Example MRIs with no new demyelination

Important observations underlined in bold

Participant: X5

MRI BRAIN W & W/O CONTRAST

Collected on March 19, 2011 12:43 PM

PROCEDURE: MRI brain with and without contrast

HISTORY: History of multiple sclerosis.

TECHNIQUE: MRI of the brain was performed with and without gadolinium according to the standard institutional protocol.

COMPARISON: MRI brain 02/06/2010

FINDINGS: There is no hydrocephalus. The basal cisterns are patent.

There are multiple patchy foci of T2/FLAIR hyperintensity in the periventricular, subcortical, and deep white matter which have a distribution and configuration consistent with the provided history of multiple sclerosis. Several of the periventricular lesions are oriented radially relative to the lateral ventricles and have an ovoid morphology. There is a T2/FLAIR hyperintense lesion periventricular white matter adjacent to the temporal horn of the right lateral ventricle. There has been interval development of a new T2/FLAIR hyperintense lesion in the right corona radiata. There is also a new T2/FLAIR hyperintense lesion in the right inferior cerebellar peduncle. A T2 hyperintense lesion in the left dorsal medulla is unchanged. There is a new T2 hyperintense lesion in the right lateral pons. A previously seen T2 hyperintense lesion in the right cerebellar hemisphere is less conspicuous than on previous examinations. A few of the lesions in the supratentorial white matter are associated with T1 hypointensity, suggesting chronicity.

There is no restricted diffusion. No pathologic enhancement is present. There is no mass effect, midline shift, or pathologic extra-axial fluid collection. The clivus, and craniocervical junction, and limited views of the sella are unremarkable. Expected major intracranial vascular flow voids are present. There is mild mucosal thickening involving scattered ethmoid air cells, greater on the left. There is trace mucosal thickening involving the maxillary sinuses.

IMPRESSION: Multiple T2/FLAIR hyperintense lesions in the supratentorial white matter, pons, right inferior cerebellar peduncle, and right cerebellar hemisphere are consistent with demyelinating plaques in this patient with history of multiple sclerosis. There are 3 new T2/FLAIR hyperintense lesions located in the right corona radiata, right hemipons, and right inferior cerebellar peduncle. A T2 hyperintense lesion in the right cerebellar hemisphere is less conspicuous than on previous examinations. No enhancing lesions are seen to suggest the presence of actively demyelinating plaque. The overall T2 lesion burden is moderate.

Participant: X5

MRI CERVICAL SPINE W/O & W CONTRAST

Collected on March 19, 2011 1:22 PM

Results

PROCEDURE: MRI cervical spine without and with contrast

HISTORY: Multiple sclerosis.

TECHNIQUE: MRI of the cervical spine was performed with and without gadolinium according to the standard institutional protocol.

