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What Does The Following MRI Report Indicate?
Question: I saw this report from a neurologist at the VA and my hypochondria spiked to an extreme level- this is what has been causing my severe anxiety surrounding MS. I was wonderinig if you could explain it in simpler terms:
Multiplanar multisequence MR imaging of the brain with and without intravenous contrast with 17 cc of Magnevist. No prior exam available for comparison. There is a 2 mm focus of magnetic susceptibility artfiact on gradiant-echo imaging in the anterior aspect of the left frontal lobes subcortical white matter near the vortex. This is dark in signal intensity on all other sequences and does not demonstrate any enhancement. Findings raise a possibility of a small amount of calcification though old blood products cannot be excluded. There is a 2-mm T2-weighted hyperintensity in the subcortical white matter of the posterior left frontal lobe and an adject 2-mm hyperintensity. A 4-mm hyperintensity is present in the subcortical white matter of the parietal lobe. None of these T-2 bright lesions are oriented perpendicular to the lateral ventricles. The corpus collosum is normal. The proximal cervical cord appears normal. No cerebral edema, mass, mass effect, or extra-axial fluid collection is present. Gray white matter differentiation is normal. The ventricles and sulci are normal in configuration. I see no evidennce of abnormal enhancement or restricted diffusion. A retention cyst is present in the right maxillary sinus. The usual vascular flow-voids are identified.
Impressions: Tiny focus of magnetic susceptibility artifact subcortical white matter left frontal lobe near vertex may be secondary to remote blood products or calcification. Brain CT without intravenous contrast might be useful for further differentiation. Nonspecific tiny foci of T-2 weighted hyperintensity each frontal lobe and left parietal lobe up to 4 mm in diameter. No abnormal enhancement or restricted diffusion.
Primary Diagnostic Code: No immediate attention required based on imaging findings
I don't really understand what any of this means. I know the article you sent me awhile back mentions high blood pressure as a major cause, but as far as I know my blood pressure has always been on the lower end. I don't believe I've had any mini-strokes, and I'm not that old. All I can think right now is MS. did have a motorcycle accident that left me unconscious for a period of time, and a car accident that also left me unconscious for a period of time (longer than 30 minutes)
Multiplanar multisequence MR imaging of the brain with and without intravenous contrast with 17 cc of Magnevist. No prior exam available for comparison. There is a 2 mm focus of magnetic susceptibility artfiact on gradiant-echo imaging in the anterior aspect of the left frontal lobes subcortical white matter near the vortex. This is dark in signal intensity on all other sequences and does not demonstrate any enhancement. Findings raise a possibility of a small amount of calcification though old blood products cannot be excluded. There is a 2-mm T2-weighted hyperintensity in the subcortical white matter of the posterior left frontal lobe and an adject 2-mm hyperintensity. A 4-mm hyperintensity is present in the subcortical white matter of the parietal lobe. None of these T-2 bright lesions are oriented perpendicular to the lateral ventricles. The corpus collosum is normal. The proximal cervical cord appears normal. No cerebral edema, mass, mass effect, or extra-axial fluid collection is present. Gray white matter differentiation is normal. The ventricles and sulci are normal in configuration. I see no evidennce of abnormal enhancement or restricted diffusion. A retention cyst is present in the right maxillary sinus. The usual vascular flow-voids are identified.
Impressions: Tiny focus of magnetic susceptibility artifact subcortical white matter left frontal lobe near vertex may be secondary to remote blood products or calcification. Brain CT without intravenous contrast might be useful for further differentiation. Nonspecific tiny foci of T-2 weighted hyperintensity each frontal lobe and left parietal lobe up to 4 mm in diameter. No abnormal enhancement or restricted diffusion.
Primary Diagnostic Code: No immediate attention required based on imaging findings
I don't really understand what any of this means. I know the article you sent me awhile back mentions high blood pressure as a major cause, but as far as I know my blood pressure has always been on the lower end. I don't believe I've had any mini-strokes, and I'm not that old. All I can think right now is MS. did have a motorcycle accident that left me unconscious for a period of time, and a car accident that also left me unconscious for a period of time (longer than 30 minutes)
Brief Answer:
Least possibility of MS
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
This is Dr.Vivek, Radiologist and I come across such findings commonly.
There is a 2 mm calcification or old bleed in the left frontal lobe anteriorly. This is not something you should worry about. However a CT scan will confirm that it is indeed a calcification. A 2 mm calcification is very small and cannot be classified. It might be from an old infection or trauma sustained.
There is mention of small T2 sequence hyperintensities in left frontal and parietal lobes. These are also very small and the pattern is unlikely that of MS which has typical findings. You need not worry if your clinical neurological examination is normal. Again, the areas are very small to say with confirmation the changes which have taken place.
Please do not worry for the MRI findings as they are of trivial nature at the moment but if you have progressive clinical symptoms then the MRI may need to be repeated at 6 or 12 months depending on your symptoms.
Hope your query is answered.
Do write back if you have nay doubts.
Regards,
Dr.Vivek
Least possibility of MS
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
This is Dr.Vivek, Radiologist and I come across such findings commonly.
There is a 2 mm calcification or old bleed in the left frontal lobe anteriorly. This is not something you should worry about. However a CT scan will confirm that it is indeed a calcification. A 2 mm calcification is very small and cannot be classified. It might be from an old infection or trauma sustained.
There is mention of small T2 sequence hyperintensities in left frontal and parietal lobes. These are also very small and the pattern is unlikely that of MS which has typical findings. You need not worry if your clinical neurological examination is normal. Again, the areas are very small to say with confirmation the changes which have taken place.
Please do not worry for the MRI findings as they are of trivial nature at the moment but if you have progressive clinical symptoms then the MRI may need to be repeated at 6 or 12 months depending on your symptoms.
Hope your query is answered.
Do write back if you have nay doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your response. What could cause such findings? I had two concussions and initially got an MRI because I was having headaches after the first concussion. My blood pressure had always been on the lower side (110/70). I am so concerned I guess because I don't understand why the spots are there and if they indicate something sinister. Every neurological exam I have ever had ( and there have been a lot) were normal. I had normal visual and somatosensory evoked potentials. The doctor refused to perform a spinal tap. Could they be incidental or is their presence definitely indicative of something bad?
Brief Answer:
Answer in details given below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
The 2 mm suspected calcification may be confirmed by CT scan which can be due to old healed parasitic infection. As the examinations have been normal, there is no need to worry. Concussions are mildest form of brain injury which do not have any structural changes. It is less likely to be an old bleed. Anyways 2 mm is very small in measurement to worry about without any clinical problems.
The T2 hyperintense spots 4 mm and 2 mm cannot be explained or related to any clinical reason, incidental findings. Sometimes these are most likely due to very small vessel ischemic changes which are usually seen after middle age. Either way in the absence of clinical symptoms, there is no further intervention required.
Hope your query is answered.
Do write back if you have nay doubts.
Regards,
Dr.Vivek
Answer in details given below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
The 2 mm suspected calcification may be confirmed by CT scan which can be due to old healed parasitic infection. As the examinations have been normal, there is no need to worry. Concussions are mildest form of brain injury which do not have any structural changes. It is less likely to be an old bleed. Anyways 2 mm is very small in measurement to worry about without any clinical problems.
The T2 hyperintense spots 4 mm and 2 mm cannot be explained or related to any clinical reason, incidental findings. Sometimes these are most likely due to very small vessel ischemic changes which are usually seen after middle age. Either way in the absence of clinical symptoms, there is no further intervention required.
Hope your query is answered.
Do write back if you have nay doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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