I’ve had two brain MRI scans three years apart which show the same three lesions which are still active. Is it usual for lesions to stay active for so long? I have had symptoms pretty much on-going and have a diagnosis of probable ms. Thank you for answering my query.
Hi Anon,
Have you been told unambiguously they are still active, or are you just concluding they must be, from the fact they’re still there?
I think a lesion can remain visible on MRI almost indefinitely (i.e. after it has healed), so the lesions still being there isn’t remarkable in itself. But if you have been told they are definitely still active (i.e. “glow” with contrast), that is a little bit unusual. It might indicate you are having a relapse - which I believe can consist of renewed activity of old lesions. However, I think it would be quite unusual, in the course of three years, to have “only” renewed activity of the same three lesions, but no evidence at all of any new ones.
Many/most people do have residual symptoms after each episode/relapse, because even healed lesions may not heal perfectly, so you’re left with whatever damage couldn’t be repaired. So having ongoing symptoms after even just one single attack doesn’t prove damage is still happening. It may just prove it was never fully repaired.
Sorry if this leaves more questions than it answers.
P.S. if the latest scan wasn’t with contrast (i.e. where you come out of the scanner and have an injection, before going back in), there is no way they could tell whether the lesions were still active or not. A scan without contrast doesn’t show the difference between active and historic lesions.
Tina
Hi Anitra Many thanks for your reply, I think it is probably my ignorance but wonder if you could clarify something for me. My first scan showed two lesions in callososeptal interface and one in the frontal lobe. The second scan showed high signal in right periventricular white matter, one in post central gyrus and one in left cerebellar peduncle. The neurologist told me these were the same as on the first scan. Are the areas the same but just under different names? I have not had a scan done with contrast. Thanks again.
Hi again,
I’m afraid I only have a layperson’s knowledge of brain anatomy, as well - or at least, no more than one picks up incidentally, after having been diagnosed with a brain disease for a while.
A former regular here (she’s still OK, as far as I know, just taking a break from posting) produced a beginner’s guide to the brain and MRI, which you may find helpful. here:
http://www.mssociety.org.uk/forum/new-diagnosis-and-diagnosis/brief-beginners-guide-brain-and-mri
However, having scanned through, I do not think it answers your question specifically (not surprising, as it is supposed to be a brief beginner’s guide, not an attempt to answer every single question anyone might have).
However, my guess - and it’s only a guess - is that you can trust the neuro when he says it’s the same three lesions, and they are just being described in different language. I do not think it likely he’s made a mistake about something as basic as whether these are the same lesions, or new ones - so yep, if he says they’re the same, it’s just that one radiology report has used a slightly more technical level of description than the other.
If you’ve never had an MRI with contrast, we can’t say whether these lesions were active at the latest scan, or even at the first scan, three years earlier, as there’s a possibility they’d already been there some time, even then.
When I had my first scan showing lesions, I asked the neuro outright: “Do we have any way of knowing these haven’t always been there?”, and he admitted: “No.” Unless you have before and after scans, and the first one was clear, there is no way of dating when the lesions first appeared. They might have been recent, or there for years.
On the whole, I would say it’s good news you haven’t shown any increase in “lesion load” (the term they use for the number of lesions) in as long as three years.
True, it doesn’t move you any closer to a diagnosis, but it does suggest whatever “it” is can’t be highly active and aggressive, otherwise it’s likely there would be significantly more damage evident by now.
At the time of my first brainscan, I was found to have six lesions, and just six months later, there were more, although I was never told exactly how many, and didn’t ask, as I was sure the reason they didn’t tell me was I wouldn’t like the answer!
However, even that was considered “not bad”, as I was told many patients my age (40s) have literally dozens.
So just three, which have not multiplied in three years, is good going.
Of course, I’m not making light of your situation - it’s not normal to have any number of brain lesions, at any age, so three is still three too many. BUT, if it’s stopped at that for three years, you’re doing quite well. Being still there is not too much to worry about, I don’t think. Lesions in the brain, just like anywhere on the outside, can leave scars, and these scars might fade over time, or remain visible. A visible scar doesn’t mean the injury is still current, but as I mentioned last time, you might still have symptoms from it, if the body couldn’t repair it 100%.
Tina
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