COMPARISON: MRI cervical spine 02/06/2010, MRI cervical spine 06/27/2007

FINDINGS: Please refer to the separately reported MRI of the brain for details regarding T2 hyperintense lesions within the pons and medulla consistent with demyelinating plaques in this patient with history of multiple sclerosis. There is anatomic alignment of the cervical spine. Vertebral body heights are well-maintained. There is moderate loss of intervertebral disc height at the C5-C6 level and mild loss of intervertebral disc height at the C6-C7 level. There are minimal anterior osteophytes at the C5-C6 level. There is a T1 and T2 hypointense lesion within the anterior aspect of the C5 vertebral body on the right which is nonspecific but unchanged from June 2007 and most likely represents a bone island. No focal worrisome marrow signal abnormality is present. Small amount of increased T2 signal within the C5-C6 intervertebral disc is unchanged. The finding is nonspecific. Nonspecific mild enhancement at the C5-C6 intervertebral disc there is diminished from 02/06/2010. The spinal cord demonstrates a normal caliber. There is redemonstration of lesions demonstrating increased signal on proton density images at the C2, C2-C3, C3-C4 levels although these are less conspicuous than on previous examinations. There is a new proton density/STIR hyperintense lesion within the spinal cord at the C5 level. There may also be a new focus of increased proton-density signal in the left aspect of the spinal cord at the C7 level although this is not confirmed on other sequences. No enhancing lesions are seen within the cervical spinal cord to suggest the presence of actively demyelinating plaque. At the C2-C3 level, there is no spinal canal or neural foraminal stenosis. At the C3-C4 level, there is a small central disc protrusion but no spinal canal or neural foraminal stenosis. At the C4-C5 level, there is a posterior osteophyte-disc complex, mild bilateral uncinate hypertrophy, and mild right facet hypertrophy resulting in partial ventral effacement of the thecal sac but no significant spinal canal stenosis. At the C5-C6 level, there is a posterior osteophyte-disc complex, slightly asymmetrically prominent in the regions of the axillary recesses, and moderate bilateral uncinate hypertrophy as well as mild bilateral facet hypertrophy. There is mild spinal canal stenosis and mild bilateral neural foraminal stenosis. At the C6-C7 level, there is a posterior osteophyte-disc complex and bilateral uncinate hypertrophy resulting in mild spinal canal stenosis and mild left neural foraminal stenosis. At the C7-T1 level, there is no spinal canal or neural foraminal stenosis.

IMPRESSION: Multiple small lesions demonstrating increased T2 per proton density signal within the cervical spinal cord as described above including a new lesion demonstrating increased proton-density signal in the left aspect of the spinal cord at the C5 level and a possible mid focus of increased proton-density signal in the left aspect of the spinal cord at the C7 level are consistent with demyelinating plaques in this patient with history of multiple sclerosis. No enhancing lesions are seen to suggest the presence of actively demyelinating plaques. Multilevel degenerative changes in the cervical spine. Spinal canal stenosis is greatest at the C5-C6 level where it is mild. There is mild bilateral neural foraminal stenosis at that level.

Participant: X5

MRI BRAIN W & W/O CONTRAST

Collected on December 8, 2012 8:23 AM

Results

HISTORY: Relapsing remitting multiple sclerosis.

COMPARISON: MR 10/01/2011 Technique: Multiplanar multisequence MR images of the brain were obtained with and without contrast.

FINDINGS: Again noted and not significantly changed are innumerable foci of subcortical and periventricular white matter T2 prolongation in the frontal and parietal lobes and to a lesser extent the occipital and temporal periventricular regions. T2 prolongation is also again noted in the left dorsal midbrain and right dorsal medulla. There are no enhancing lesions seen. There is no evidence of pathological enhancement.

There is mucosal thickening throughout the paranasal sinuses and air-fluid levels within the maxillary sinuses. There is mucosal thickening throughout the middle ear cavities and mastoid air cells bilaterally.

CONCLUSION: Stable exam demonstrating innumerable nonenhancing foci of T2 hyperintense signal as described compatible with provided diagnosis of multiple sclerosis.

Participant: X5

MRI BRAIN W & W/O CONTRAST

Collected on December 8, 2012 8:23 AM

Results

HISTORY: Relapsing remitting multiple sclerosis.

COMPARISON: MR 10/01/2011 Technique: Multiplanar multisequence MR images of the brain were obtained with and without contrast.

CONCLUSION: Stable exam demonstrating innumerable nonenhancing foci of T2 hyperintense signal as described compatible with provided diagnosis of multiple sclerosis.

Participant: X5

MRI BRAIN W & W/O CONTRAST

Collected on February 28, 2015 7:43 AM

Results

CLINICAL HISTORY: MULTIPLE SCLEROSIS, RELAPSING-REMITTING

TECHNIQUE: MRI of the brain was performed without and with IV contrast.

CONTRAST: GADAVIST 7.5 ML COMPARISON: Prior examination dated 12/08/2012 brain

MR. FINDINGS:As demonstrated on the prior examination there are multifocal areas of abnormal altered signal involving the periventricular white matter and corpus callosum consistent with the patient's clinical history of multiple sclerosis. Medullary signal abnormality is again seen. There are no additional areas of pathologic contrast enhancement and there is no expanding intracranial mass. Ethmoid air cell inflammatory disease also seen.

