MRI help!! T1 and/or T2 necessary?

Question

Are T1 or T2 weighted images necessary to see lesions?  

I had a brain and cervical MRI last week and both showed no lesions however, I just noticed on my MRI report it indicates that neither T1 or T2 weighted images were taken of my brain.  Someone please help!

cheekyholly · Answer

Thanks a lot!  Looks like I'm covered!

My symptoms include left side numbness, tingling, vibrating, muscle spasms, blurry/jumpy vision, itching, tinnitus and burning hamstrings and feet. Shakiness comes and goes.  My appt w/ the neurosurgeon is tomorrow.  Hopefully, he can help.

biowham · Answer

The brain protocol did use T1/T2 sequencing. You got all the correct imaging. In fact...right now, I can't even think what someone would do on an MRI if they didn't do the basic T1/T2 imaging protocols. DWI, I guess, which involves pulses instead of a uniform magnetic field. That's pretty much good for strokes. Presumably, they didn't find any evidence of that.

FLAIR images are essentially T2 related and the important ones for identifying MS lesions.  The 1 and 2 just refer to what is measured after they use the magnet to make things wobble around in the tissues. Most of the images for assessing pathology--disease--are T2 images. T1 is good for visualizing anatomy, and if they had used dye, giving a before and after for the dye.

In general, all protocols are going to include the basic t1/t2 sequencing. I don't think you've got anything to worry about.

With that rupture in the c5--are you having hand problems--numbness, tingling, pain?

Bio

cheekyholly · Answer

Hello! Thanks again for your responses! Both of you have been so informative! Just to clarify, my question was - Are T1 or T2 weighted images/sequences/scans necessary to see lesions? On my MRI report it says that the T1/T2 sequence was used on my cervical spine but it doesn't specifically say that on the protocol for my brain. That was my confusion but, according to shell, it looks like the protocol was good even though it doesn't specifically say T1 or T2 was used on the brain scan. As for the dye, I called my PCP the next morning after my MRI was done to explain to her what the radiologist said and she still said she did not think it was necessary. The good thing is that she is sending me to a neurosurgeon because the cervical MRI did reveal that my c5-6 were protruding with a tear in the disc. Hopefully, that is what is causing my symptoms. I am so shaky today that even when I take deep breaths my chest shakes. Thanks again for your help!

sllowe · Answer

Hi there!

I'm so sorry I've not said hello yet.

Seems you did get good protocol w/your MRIs.  Flair, spin-echo, stir, etc. It's also good that your PCP was concerned enough to order them up.  

I'm sorry the imaging didn't seem to tell the tale of what is going on though.  Has your primary recommended you moving along to another Dr. to investigate further?

Sorry you are having problems. Like Lynn says above, our health pages will describe fully how MRIs show lesions.

Lynn - a big welcome to you! I aplogize to you too for not meeting up when you 1st came on - see you around!

-shell

jdhecaj · Answer

You have had both T1 and T2 scans, when it says T1-weighted images & T2-weighted images that was the T1 &T2 scans. T1 and T2 lesions would have shown on those scans.

I agree with your radiologist, this it is an expensive test so the dye should have been used, when it was being done anyway.. Your question was not are T1 & T2 necessary, your question was is the dye necessary?

Here is a post that asked that...http://www.medhelp.org/posts/Multiple-Sclerosis/confusion-over-contrast-and-no-contrast/show/798999

Also if you go to HP, the Health Pages you will see many helpful topics about lesions. A link to the Health Pages is in the upper right hand side of this page.

 On the first HP page I can direct you to the first post *How lesions show in MS, & *Can a person have MS with a negative MRI and on the second HP page is *Lesions come & go. Those would be interesting to you.

The dye shows new or active lesions, without the dye it is not possible to determine if a lesion is active. But within about a day of becoming new or active, a corresponding T2 lesion will show without the dye. So your sagital scans...side view scan....should show lesions without the dye. But I agree with your radiologist, while you were getting the scan, the doc should have ordered the dye, just for efficiency. If your getting the scan., might as well collect all the information that can be collected.

I did read a post from a woman who had a lot of allergies to many substances and her doc did not order the dye, but it made sense. Although she had never had the dye, she would likely have been allergic to it & it didn't get so much information that it was worth a potential allergic reaction.

That's a quick response, check out the other post and the HP pages. And good luck with this.

Lynn

cheekyholly · Answer

Thanks for your response!  I had an MRI of my brain and cervical spine. My initial complaint was back/neck pain however, over the course of the last two weeks I have had a lot of new really strange symptoms so my PCP finally ordered an MRI.  My symptoms are left side numbness, tingling, vibrating, muscle spasms, blurry/jumpy vision, itching, tinnitus and burning hamstrings and feet.  I got my report directly from the imaging center where the MRI was done.  Both brain and cervical images were done w/o contrast however, the radiology tech said he thought the dr should have requested it.  Here's exactly what the protocol says on my report:

(C-spine) Protocol: 
An MRI of the cervical spine was performed on a state of the art GE 1.5 Tesla short bore MR scanner.  Sagittal T1-weighted images, sagittal and axial fast spin echo T2-weighted images and sagittal and gradient echo images of the cervical spine were performed.

(Brain) Protocol:
An MRI of the brain was performed on a state of the art 1.5 GE Tesla short bore LX high field strength scanner operating with 9.1 level software with the following sequences: Axial dual spin echo; STIR coronal; FLAIR axial and diffusion weighted axial.

Luckily, my findings came back normal however, everything I read regarding MS lesions seem to always refer to T1 or T2 lesions.  I don't know all the MRI lingo but it doesn't look like T1 or T2 imaging was even used for my brain MRI.  Can you please clarify?  I'm just really confused and scared.  By the way, I'm in Santa Monica, CA.

jdhecaj · Answer

cotrrection T1 &T2 are MRI sequences. Not MS sequences. Not specific to MRI scans for MS lesions..

jdhecaj · Answer

I'm not understanding what kind of MRI you had. I think to in any way comment on your post, you need to provide more information about your MRI experience. Why was it ordered and who ordered it? How did you get your report? T1 & T2 are just MS sequences, the sequence the MRI radiologists puts into the machine to have to start. So if T1 & T2 sequences were not used, what sequence was? The T1 sequence is often used with DYE, but it can be used without dye also. In a post a few days ago someone posted another sequence, I can't find that post. I didn't recognize the term and did a search on it and found out it was a new MRI sequence that was being used. There are actually quite a bit of different sequences which one did your report use? Where are you located? That might give a clue to what sequence was used in your MRI? If it is a high tech are, teaching hospital thing? T1 & T2 are just the most common.