How MRI's Show MS Lesions

[Quixotic1]

MY QUICK AND DIRTY EXPLANATION OF HOW MRI'S SHOW LESIONS IN MS

I am going to overexplain the MRI with contrast / without contrast thing again, so that you and your husband can have it as clear as possible in your minds.

MS does it's damage by causing the nerves in localized areas in the brain and spinal cord to lose their protective sheaths, called myelin.  At first, when the myelin is being attacked, the body brings a higher blood supply to the area to fight the attack and the area becomes inflamed.  These areas, now become lesions.  At this point they are called "active lesions."   At first the nerves haven't changed much and they appear (and have the same density) as the healthy areas around them.  At this point after some time, probably months, the body CAN repair the damage and remyelinate the nerve.  This repaired nerve still won't be as good as new, but the lesion "looks" like normal brain.  Sometimes later an old scarred lesion will "reactivate" and the adjacent areas will inflame and have increased blood flow.

If the attack on the myelin sheath is too strong for the immune system to repair, more and more myelin disappears and the area of nerves eventually dies.  Then it contracts and scars.  The blood flow is decreased to that area and the area becomes "less dense" then the surrounding normal nerve tissue.  After a longer time - probably years - the scar can reabsorb and the area becomes "empty."  It's called a black hole.

When you image these lesions with an MRI you can see different things, depending on the technique,the age (stage) of the lesion, the power of the MRI, and whether contrast is used.

The first image is done without contrast.  This technique will show old lesions that are big enough to be seen by the power of that MRI machine.  WE KNOW that many lesions in MS are too small to be seen.  If the newer, more powerful MRI with a 3 Tesla magnet is used many more lesions will be seen (by at least 25%) than on the older 1.5 Tesla machines.  The classic old, mature MS lesion is a little bit oval, will have well-defined borders and will be in the white matter.  Characteristic places are subcortical, peri-ventricular and in the corpus callosum.  The classic MS lesion will also have it's long axis perpendicular to the ventricles of the brain.  Also, important and very symptomatic lesions are found in the brainstem, the cervical and the thoracic spine.  The spinal cord ends at the bottom of the thoracic spine, so there is no such thing as a lumbar spinal cord lesion in the normal spine.

These scarred lesions will show up as light, bright areas.  These are the classic, MS lesions or "plaques."

Now the very old, scarred ones that have been reabsorbed will show up as a black (empty) space or black hole.  If there are many of these empty areas the brain will contract around them eventually and show up as a loss of brain volume.  This is also know as brain atrophy.  This is particularly seen in the progressive types of MS.

However, a newly active MS lesion may not show up on a regular MRI because the area of nerves, though inflamed, is still pretty much intact and has normal brain density.  On the MRI it will look like normal brain.  Without contrast it won't show up and will be missed.

When the next phase of MRI is done the contrast is in the blood vessels.  So the large blood vessels show up, too.   Anywhere the tiny blood blood vessels are more dilated than usual, as in inlfammation, the areas will "highlight"  or "enhance."  They show up as even brighter.  So new lesions will show up as enhancing, or active.  Also, older lesions, that have undergone new attack right around them will show an enhancing rim or ring.  When you compare the regular MRI to the Contrast MRI you can see this reactivated, old lesion.

That's how some reports can call active lesions or some report no newly enhancing lesions.  Also since some new ones heal they can be compared to old films and show they disappeared.  In addition, between different sets of MRI done after a time has passed, the radiologist can see an increase in old and in new activity.

Please ask question where I haven't been clear.

Quix

[Darlene499]

I am glad I got this blog. I read your explanation of MS and found it to be very informative.  But, I would like to ask a question. In January 2006 I had a MRI done on my brain and the report came back saying I had lesions on the brain, possible MS. Then the neurologist (I did not like) dig a lumbar puncture and sent that off to be tested. He said that it came back ok. I am still worried about the lesions on the brain. Is there something that I should do or go from here?

[Udkas]

Hi Guys, more story is quite long but I will go into the full detail to see what people think.  I would appreciate anyones comments as I am quite depressed at the moment.  13 years ago I had some pins and needles in hands and feet, some numbness, double vision and some blurring of vision and some bladder problems.  Most of my symptoms were sensory.  I went to neurologist who did Evoked Potentials tests which the checkerboard one was abnormal.  I had a brain MRI which was normal and I was put in hospital and had predinisolone via drip (large dosage).  My optic discs were pale. I also presented with abnormal reflexes, clonus in my ankle, hyperreflexia etc.  I also had lots of burning and cramp like pains, plus some muscle twitching.  My neurologist was certain I had MS.  He repeated an MRI 2mths later and that was also normal.  The machine was very old..  I had another MRI of spine and head another 6mths later and then he said maybe it's not MS but you can't totally rule it out. So I was confused. So now 13 years on my symptoms have raised their ugly head again, I have always had some symptoms but mainly when I get tired, sick (run temp) or really stressed. I felt that my symptoms were new this time and worse, I had vertigo, some facial numbness, burning and pins and needle in my stomach and bum as well as my feet. My left leg has always been worse, it was a sort of prickly feeling.  I decided to go back to a new neurologist and get a second opinion. This guy specialises in MS.  He seemed to think it was a MS like thing and that I definately had lesions and that perhaps the new MRI machine would show old lesions.  I had an MRI done and it was clear.  I was depressed, I know that I don't want to have MS but I did want an answer as my groin and pubic area was going numb and I had suffered a few probs with my bladder etc. and the prickly feeling was driving me insane.  I was prescribed Gabapentin to take and told that it was likely to be Transverse Myletis and he didn't think that it was new but prob from 12 years ago.  Now 6mths since my last visit I have had another flare up. This time my whole left leg has gone numb, like it's dead, or gone so bad to sleep, the sensation when you lay on something funny but not pins and needles, just really heavy so it makes it difficult to to walk on and clutch in the car etc. but today it's okay.  My GP did a CT scan of my lower back as I was convinced that I had something pressing on that bundle of nerves but that was clear too and then I cried and now I'm quite depressed as I feel like I'm going crazy.. I am  otherwise healthy, I take no medication (not even the Gabapentin was was prescribed but I think I will give it a go.) Can MRI be in accurate? Why is nothing showing for the level of symptoms I have.  I know the neurologist believes that I have lesions in my spinal cord. THe MRI was a T3 machine.. brand new. Does anyone think my symptoms sound like MS?  I have good and bad days and my left leg always feels a bit weaker than my right...I did have vertigo last time when I had my symptoms and the dr reckons it was migraine caused by the lesions but I don't get headaches as such..?  but the vertigo seems to have gone away now.. along with the facial symptoms.  I only seem to have some muscle twitching in my thighs when I go say walking up the drive etc. (our drive is steep).  I am otherwise fit, I don't do drugs etc, I am not overweight.  But I must admit this time round I have found my symptoms have got to me and I know if I have another MRI and it's clear I will be depressed as I am starting to feel like I am imaging my symptoms or am just crazy.  Sorry for the long winded post, just needed to put it all out there and see what people say.  I have an appointment with the neurologist in about a weeks time.

