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Active inflammation on MRI question

Hello Everyone - this is my first post and I wondered if anyone could help with a specific question on interpreting MRI results.

Background:

I’m being investigated for MS and have had, what I think are, optic neuritis, leg numbness/weakness, muscle spasms, and lots of fatigue. These have come and gone over the last few years but I’ve had a particuarly hard time over the past six weeks.

I had an MRI scan in a 1.5T scanner in June and have read the report. It showed numerous lesions in periventricular, callosal septal interface and juxta cortical areas of the brain. No lesions in spine, brain stem or cerebellum. The lesions are non-specific but ‘markedly abnormal’ for someone of my age (44).

Question:

The neurologist said that the MRI showed ‘no active inflammation’. I thought that it wasn’t possible to tell active inflammation without a contrast enhanced MRI. Does anyone know if this is correct?

He used the lack of active inflammation to advise me taking steroids but he did offer them. I’ve felt terrible at times over the past six weeks and am now wondering whether I should take a course of steroids after all.

Thanks

Paul

Hi Paul, I must admit, I did not think active and historic lesions could be distinguished without the use of contrast either (I’m a diagnosed person). In fact I thought that was the whole point of contrast! So I’m a bit confused how your neuro could tell there was “no active inflammation”. On the steroids issue, though, there is no evidence they change the overall course of MS, or the amount of damage done. In other words, the extent of recovery is just the same, whether you take steroids or not. Steroids may make it faster, but not better. Also they are non-trivial drugs, and can have a number of side-effects, both temporary and long-term, and they are usually most effective if given early in the MS episode, or relapse. If you’ve already put up with it for several weeks, there may be little to be gained by starting steroids now, but you’d have all the attendant risks and side effects, so there may be a case for leaving it to nature this time round, and only taking steroids if you’re in a really bad way next time. Of course, if you’re lucky, perhaps there might not be a next time, but steroids now won’t influence that at all. Hope this helps a bit, Tina

I had MRI in May and my neuro said I have some areas of inflammation that’s all he said not sure if it is helpful.

Thanks both - the advise on steroids is useful. I was worried about them as the dose for MS is massive compared to that for other conditions and I have been getting better.

I’ve asked my neuro just to clarify whether he is sure that there’s no active inflamation. It may be that he thought a contrast agent was used.

He’s referred me for a lumbar puncture and visual evoked potential tests anyway - so they me clarify things.

Paul

I forgot to say was a MRI of brain neck and spine, no contrast vep and LP this coming week.

Hope the LP goes well - I’m waiting for my appointment to come through. As everyone else seems to say - it’s just a case of waiting and trying to patient at the moment.

I’ve been lucky my neuro is a ms specialist he’s been so fast 2 weeks for MRI results then another 2 weeks for vep and LP kind of wished he waited 2 weeks more then daughter would be off school lol.