is June or on the two MRI's in September, aren't they then "new". I understand that they are not enhancing but they must have come from somewhere. Am misinterpreting the report somehow? I have attached the report below.

Thanks!

MR brain and total spine with and without contrast 2/1/2019

HISTORY: History of atypical inflammatory CNS syndrome that presented in 2004 and with evolving possibly brainstem symptoms, immunosuppressed for Behcet's disease.

COMPARISON: MR brain and total spine 9/29/2018, 9/19/2018, and 6/26/2018

TECHNIQUE: Multiple sequences of the brain and total spine on 3 Tesla scanner

Contrast: Intravenous gadolinium was administered

FINDINGS:

BRAIN:

Since 9/19/2018, complete resolution of abnormal enhancement, rim of reduced diffusion, and surrounding vasogenic edema associated with the left superior parietal lobule white matter lesion (11 mm).

No interval change in numerous additional periventricular and subcortical white matter lesions within the supratentorial brain. The 2 largest of these are once again seen within the right periatrial white matter and right superior frontal centrum semiovale ovale each measuring 8 to 10 mm. No new lesion is identified. No definite posterior fossa lesion is noted.

Normal brain volume. No hydrocephalus.

SPINE:
Again seen is a left lateral cord lesion (best seen on axial T2 series 13 image 16) at T3-4 level without change. Additional lesions within the spinal cord at T10 and T11 levels are also unchanged. No new cord lesions. Mild degenerative changes of the spine without evidence of remarkable spinal canal stenosis or neural foraminal compression.

IMPRESSION:

Since 9/19/2018, complete resolution of abnormal enhancement, rim of reduced diffusion, and surrounding vasogenic edema associated with the left superior parietal lobule white matter lesion.

No interval change in numerous additional periventricular and subcortical white matter lesions within the supratentorial brain.

Chronic spinal cord lesions at T3-T4, T10, and T11 levels without change. No new cord lesions.

[pennstater]

Key sentence "Additional lesions within the spinal cord at T10 and T11 levels are also unchanged. No new cord lesions. "

Do you have your prior reports? I took this paragraph to mean that lesions at T10 and T11 existed on prior MRIs. They used the word additional just to mean in addition to other T spine lesions, not that the lesions were added since last MRI.

If the lesions in T10 and T11 weren't in the report from prior test, I would want neuro to look at prior MRI and current to compare and clear up if they existed and were omitted from prior report or if the wording on this year's is poor.

Good luck.

[polopuppy]

Hi Kathy,

Thank you for your kind reply. The lesions at T10 and T11 are not mentioned on any prior MRI report. My first spinal lesion appeared on the 06/2018 MRI and that is the one at T3 -T4. I had two more brain/spine MRI's in 09/2018 and neither of them say anything about the lesions at T10 and T11. I agree, either they were present on a previous MRI or the radiologist described the situation in a strange way. I will have to wait on my neurologist.

I hate finding out about medical issues in a roundabout way. A couple years ago, I was sent to see an endocrinologist about my severely low Vitamin D level. She casually asked me how long I had had Hashimoto's Thyroiditis and I proceeded to answer that I did not have it. She then told me that my anti thyroid antibody test from 2 years ago prior was off the charts and that I most definitely had it. I was flabbergasted that none of my doctors had bothered to tell me. On top of it, I had all the symptoms and needed to start Levothyroxine ASAP.

[Jules A]

My reports rarely list specific lesions in detail like this radiologist did so I'd wonder if they were there but not mentioned specifically? Otherwise it sounds like a decent MRI plenty of issues, as we all have
, but overall a stable MRI?

[polopuppy]

Thanks for your reply, Jules. My MRI reports are always this detailed but maybe because they are done at a large teaching hospital?? I have no idea. I agree with you that these lesions must have been seen on a prior study but not mentioned. And yes, it is a stable MRI which is wonderful since it is the first stable one in over 14 months. All the others had new lesions and mostly new enhancing lesions with brain edema. I guess the Rituximab is doing its magic!

[Jules A]

And yes, it is a stable MRI which is wonderful since it is the first stable one in over 14 months. All the others had new lesions and mostly new enhancing lesions with brain edema. I guess the Rituximab is doing its magic!

This is excellent news!