CHeers,
Udkas

Open to ideas?

[AlexisZakara]

Wow, where to begin, yet keep it concise. All my life I've suffered from severe anxiety. I'm now a 54 year old woman and I live on a disability due to GAD and Depression. I recently went through a series of psycho-vocational tests and the psychologist said that I have Asperger's Syndrome. After I read info on Asperger's, it explains just about everything all through my childhood, adolescence and adulthood. However, over the past few years, perhaps due to my ineptitutde in social gatherings and my horrible childhood, I've developed a "benign" head tremour. My husband was killed by a drunk driver 20 years ago and was burned severely. He lived for 7 hours and I was with him during his last 4 hours, although he wasn't conscious. My whole body began to tremble and tremour and it seems to subsiand come back. I'm sorry for being so lengthy about this explanation, but I've been treated for depression and GAD but my current doctor is sending me for an x-ray of my back and and MRI at the local hospital. I asked him why, but he's very terse. His reply was, "MS." That was it.  My head tremour is very evident when I'm under extreme stress, and I often have a couple of beers to get it under control. I've been a benzodiazepene in one form or another for about 30 years now, but even they don't reduce the tremour. (The reason for the seeming  misspelling of my words is because I'm a Canadian and we follow British English.)
I read in your text that there is a blood test that will exclude other things, but not necessarily show MS symptomology. I'm almost 55 years old! Isn't this rather late to find MS?
If you could add any comments to this I would greatly appreciate it.  I do hope I rememebered your username and applied it correctly.

[jensequitur]

Farrah, welcome to the forum!

Could you repost your question as a new thread?  Also, because many of us (including me!) have a hard time with reading big blocks of text, break up your post into several different paragraphs.  (Just putting a return every five sentences or so really helps!)

[Farrahlicious]

Quix, could you help me out, please?
I had my first symptoms about 4 months ago. It began with shaking of the right side, and a total loss of strenght. My left leg had no strenght and my right one, whenever i could get myself up (when i try to get up off a chair i feel like an 11 month pregnant elephant!) it starts wobbling around. I can't right, so i wanna kiss whoeven invented laptops. I also felt a terrible numbness in my feet and shins. One very hot day, after enjoying a music festival in Virginia, we went home with my boyfriend and i fell to the ground, not able to move. I asked him to "take whatever it was covering my feet" and he said "you're barefoot". The worst symptoms were not able to pronounce words ans sound like a drunk idiot, not remembering words, spasms, double vision and one time i got into my car and couldn't remember how to get to the gas station. But the fatigue is impossible to bear. I'm out of breath just sitting in my car. Typing is a nightmare. I have to go back over and over again and change the words i thought i meant and ended up typing something else, sorry for the typos. I was ok during a vacation, i could walk without my pink can (hey, i'm a girl in style!) and was better with the shakes and fatigue. After i came back, my parents insisted in me getting an MRI and it came out "clear" according to the MD they wanted me to see (who suggested a shrink since i have too many tattoos and that's the work of the devil.. Catholic Hospital) when i went to see my Neurologist, he looked at the MRIs and said, well, i see a couple of things, but this worries me a little. When i got the MRI they also took pictures of stuff that look more than a thunderstorm than a brain. Sorry, i can't remember which part of the brain they are, i guess it's the top? He said there was a vain that looked ok. It kinda twisted, came back and went "back", like a tail. The opposed one was supposed to do the same, but no "tail". All i have gotten is Xanax and Clobazam for the "shakes". But i haven't been able to get out of the bed for 3 days since i can't walk. My legs won't take my weight. I'm 5'7" and about 125lbs, so it's not like i'm too fat. I have spasms again and a weird feeling in my face. Tingling in my hands and of course, the pain, needles and pain came back to my legs and knees. I'm desperate. I'm (was) a student and i used to go to class at night, i also suffer from AS and imagine the pain. But i know how AS pain feels, and this is different.
What can i do to make my Neurologist take me seriously? it seems all they want to do is pat you in the back and send you home, but i know there's something wrong. Any help?
Thanks, guys.
Farrah

[Quixotic1]

This is not the best version of this discussion.  the one on the "Health Pages" is more thorough.  Please read it instead.

Quix