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Spinal MRI report - translators required!!

Hi everyone : hope you all soldiering on!thumbsup

Here’s one for those in the know – eg Karen et al.angel
I have obtained a copy of my spinal MRI report and need some help with the translation.confused
It says some good things ( I think) : alignment preserved with no sig. Signal alteration in disks/vertebral bodies; contour of thecal sac = maintained; v.b, discs, thecal sac and conus within normal limits; CV junction preserved.

It then says “ 1.2cm focal hyperintensity is noted in cord, without sig. Swelling at D7-8”   confusedWhat does this mean?

And finally ;
“Impression: focal hyperintensity within the cord at t7-8.  Myelitis and demyelination are high in the differential.  Patient should have enhanced study of the spine and MRI of brain”
I had a brain scan last year that says I have 2 very large lesions consistent with MS.  Is enhanced study of spine a lumber puncture?   Are t7-8 and D7-8 the same place?  What is focal hyperintensity?
confusedLots of questions I know, but I have my 1st neuro appointment on Thursday and I want to be as prepared as possible so that I don’t waste time.  Thanks in advance xx
 

It's basically saying that your spine is fine structurally but you have a lesion at the 7th-8th thoracic vertebrae that is consistent with demylination. (D7-8 is the same place, just a different way of saying it.)

 

Focal hyperintensity means a white spot which basically means a lesion.

 

I think that enhanced study means a better MRI scan using thinner slices so they can see more detail. I don't believe that the radiologist would say that if he/she meant LP - I think in that case they would say something along the lines of "examination of CSF".

 

I'm guessing that you are wondering what this means with regard to a diagnosis. If your brain lesions are in a typical MS area (i.e. periventricular: touching the ventricles which are the large reservoirs of CSF in the middle of the brain, or juxtacortical: next to the gray matter) then this new lesion means that you now satisfy the 2010 McDonald criterion for dissemination in space. This is because a spinal lesion is an accepted substitute for an infratentorial lesion - the third MS typical area, which is the cerebellum and brainstem. (You need to have at least one lesion in at least two typical areas.) If this is a new lesion, then you also satisfy the dissemination in time criterion. If this is the case, then (sorry) you are likely to be told that it is MS.

 

If they have never scanned your spine before, then this lesion may have been there for a while. In that case, you need to have had at least two attacks to satisfy the dissemination in time criterion.

 

If your neuro tells you that you have probable MS but won't diagnose MS, then you need to be asking which version of the McDonald criteria they are using and why they think that you don't satisfy the latest, 2010 revised version (published in early 2011). If you've had the runaround for a while from this neuro, think about going armed with a list of your relapses to date (along with the standard list of symptoms and questions) and have a read of Polman et al (2011) Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria. It's free to download.

 

If you do get a diagnosis, then please ask about whether or not your neuro can prescribe DMDs. If he/she can't, then ask about getting referred to an MS specialist. You may not be eligible yet, but it's better to be in the right place when you are.

 

It's just occurred to me that you may not be RRMS. If you aren't, please let me know and I will go through the diagnostic criteria for PPMS for you. These are in the Polman et al paper too of course.

 

I hope this helps!

 

Karen x

 

Thanks Karen - I knew you would come up trumps.  I hope you have had one of your better days today.

I don't know if what I have been having is classed as a relapse.  It feels like a continuous string of symptons that have got progressively worse since July with no real let up. 

Do relapses stop and you return to "normal" for a bit of are they always there but not as noticeable.  I bet, judging by what I have learnt from posts on this website so far, it is different for everyone.  scared2

I will wait and see what the neuro says and bear in mind what you have said.  Thanks again, your words are invaluable and a support for many.  angel

Will probably be back in touch tomorrow after my appointment.  It is a weird feeling to be secretly hoping that they tell me that my fears are right whilst, at the same time, hoping that they don't know whats going on.  Its hard to think that some people go for years without answers.

Tf x

You're right - it's different for everyone! Relapses can last from a day to many months and sometimes they go away completely and sometimes they go away only a little, if at all.

 

Fingers crossed for you for tomorrow.

 

Karen x

I have read the Polman report now - thanks for that - I now have a cracking headache from all the big words....... my google bar has earnt its money today!!

TF x

I have been told that I am probable ms. With CIS. The neuro ms specialist said I need 2 have another attack to be ms proper. He ummed and ahhhd 4 a bit then asked if I wanted a lumber puncture. I said yes. He says my present symtoms could last upto 6 months.has prescribed me gabapentin? Referred me 4 lp and further mri in 6 months with return 2 him.
I think this is prob as gd a response as I could expect. What d’you think?
I concerned about the drugs. Loads of side effects possibl. Yr x e…
Feel a bit confused ad to what to feel… And think.

In theory you don’t need the lumbar puncture, but it will make things easier if it’s positive. If you have new symptoms between now and the 6 month appointment you can always ask your GP to ask for an earlier appointment (or phone the neuro’s secretary yourself and ask for one). If you have either new lesions or a new attack between now and the next appointment, your neuro should be able to diagnose MS when he sees you. Remember it’s only a label. It makes it easier to explain things to people and to get support, but your body doesn’t care what it’s labelled with - it will carry on regardless. So better to know, so you can take action and get to grips with it all.

Gabapentin is a commonly prescribed drug for MS. Although the side effect list is as long as your arm(!), most people find any side effects wear off after a few weeks as long as they take the increase in dose slow. (You should start on a low dose and then gradually build up to whatever the dose is that you need - we are all different, so we need different amounts.) If your side effects are bad, then you should stop taking it and ask for something different - there are alternatives.

Hth.

Karen x