MRI results - can you help?

[ebrownkirkland]

Hi. I have a question about my MRI results that I'm hoping someone can help me to make sense of. My neurologist had me go in to "assess for demyelinating disease" (the MRI report said "Evaluate for multiple sclerosis"). Here are the findings of the MRI:

COMPARISON: Outside MRI on 10/11/16
FINDINGS: MRI examination of the brain was performed both prior to and after administration of intravenous contrast material. Intravenous Gadavist
9 cc was utilized.

Scattered white matter lesions are present. One of these is new or has increased in size compared to the prior study. It is immediately adjacent to the right lateral ventricular atrium. It measures a maximal 8-9 mm in size. There is no diffusion restriction, but the lesion mildly enhances on post-contrast imaging.

Other lesions are stable. Occasional subcortical right frontal lobe lesions are noted, each measuring about 2 mm in size. There is a 3 mm lesion in the lateral right frontal lobe. There are similar small lesions in the lateral left frontal lobe. No large tumefactive or worrisome confluent lesion is present.

There are no abnormal fluid collections. There are no masses. There is no mass effect or midline shift. The ventricles are normal in size, shape, and configuration. Diffusion-weighted imaging is unremarkable. There is no evidence of acute infarction. The intracranial flow voids are grossly normal. The gray-white matter junctions are unremarkable. Clival and calvarial marrow signal is normal.

IMPRESSION:
1. There is an 8-9 mm lesion in the right periatrial white matter, new or increased in size from the prior study. It enhances on post contrast imaging.
2. Other lesions are stable

Just hoping someone can tell me what all this means. I have been monitored by a neurologist off and on since 2011, but in 2011 when I was sent for a lumbar puncture, it came back normal, so I went for a long period of time ignoring other symptoms until October of 2016 when the thumb on my left hand went completely numb. Since then I've had other odd symptoms, including numbness/tingling in one side of my face (that's how all of this began back in 2011), and, more recently, numbness and tingling in my shins and all down the outside of my left leg to my ankle. I thought it was my lumbar spine that was causing all the issues but my neurologist only sent me for an MRI of my brain and c-spine (c-spine MRI was pretty much normal except for some bulging discs) because he is thinking it is MS. I do have a history of low B12 but I have been treated for that for some time now, and am now in the normal range. The neurologist said low B12 would not cause the issues I am experiencing, especially since my levels are up now. I am a 39-year-old female.

Thanks in advance for your help. Sorry for the long message.

[aspen2]

The most important points from this note are as follows:

You were given a contrast agent.  The point of a contrast agent is not to help see lesions (they will show up without contrast), but to see if a lesion is currently active.

Your imaging is almost completely stable from the last set of MRIs done.  The exception is a new or larger lesion by your right ventricle.  It's a bit less than 1 cm in size, which is large enough to be considered ms plaque. It also seems to be active currently (the findings suggest "mild" enhancement.

Other lesions mentioned are all 2-3 mm, which would not be considered by most ms neurologists.  They are more likely to be due to migraine or other conditions, and although "could" be caused by ms, are not at all diagnostic for ms based on their size or location (subcortical, frontal lobe).

If you have had a significantly sized lesion previously in a different ms-typical area of the brain, this might lead a neurologist to move closer to an ms diagnosis.  If this is the only one, I don't think you would meet McDonald Criteria yet.  Certainly, my ms neuro would have discounted the small lesions as meaningless.

i am not a doctor, however. Your neurologist will need to assess the "mild" enhancement to make sure it's not an artifact -- I've never heard of enhancement being mild before.  And he/she will have to compare the larger lesion to previous studies to make sense of the radiologist's description of "new or larger".

Do you have a copy of a previous report?

It would also not hurt to have the bulging discs evaluated because they can cause ms-type symptoms in arms and legs.

IF when you see your neurologist, and he's a general neuro, and feels it's ms, I would definitely want a second opinion with an ms neurologist.

SO sorry you're still waiting to get answers. It's a difficult time.  We want answers fast and things move at a snail's pace.

[ebrownkirkland]

Thanks, Aspen. I was finally able to find my old MRI report which was done in 2010, apparently. (Thank GOD I save emails!)

Back then, I was admitted to the hospital after showing signs of Bell's Palsy. Bell's Palsy was ruled out, after it was concluded that my facial droop (on the left side) was not consistent with that shown in Bell's Palsy cases. A CT scan showed no abnormalities, but an MRI found "two nonspecific punctate foci of elevated T2 and FLAIR signal...within the subcortical white matter of the parietal regions bilaterally."

The radiologist further indicated, "Nonspecific punctate foci of elevated T2 and FLAIR signal within the subcortical white matter of the parietal regions, one site on the left and a second on the right which may represent changes secondary to demyelination, vasculitis, chronic small vessel ischemic changes or another nonspecific underlying inflammatory or infections process."

[aspen2]

You won't know until your appointment where the neurologist will go, and neither do I. I'm curious though.  Really only this current possibly active lesion "counts" as possible ms plaque, not non-specific (not diagnositic) punctate (tiny) lesions as described in your first and second reports.

Best of luck when you see your neurologist, and keep us posted :).