Neurologist VS Radiologist OMG -$#*@#

[johnniebear]

I've had my first   Cervical spine  &  fourth Brain MRI , so  I've had  the latest report in my hands for ten days now,  My Neurologist called me to go over the report .

Here's how it went,   he said he talked to the Radiologist  because he doesn't see  the spine lesion as the  mention on the report, and thinks the Radiologist over reported, I guess that's code  for reading  the MRI wrong!!
So I asked the Neurologist is there a lesion or not- he then stated that it  doesn't present very well- but make sure I follow up my the new MS Neurologist in late April for the second opinion. and blah blah & how was I doing overall.

I know that I all my results are boarder line.
3 brain lesion
Positive VEP
One O band
One Spine Lesion, Maybe?

                             Does anyone have any thoughts, or had this happen? Do  MS spine lesions grow or change ?

Do I under stand that neither the Neurologist & Radiologist can't read the MRI like the expert MS Neurologist can?


  I know this road  filled with missed DX . I'm in Limbo ,  I'm not upset, rather concerned with all these Dr's and their different opinions..  I'm sure most you have been there!!

[Lulu54]

Hi Johnniebear,
You raise several questions here and I will attempt to give an explanation -

The radiologist is going to bill your insurance for reading your MRI, regardless of whether your neuro refers to that report or not.  Sometimes they just give a basic report and other times it is more indepth.  A radiologist looks at films and pictures all day long - everything from suspected broken bones to complex ones like our MS MRI's.  


Radiologists undergo complex training, but can't do an indepth study of every disease and how it presents itself in imaging. MS dx'ing is one of those very difficult diseases to spot sometimes, unless you have all the classic lesions (like I had!).  Many MS neuros do not use the radiologist's report at all and prefer to read their own films.  They also don't want to be biased by another person's opinion and read our films with no preconceived ideas about our health.

Whether your neuro uses the radiologist report, or not, you are still going to get a bill for the service from the radiologist.  Always. It does seem a shame - I just got my bill and it was over $400 to my insurance company and my MS neuro absolutely does not use it.  Ever.

You know when you get a flat tire - sometimes is can be repaired ?  The tire will hold the air, but you know that the integrity of the tire has been compromised.  The same goes for those myelin repairs - they give us borrowed time on the repair, but no guarantees that it will be permanent.

Our bodies are marvelous machines.  In most of us, our body is constantly trying to repair damage, this includes those pesky lesions.  We know that remyelination occurs - the replacement myelin is not as good as the original, but it can be effective in repairing the lesion.  

Hence you get the condition that - lesions come and lesions go.  What showed up in last MRI may not be there at all the next time.

O-bands are often present in our CSF.  The magic number for raising an eyebrow for MS for most neuros  is 3 - but the Mayo Clinic folks and their followers want 4 or more.  This is a number of o-bands that are unique to the CSF and don't appear in the blood serum sample taken at the same time.  


I hope something in here is of use to you..........

be well,
Lulu

[johnniebear]

thanks to all that posted.

As always very helpful..   :-))


john

[Deb61]

I know how disconcerting this is.  Yes, it does happen that the neurologist and radiologist see things differently on the MRI.  In my case, the neurologist saw things on the MRI that the radiologist didn't see.  My neurologist pointed out the lesions with me looking over his shoulder when it was brought up on the computer.  He talked about the lesions and why he thought this was MS (location, increase in number, size, etc.).  

It's a good thing that you're going to an MS specialist in April.  I hope you find someone that you can trust.  The trust issue sure can be harmed with experiences like this.  It will help if you have a neuro like mine that comes off like he knows exactly what he's doing, and shows why he is thinking what he's thinking.

April's not far away!  Hang in there . . .

Deb

[HVAC]

John,
  I am sorry this is frustrating. I had the same MS Specialist look at the same MRI  twice over a six month period and write a totally different review of it each time. The first time he said it definitely was not MS the second he said he saw Dawsons fingers and it was a sure sign of MS. Go figure. It was as if the reports were written on two different patients.

Neurologists are used to looking at things over time and making decisions. Usually three to six month intervals.

If it is MS it probably will not advance that much in the time it takes to be diagnosed. Mine went from October 2007 to April 2009. Nothing really changed. Of course we now know I have had it since the 1960's and it has been slow all along.

Hang in there and give Kouper a hug for me.

Alex

[johnniebear]

thanks ,

I don't see the MS Dr  until the end of April,  don't get me wrong,  this  Neurologist  is better than the first one I had- the first dismissed me saying it was age related.

However this DR  isn't MS DR,   this Dr gave orders for all other testing, but wants me to follow up with the MS DR for a second opinion. So for that I'm grateful  ...


John.

[daisy.girl]

hi....
I had a similar experience. My radiologist report read: a few small subcortical lesions non specfic....however, when my neurololgist looked at the MRI disc himself, he said: approximately 10 white matter lesions consistant with MS. This actually led to my dx of RRMS in Jan 2010

This has lead to confusion and doubt on my part. I did ask the neuro why the difference, he say radiololgists many time just make their report vague to cover there butts. Now I question everything....to the point of driving myself crazy.

Will you see a MS neurologist soon?

Remember, the MRI is just a piece of the puzzle, the neuro is looking at your exam, clinical history/symptoms, blood work, LP, VEP altogether to make a DX.

Blessings