IMPRESSION: Stable appearance of brain lesions most consistent with clinical history of multiple sclerosis. No new evidence of pathologic contrast enhancement.

Participant: X5

MRI BRAIN W & W/O CONTRAST

Collected on April 30, 2016 12:21 PM

Results

CLINICAL HISTORY: Multiple sclerosis.

TECHNIQUE: MRI of the brain before and after gadolinium: T1 sagittal, pregadolinium and postgadolinium T1-weighted axial, postgadolinium T1-weighted coronal, FLAIR sagittal and axial, T2, GRE and diffusion weighted axial MR images of the brain at 1.5 Tesla.

CONTRAST: GADAVIST 7.5 mL

COMPARISON: MRI of the brain 2/28/2015.

FINDINGS: No pathologic parenchymal enhancement or mass effect.

A left occipital periventricular lesion has decreased in size. Otherwise stable pattern of cerebral demyelination. Small lesions in the medulla are unchanged.

No hydrocephalus, midline shift, subdural fluid or acute infarct.

Trace fluid in the maxillary antra and mild maxillary and ethmoidal mucosal thickening, unchanged. Single opacified right mastoid air cell is also unchanged. Orbits are unremarkable.

IMPRESSION: A left occipital lesion has decreased in size. Otherwise stable pattern of chronic demyelination. No enhancing plaques.

Participant: X5

MRI CERVICAL SPINE W/O & W CONTRAST

Collected on April 30, 2016 12:21 PM

CLINICAL HISTORY: Multiple sclerosis.

TECHNIQUE: MRI of the cervical spine and before and after gadolinium: Pregadolinium and postgadolinium T1-weighted sagittal and axial, proton-density, STIR and T2-weighted sagittal and T2 weighted and/or GRE axial images of the cervical spine.

CONTRAST: Gadavist 7.5ml COMPARISON: MRI of the cervical spine 2/28/2015.

FINDINGS: There is motion artifact. This probably limits sensitivity and specificity of the exam. As on the previous scan, there are lesions along the ventral and lateral surfaces of the medulla. There is no pathologic enhancement in the cervical spinal cord.

A subtle area of increased T2 signal intensity in the left lateral column at the level of the base of the odontoid has not significantly changed. On some images, there is subtle increase T2 signal intensity at approximately level of C3-4 disc, which could be new. A lesion centered posteriorly to the left of midline in the spinal cord near the inferior aspect of C5 has not significantly changed.

Mild cervical spondylosis. As on the previous scan, there is marked loss of disc height at 7 and moderate loss of disc height at C5-6, with relatively mild loss of disc height at C4-5. Discs are desiccated.

Disc levels:

C2-3: No disc herniation or stenosis.

C3-4: Resolution of previously demonstrated left paracentral disc protrusion. No stenosis. Improvement in caliber of the spinal canal.

C4-5: Unchanged small posterior disc osteophyte complex. No stenosis.

C5-6: Posterior disc osteophyte complex and uncinate spurs with mild foraminal narrowing. No significant central stenosis.

C6-7: Posterior disc osteophyte complex and uncinate spurs, more prominent on the left. Mild to moderate left foraminal stenosis. Mild narrowing of the spinal canal. No significant right foraminal narrowing. No significant change.

C7-T1: No disc herniation or stenosis.

IMPRESSION:

Questionable subtle new spinal cord lesion at C3-4.
Lesions in the left lateral spinal cord at C2 and posterior spinal cord to the left of midline at C5 are unchanged.
No enhancing plaques.
Interval resolution of previously demonstrated small left paracentral disc protrusion at C3-4. Otherwise similar pattern of spondylosis.

