Last reply 1 week ago
Brain lesion atrophy

Hi everyone

The results from a recent MRI showed no new lesions and that several existing lesions had faded.

I wasn’t sure how common ‘fading’ lesions are and how to interpret the implications. I came across this article reporting on a five and ten year study, which found that lesion atrophy is a better predictor of disability progression over the long term than new and/or enlarged lesions. That atrophied brain lesions are a more robust predictor of disability progression than whole brain atrophy https://multiplesclerosisnewstoday.com/2018/06/07/atrophy-brain-lesions-predicts-disability-ms-study-finds/

I’m unfamiliar with some of the terminology nuances and would be grateful for information and clarification that others might share. My questions are:

– Is fading used interchangeably with shrinking?
– