Brain Talk or How to Make Sense of your MRI
So maybe some of you have gotten an MRI. And you get this report back which is pretty much written in doctor-ese. “What in the heck does this mean?” you think to yourself. I was a student in Psychology many years ago and so I know a little bit about the brain but I could make no sense out of my MRI report. And granted, what you need is for your neurologist to decipher and translate the written report and visual scans. But in the meantime it doesn’t hurt to know a few basics of what the data on your MRI report means. After all, if you have Multiple Sclerosis, you will most likely be getting MRI’s for a good long time.
I am going to use my first ever MRI report as an example and we will go through some of this gibberish.
My report from way back in May of 2007 says the following:
MRI OF THE BRAIN WITH AND WITHOUT CONTRAST
Usually when you get your first MRI they are going to do one just of your brain. If there is nothing there and they don’t think it is MS after all then they won’t bother doing the spine. But if they find lesions as they did with me, subsequent MRI’s will usually include part of your spine. I would like to know your experiences, however. Was your very first MRI just of your brain or of your brain and spine?
It is usually good to get an MRI with and without the contrast. What they do is to infuse you with this stuff called gadolinium into your veins. So when you get an MRI with the contrast you will need to deal with an IV needle unfortunately. What this contrast does is that it provides a much better visual view for the technicians to see certain things. In my case it would show which lesions were more active (recent). In other cases it might be used to see a tumor or highlight blood vessels. Just depends on what brought you in for the MRI in the first place.
TECHNIQUE: Multiplanar MRI was performed of the brain, including diffusion weighted sequences. Images also were obtained following IV administration of 12 ml of magnevist.
Basically this just tells me that they did the MRI and used a contrast agent called magnevist.
One tip I want to tell you about the dye is make sure that they dry the alcohol they use on the swab to clean the injection site, otherwise it burns like the dickens. I wanted to scream during one of my MRI"s because the alcohol also got into my veins. I rode it out though because I didn’t want to have to retake the MRI.
And if you have small non-existent veins like I do, let them know ahead of time so that they don’t mangle you. Get a nurse or technician who knows what they are doing as far as getting the IV into you.
FINDINGS: There are multiple subcortical and periventricular white matter signal abnormalities, more numerous than expected for age. No signal abnormalities are seen within the corpus callosum or posterior fossa. A small focus of enhancement is suspected along the left optic nerve seen on axial images. No diffusion-weighted abnormalities are identified.
The first time I read this I was like, “What???”
Okay first of all I want to tell you about lesions. When they talk about “white matter signal abnormalities” generally they are talking about the plaque surrounding myelin sheath or the protective covering on our nerves. On the MRI these plaques or lesions are going to show up as white spots. To the untrained eye, however, it is sometimes difficult to figure out what is a lesion and what is not just by looking at the scan. It is helpful for your neurologist to look over your scan with you so he or she can point out where the lesions exist.
Doctor Sethi explains the terminology on his Brain Diseases web log:
"White matter signal changes on the MRI essentially means that on the MRI, the white matter showed some scattered bright spots. White matter in the brain refers to the fiber tracts that carry information to and from from the brain.
If the MRI was done because there was a clinical suspicion of multiple sclerosis then these white matter lesions may indeed have significance and may represent radiological evidence of MS plaques"
I also want to point out that white matter signal abnormalities are not always indicative of MS. We all get some plaques or lesions especially when we age. This is why they noted on my report that my lesions were more than what would be expected for my age.
Some other reasons for the finding of lesions are noted in this article where the author states:
“Although white-matter lesions are viewed as a normal part of aging, and are found in people with no dementia or other neurocognitive disorders, they are linked with other health problems. In this study, hypertension accounted for a small but significant amount of variance both in white-matter lesion scores and in general cognitive scores in old age. This finding builds on other recent evidence that white-matter abnormalities may be related to circulatory problems (including hypertension, diabetes, heart disease and cardiovascular risk factors).”
In scanning the literature there can be many reasons other than MS for having brain lesions including: Migraines, schizophrenia, epilepsy, hypertension, diabetes, cancer. heart disease, dementia, and old age.
When they talk about the small focus of enhancement on my MRI, they are showing evidence that one of my lesions was active and causing me trouble recently. And this was certainly true for me. I was experiencing some visual disturbances including seeing bright flashing lights in my periphery. I was sent to an eye doctor who was unable to detect anything wrong. Just goes to show you that the MRI is quite often able to detect things that the doctors are unable to.
IMPRESSION: FINDINGS MOST CONSISTENT WITH DEMYEINATING DISEASE WITH NUMEROUS SUBCORTICAL AND PERIVENTRICULAR WHITE MATTER SIGNAL ABNORMALITIES. THERE ALSO APPEARS TO BE SUBTLE ENHANCEMENT ALONG THE LEFT OPTIC NERVE
And this little note of two sentences was the root of my bad news. When they talk about demyelinating disease they are talking about Multiple Sclerosis here. I never have gotten an answer as to what constitutes “multiple” lesions. Is there a certain number that if you have more than this number, you are suspect for having MS? Perhaps one of you can answer that one.
Now what of these terms of “Subcortical” and “Periventricular”? Subcortical refers to nerve centers found immediately below the cerebral cortex. The cerebral cortex is important for such mental functions as memory (what else…I have forgotten already :>)), attention, and language. This does explain some of my symptoms.
I found a good definition for periventricular white matter on this site where the author defines it as “white matter that is immediately to the side of the two lateral ventricles of the brain. The lateral ventricles are two curved openings (shaped like a horseshoe) located deep within the top section of the brain. White matter is a group of white nerve fibers that conduct nerve impulses quickly. White matter is important for muscle movements.”
So this does explain many of the symptoms that I have pertaining to movement.
Lastly I want to leave you with a link which I found to be very helpful. This site is called the Radiology Assistant and everything and anything you want to know about MRI’s will probably be there.
I hope this was helpful. Feel free to share any more information you have about MRI terminology or what certain things mean. It does help to be aware and knowledgeable about what the tests can mean. It makes me feel more empowered. I would love to hear your thoughts. Please don’t hesitate to share them here.