Participant: X5

MRI BRAIN W & W/O CONTRAST

Collected on June 2, 2018 5:13 PM

Results

IMPRESSION: Stable pattern of chronic demyelination. No enhancing plaques.

Narrative

CLINICAL HISTORY: Multiple sclerosis, relapsing remitting.

CONTRAST: GADOBUTROL 1MMOL/ML IV SOLN: 8 mL

COMPARISON: MRI of the brain 04/30/2016.

FINDINGS: Stable pattern of chronic cerebral demyelination, with a small lesion in the ventral medulla also unchanged. No enhancing plaques. No acute infarct, regional mass effect, midline shift, hydrocephalus or subdural fluid. Clivus, craniocervical junction, pineal region and limited images of the sella are normal. Minimal paranasal sinus and mastoid inflammation. Unremarkable orbits.

Participant: X5

MRI CERVICAL SPINE W/O & W CONTRAST

Collected on June 2, 2018 3:55 PM

Results

IMPRESSION: Stable pattern of chronic demyelination in the cervical spinal cord. No enhancing plaques. Mild cervical spondylosis is unchanged.

Narrative

CLINICAL HISTORY: Multiple sclerosis, relapsing remitting.

CONTRAST: GADOBUTROL 1MMOL/ML IV SOLN: 8 mL

COMPARISON: MRI of the cervical spine 04/30/2016.

FINDINGS: Unchanged small nonenhancing lesions in the left side of the spinal cord at C2 and in the posterior left side of the spinal cord at C5. There are probable very subtle areas of increased signal in the spinal cord at C3 and C4, also probably unchanged. There is no pathologic spinal cord enhancement.

Mild spondylosis is again noted. There is marked loss of disc height at C6-7 and moderate to marked loss of disc height at C5-6 with no other significant loss of disc height. Discogenic endplate change is greatest at C6-7. No new disc herniation. As on the previous MRI, there are small posterior disc osteophyte complexes at C3-4, C4-5, C5-6 and C6-7, without significant central stenosis at these levels. Uncinate spurs result in mild to moderate left foraminal stenosis at C5-6 and C6-7.

articipant: X5

MRI BRAIN W & W/O CONTRAST

Collected on August 11, 2019 11:30 AM

Results

IMPRESSION: Stable exam demonstrating multiple nonenhancing foci T2 hyperintense signal in the supratentorial white matter compatible with multiple sclerosis.

Narrative

CLINICAL HISTORY: G35: Multiple sclerosis (CMS-HCC)

TECHNIQUE: MRI of the brain was performed without and with IV contrast.

CONTRAST: GADOBUTROL 1MMOL/ML IV SOLN: 7 mL

COMPARISON: MR 06/02/2018

FINDINGS:There is no interval change from the prior exam. Again noted are multiple punctate, patchy and linear foci of T2 hyperintense signal in the subcortical and periventricular white matter of the frontal, parietal, occipital and temporal lobes. There is T2 hyperintense: Muscle septal thickening. There are no new lesions. There are no enhancing lesions.

The major intracranial flow-voids are normal. There is no mass lesion, mass effect, hydrocephalus or midline shift.

MRI CERVICAL SPINE W/O & W CONTRAST

Collected on August 11, 2019 11:32 AM

Results

IMPRESSION: Stable exam demonstrating several nonenhancing foci T2 hyperintense signal in the cervical spinal cord compatible with chronic demyelination.

Narrative

CLINICAL HISTORY: G35: Multiple sclerosis (CMS-HCC)

TECHNIQUE: MRI of the cervical spine was performed without and with IV contrast.

CONTRAST: GADOBUTROL 1MMOL/ML IV SOLN: 7 mL

COMPARISON: MR 06/02/2018

FINDINGS: There is slight straightening of the normal cervical lordosis without spondylolisthesis. Vertebral body heights are maintained. There is loss of disc space height at C6-7. The bone marrow signal intensity, prevertebral soft tissues and foramen magnum are normal.

