Multiple Sclerosis and MRI: understanding 'new MRI activity'

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Multiple Sclerosis and MRI: In this video I answer the question: What exactly does “New MRI activity” mean?

New MS activity occurs one of two ways: either a new clinical attack (e.g. optic neuritis), or new MRI activity. So what exactly does that mean. It means there is a new or enlarged T2 lesions, or a new gad enhancing T1 lesions. OK…so what does THAT mean?

Let’s start by discussing lesions. When talking about MRI scans, the word “lesion” means “a spot.” Seriously, that’s what it means. We see a spot. Then we use other words to describe the lesion, like “T2 lesions” and “gad enhancing lesiosn”

Gad enhancing lesions reveal active CURRENT (ie. As in right now) inflammation in the brain or spinal cord. Lesions tell us that the lesions is new because they only enhance on average for 2-4 weeks (I explain this in a bit more depth in the video).

T2 bright lesions or T2 hyperintense lesions (spots) tell you where there has been inflammation at one time. Maybe it occurred the day after your last MRI, or maybe it’s new today. They are nonspecific to when the lesions occurred (unlike gad enhancing lesions). They typically can be seen for years to come, often for the life that person.

Common locations for MS T2 bright and gad enhancing lesions to show up in MS are:
1. Periventricular: touching the ventricular space in the center of the brain that contains spinal fluid
2. juxta cortical: found right at the junction between the grey matter and the white matter
3. Infratentorial: in the brainstem, or base of the brain (midbrain, pons, medulla, cerebellum)
4. Spinal cord: most commonly in the cervical spinal cord.

MRI is a very powerful tool to survey a given person with MS individual response to a DMT. If a follow up MRI reveals a new gad enhancing lesion, or a new T2 lesions, or an old T2 lesion that has gotten bigger, that’s BAD. And if it occurred despite taking a DMT, then we call that breakthrough disease activity. These findings should trigger a discussion about possible DMT escalation

Please leave your questions and comments below!

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Thanks Dr. Boster.

I'm grateful that MS hasn't taken a great toll on me as it does on other patients I meet or read about, but I'm concerned that this may change in the future. I'm finishing MBBS in two years and my memory function has been affected in many aspects. Although MS activity has been under control since I was started on IFN 1.5 years ago, I'm concerned that further decline in cognitive/physical function may affect my future career progression.

Would you recommend HSCT?

cementra
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I am very thankful that you are my MS neurologist. And I enjoy watching all your informative videos! 😊

ShannonEarthangelGem
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Thank you so much for this video. I just received my results from my follow-up brain MRI yesterday. I am so devastated 💔. I have been on Ocrevus for 2 years now.
This is what my MRI results just said.
- Interval worsening of the bilateral periventricular and subcortical white matter T2 hyperintense/T2 prolongation foci. The finding is consistent with the patient's history of Multiple Sclerosis.
Overall, there has been interval increase in the size and number of the lesions (plaques) when compared to the previous study. -
Also, my brain is atrophying again.
Awaiting appointment with my neurologist and I am just so devastated by these results 😢.
Thank you for this video it really helped me, Aaron, as I am trying to take this all in and try to wrap my mind around why my DMT Ocrevus failed💔!!!
I was on Aubagio from 2018 to 2022 before that failed...I went from 11 lesions on my brain to 30 plus...then they put me on Ocrevus and now that has failed. I am just heart broken 💔.

melindameler
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Very informative, I have nearly 50 lesions but I don’t recall any one in particular being talked about at my neurologists. I have I believe 7 in spine and to many to count in brain. Still walking and working . I often wonder when my luck will run out . Lemtrada patient 4 years post .

BR-djep
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Thank you for this easy to understand information which can help in formulating questions to Neuro team. I’m told very little information regarding my scans and don’t know why that is. Maybe that’s a question I should be asking. Thank you again. 🙏🏻 ❤️

newjersey
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I’m so glad you’re making these videos! I’m always full of questions & rarely enough time to get to them all. This really helps me decide which are most important. ❤️😎

msenitlifepattylong
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Very grateful for this information. Teaching hospital where my nuro is is very busy. I see them soon just want to not get confused

jcol
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How rare would it be to have numbness, tingling in limbs, face and some blurry vision and have brain and cervical spine show no demyelination?

jrubbo
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Thanks Aaron that is really useful, before Tysabri every MRI I had 'lit up like a Christmas tree' but since starting it just over a year ago the last two scans have shown no new activity which I'm over the moon about, thanks again for another great video.

wendymcclatchey
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Amazing as always! I'll have my doctorate degree soon if you keep this up. Hahaha have a great weekend Dr B

mattz
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Thank you for sharing #MSeducation and Awareness !!!!

squeegiedog
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Are MS lesions always bright on the MRI? Or only bright when indicating recent or active inflammation?

tburt
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Thanks it is informative.
@ 2:00
I have couple of questions:
Why did you call FLAIR T2 sequence?
If the lesion becomes bright because the water content why water disappeared in ventricles ?

aag
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Can Ms lesions be punctate hypertense in the deep subcortial white matter ? Or is that more of white matter disease areas thanks

MikeyIvers
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I have something called pseudoseizures are they really seizures?

aprilalaniz
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After how many breakthrough diseaee activities per year do you consider switching the immune modifying agent?

hosamazmy
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Excellent video, I wonder is it possible to have MS with a normal brain and spinal MRI? Does a small lesion load tell us anything about prognosis?

KoolKatie
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Can you see lesions without the contrast?

amberharris
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Hi Dr Boster. I have read a lot online about the contrast dye possibly staying in your system and causing some issues. Is this something i should be concerned about if im recommended to use the contrast dye during my next MRI

JamieS
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Can patient go for multiple brain mri within a week

sidrascooking