I had an MRI without contrast of my brain and cervical spine. Both came back normal. I have a handful of neurological abnormalities indicative of some kind of upper motor neuron issue, as well as several autoimmune conditions. Does anyone have any option about whether I should request a brain scan with contrast? Is there any chance that the first MRI could have missed something in my brain? I haven't had an LP since I was 11 either. I'm terrified of requesting one since the first one left me stuck horizontally in bed for 2.5 months (I had a CFS leak). Any input would be GREATLY appreciated.
Hi Wallis...first of all, a CSF leak should NOT have left you in bed for anymore than a day or two- why didnt they patch it sooner? Thats unheard of..nowadays, if you develope that leak, they patch it, by bascially giving you another spinal and using your own blood- its quick, painless, and relieves all the headache and problems that accompany the issue..
But, to answer your real question, its not likely that a MRI with contrast would have picked up much more...contrast shows things which are happening now- active lesions as they are known..however, if you have been having any sort of MS related things happening, the regular MRI should have shown scar tissue (lesions) that were there. They normally do not go away...the contrast simply highlights them, making them show as active. Of course the other school of thought is that it cant hurt to do it. Truthfully, if it were me, I would wait 6 months, then request another MRI and this time with Contrast..that way if something is happening now, it will be sure to show up one way or the other in a few months...sometimes, the lesions are too small to pick up, but 6 months later they appear.
Sorry to hear you feel so bad..
As far as the CSF leak... After 11 days, they did do a blood patch, which failed (apparently it fails 1% of the time). The next day they did another blood patch, which was practically unheard of to fail, and it failed anyway Then being a child, I had some bad doctors who thought I was trying to get attention from my parents by lying about the excruciating spinal headaches. Finally after 2.5 months I saw a new doctor who did a lumbar MRI and saw the leak. I had a fibrin patch instead of another blood patch to heal it up.
I've seen a few posts on the boards about MS lesions taking a long time to show up after symptoms begin, what truth is there to this? I'm just really frustrated because this has been a decade of misdiagnoses and incomplete diagnoses. All this neurological stuff is getting worse and I'm scared that the tests are missing something that is going to progress. I'm already wheelchair bound most of the time because I can't straighten my legs enough to stand and because of pain. I wish I could just figure out WHAT is causing the pain, spasticity, tremors, clonus, and hyperreflexia! I don't even care anymore if it goes away, I just want to know what it is. Thanks for your input... any more ideas you have would be appreciated
Contrast is capable of showing small lesions that might not be identified otherwise. Besides active lesions lighting up, contrast in general helps see things with more specificity. However, your doctor would really be the best one to determine if this is necessary right now but when you're scheduled to have another MRI, I would certainly request it.
Disease activity is what causes the lesions so that's one of the things they look for in dxing as proof of MS. Unfortunately, sometimes they can take a very long time to show up. I've seen people with sx for years and years who still don't have a dx for this reason.
Thanks for your reply. I'm going to see a new neuro next week, and I will mention that my last MRI was without contrast. I'm sure if he feels it's necessary he will run another test. I'm rather excited to have the appointment because this neuro is a gait and movement disorder specialist, right up my alley currently! It just seems that MS fits a lot of my symptoms. The big kicker is narrowing my diagnosis down is the fact that I am an identical twin and my sister is perfectly healthy thus far, therefore, genetic conditions (other than autoimmune) are pretty much out of the picture. I just hope to figure this out soon! :/
Sorry to hear your having such a tough time getting a diagnosis... I was just in your shoes about 2 months ago as well. I went through the ringer to get my diagnosis and was misdiagnosed with lymes disease at one point causing me to have unnescessary surgery. I hope your next spinal tap goes well... and just to let you know, I was diagnosed with MS and have no lesions (a completely normal) head, c-spine,thoracic spine MRIS.... so that is also possible. Its not as rare as it used to be either, 10% of cases do not show lesions on MRI according to my MS specialist. I had a positive spinal tap twice and minimal abnormal neuro exam which led to my diagnosis after three long years!.... So just hang in there okay??? Keep us posted.