Again noted are nonenhancing foci T2 hyperintense signal in the spinal cord at C2 and C5 and possibly at C3 and C4 as before. No new lesions are seen.

C1-2: Unremarkable.

C2-3: Unremarkable.

C3-4: There is a mild disc bulge without stenosis.

C4-5:There is disc bulge and dorsal ligament thickening. There is mild spinal canal stenosis.

C5-6:There is a mild disc bulge without stenosis.

C6-7:There is a mild disc bulge without stenosis.

C7-T1: Unremarkable.

Participant: X5

MRI BRAIN W & W/O CONTRAST

Collected on September 27, 2021 1:42 PM

Results

IMPRESSION:

Stable supratentorial white matter signal abnormality, consistent with the given history of multiple sclerosis. Superimposed small vessel disease cannot be excluded. No enhancement to support active demyelination. No acute stroke.

Narrative

CLINICAL HISTORY: G35: Multiple sclerosis (CMS-HCC)

TECHNIQUE: MRI BRAIN W AND W/O CONTRAST

CONTRAST: GADOBUTROL 1MMOL/ML IV SOLN: 8 mL

COMPARISON: September 17, 2020 MRI brain. And others.

FINDINGS: Scattered small foci of hyperintense T2/FLAIR signal are reidentified involving the periventricular and subcortical white matter of both cerebral hemispheres. These findings are nonspecific but consistent with the given history of multiple sclerosis. Superimposed small vessel disease cannot be excluded. No restricted diffusion or gradient echo abnormality. Post contrast imaging shows no pathologic intracranial enhancement. The ventricles are midline and normal in volume. The basal cisterns are open. There are no abnormal extra-axial fluid collections. The arterial flow-voids at the base of skull are visualized, consistent with gross patency. Mild paranasal sinus mucosal thickening is seen. Small fluid levels in the maxillary sinuses bilaterally. Minimal scattered fluid signal in the mastoid air cells bilaterally. Sagittal imaging shows stable midline structures with demyelination reidentified in the corpus callosum.

Participant: X5

MRI CERVICAL SPINE W/O & W CONTRAST

Collected on September 27, 2021 1:51 PM

Results

IMPRESSION:

1. Within the limitations of moderate motion artifact, no new spinal cord signal abnormality or enhancement.

2. Stable spondylosis and degenerative disc disease, resulting in moderate left foraminal narrowing at C5/C6 and C6/C7.

Narrative

CLINICAL HISTORY: G35: Multiple sclerosis (CMS-HCC) TECHNIQUE: MRI CERVICAL SPINE W/O AND W CONTRAST CONTRAST: GADOBUTROL 1MMOL/ML IV SOLN: 8 mL COMPARISON: September 17, 2020. And others.

FINDINGS:

Study is moderately limited by motion artifact.

Normal alignment. Vertebral body heights are intact. Focal sclerosis is reidentified in the C5 vertebral body. Additional bone marrow heterogeneity is within normal limits. There is multilevel disc desiccation with stable moderate loss of disc height at C5/C6 and C6/C7. Ill-defined patchy hyperintense T2/PD signal in the spinal cord at the C5-T1 vertebral body levels is grossly unchanged. A small focus of hyperintense T2 signal is reidentified extending to the right dorsal aspect of the spinal cord at the C3/C4 disc level. Post contrast imaging shows no pathologic enhancement.

C2/C3: Stable minimal disc and osteophyte complex. No stenoses.

C3/C4: Stable small disc and osteophyte complex. No stenoses. C4/C5: Small disc and osteophyte complex, asymmetric toward the right. Stable mild right foraminal narrowing. No left foraminal narrowing or central stenoses.

C5/C6: Stable small disc and osteophyte complex. Stable moderate left foraminal narrowing. No right foraminal narrowing or central stenoses.

C6/C7: Stable moderate disc and osteophyte complex, resulting in moderate left foraminal narrowing. No right foraminal narrowing or central stenoses.

C7/T1: Normal. Sagittal imaging of the T1/T2 disc level is normal.