Wednesday, January 30, 2013

Setting the record straight on my MRI this is one part public service announcement and one part making sure I've got my act together!

For some reason, I always want to think there are a "couple" of pits left in my spine.  I was looking through my last MRI, and there are five.  So in order for me to remember this important fact, I'm making a post on it.

The public service announcement is what I've learned about MRIs and how to read the report.  So I'm going to put mine up here and say what I think it means.  :)   The italics are my comments.


MR OF THE SPINE AND PELVIS  I got out of a full body one this time, saving me some time in the machine

MR TECHNIQUE: Sagittal T1 and STIR weighted studies of the entire spine and coronal T1 and STIR weighted studies of the pelvia.    Sagittal refers to the plane of the scan, as does coronal.  T1 and STIR are different types of scans.  My understanding is that the T1 has higher image quality, and STIR causes any lesions to stand out more prominently, so the two are used together.

COMPARISON STUDY: MRI of the spine and pelvis of 4/9/12  Obviously we're looking at how things change over time


STIR weighted studies of the spine and pelvis demonstrate a hypo to isointense marrow in relation to adjacent muscles.  On T1 weighted sequence, the marrow is hyperintense in relation to disc interspace.  Signal intensity is heterogenous on STIR weighted study and homogenous on T1-weighted studies.

Well this one is a mouthful.  There are three ways to describe the intensity of marrow relative to nearby muscles: hypointense (there is less of it), hyperintense (there is more of it) and isointense (it's the same signal strength as the muscles).  Because the T1 scan reacts more strongly to the presence of water in the body, it makes things look more hyperintense so the STIR study is the more important one to go by. According to this, I have hypo to isointense marrow, which means there ain't as much of it yet as a normal person would have, I think.  Probably not surprising since normal people haven't had their bone marrow totally destroyed twice by high dose chemotherapy, and then suppressed on a drug cocktail for three years.  :)

The other vector here is homogeneity (all the marrow is distributed the same) versus heterogeneity (it is more splotchy).  I'm homogenous on T1 but heterogenous on STIR; I'm not sure what that means although perhaps it means I'm not quite normal but getting there, in terms of distribution of the marrow.

In the cervical spine, heterogenous marrow is identified with no distinct focal lesion noted.  Degenerative disc changes at C5-6 and C6-7 is noted with disc protrusion as identified at C5-6 and C6-7 unchanged from the previous study.

These discs were on their way to being destroyed by the myeloma, but we got to them before they broke.  So they're a little tweaked but should be okay.  The marrow, again, is heterogenous -- MM attacks the spine in many cases and I was no exception -- it was active in a lot of places in the spine.  We'll eventually want the marrow to be homogenous here, I think.  C5-6 and C6-7 refer to the cervical vertebrae -- these are the 7 vertebrae beginning with C1 at the base of the skull and continuing down through the neck.

In the thoracic spine, small focal areas of hyperintensity involving the vertebral bodies of T2, T3 and T4 are again seen.  Fracture with vertebroplasty changes at T4 is again identified.  Vertebroplasty changes at T11 remain stable.  Focal areas of hyperintensity involving T10 and T12 are again identified.

These are the thoracic vertebrae and they run from the middle of the neck down through the back. Here, I have some patchy marrow (the hyperintense areas haven't recovered) and we see two of my repaired vertebrae and T4, and T11.  There are focal areas at T2, T3, T4, T10 and T12.  So five small spots that are still here.  They don't specify the size -- the time before they had been identified as 4mm or so.  

In the lumbar spine, no new focal lesions are identified.  Fractures of vertebroplasty changes at L3 and L4 are again seen.

The other two broken vertebrae are in my lumbar region, at the bottom of the back.  So that's a total of four repaired vertebrae.

In the pelvis, a slightly heterogenous marrow is noted without distinct focal lesions.  No evidence for avascular necrosis of the femoral heads are identified.

So again, the marrow is a little patchy here, but there are no remaining focal lesions.  This is good -- I had an 8cm lesion here at one point!  Avascular necrosis is bone death from a lack of blood flow that can be caused, it is believed, by chemotherapy.  So I'm glad they checked it, and I'm glad I don't have it!


1.  Hypointense heterogenous bone marrow on STIR weighted studies.   I need more marrow, more evenly distributed, for this all to look normal.  How much is due to the Myeloma versus the treatment is unclear -- I suspect mostly the latter.

2.  Stable small focal lesions of T2, T3, T4, T10, T12 vertebral bodies.   This is the part I don't like.  Five of them, and they are stable -- meaning they didn't shrink from the last scan six months before.  This is what BB wants to go away.

3.  Stable vertebroplasty changes at T3 and T11 vertebral bodies.   They didn't sum up the lumbar ones...I wonder why?  I also wonder about the "fractures" reference -- is the vertebroplasty fracturing?  Or is this simply because those vertebrae had actually fractured before the vertebroplasty was done there, whereas in T3 and T11 they damage was caught before the bones actually broke.  Hmm....something to ask somebody about.

4.  No evidence for avascular necrosis of the femoral heads are identified.  Whoopee!!  :)

So there you have it, folks, the readout of an MRI.  And I have a reminder that I have FIVE lesions that I want to see fully resolve.