As far as the contrast goes, some docs feel it is more helpful than others. If the lesions are present, they will show up without the dye. "Active " lesions will show up with the contrast. Where I work (im a tech), our radiologist usually override the referring physcian (your doctors) request for contrast unless it is a case of known MS. I hope this helps.
I have been told by more than one medical professional that new, small active lesions can often be seen only with contrast. Ultimately, it's the doctor's decision and as Tara siad, sometimes the radiologist makes the call.
On another note, a friend of mine was dxed after getting her latest MRI done on a newer machine (stronger magnet) than she had been imaged in previously. That said, I don't think it's always the machine itself -- the facility I use doesn't have the newest machines but they replace their software every 6 months. (Tara, perhaps you have some insight on this?)
Thanks everyone. I AM going to bring up the possibility of MS despite a positive MRI. I'm terrified of experiencing a spinal tap again, but I guess anything to finally figure this out. Only a week left until my appointment.
Just to play devil's advocate for a minute, even if you had/have lesions on your brain, that's no "FOR SURE" DX either. As y'all all know by now...LOL, I have brain lesions but no firm DX of anything really.
I'm going to have another MRI with contrast done ASAP to include my spinal cord.
I had a horrible experience with CSF, too. I have a Subchondral cyst in the epidural area that they take the fluid from and needless to say, them sticking a huge long needle into it, did NOT feel good. Nor were they successful, in getting enough (or any in my opinion) spinal fluid. Since the procedure took 3 hours and was, for all intents and purposes, unsucessful, I won't be repeating mine either!!
I'm hoping that my MRI with contrast will help them narrow down my problems, as well.
Poor Bec..youve had it bad! I want you to know, but it probably wont make you happy, that I had a for sure dx based on my MRI alone. Of course, they did the spinal tap and nerve conduction tests to be 100% sure, but everything is normal in my world, except for the 50+ lesions ALL on my brain. That itself, along with the symtoms I was presenting, gave me a firm dx..
no other tests gave us any information.
the software versions can be upgraded and give better detail (thats for sure)... I know different hospitals in our company that have indeed gotten the upgrade and have noticed a difference in their overall image quality. However, this is rather insignificant when comparing different "Tesla" or the strength of the magnets. When you double the field strength of the magnet (the tesla) you increase this factor by a factor of four I believe. So what I'm trying to say is an upgrade to a newer version of software on a 1.5 T magnet isn't even comparable to the power of a 3.0 Tesla scanner. The T1 times actually get longer however (due to a bunch of physics that I can't explain) and the noises get stronger due to the gradients inside the magnet and the scan times are therefore increased. So there's a price for everything in MRI....... but inevitably.. you get a much better picture. However, if someone has braces or permanent bridges inside their mouth, the "metal sucepitibility artifact" is increased on the images and they come out more distorted on 3T scanners.... okay.... enough physics for now. Sorry to bore you! ...
So I just had to make a trip to the ophthalmologist, yet again. I had previously been diagnosed with uveitis connected with arthritis and ulcerative colitis, however, he examined me and told me I have zero inflammation, so its not uveitis causing this excruciating pain. He thinks I have optic neuritis. Fantastic. He said my pupil in my affected eye is larger than the other, and is responding slowly to stimuli. He also said that the opening to my optic nerve is enlarged. He's sending me for yet another MRI, this time of my optic nerves and orbits, with and without contrast. He did a visual field test too, which was in the normal range, but with differences between my two eyes, the right one being worse (the affected eye). Will an orbital MRI scan my brain too? Everything is getting more and more suspicious...
Oh and as far as higher strength magnets for MRIs, of course I'm more complicated than other people... I have a permanent Maryland Bridge in my mouth. PS. I have fantastic genes to start out with, thanks grandma for the missing teeth.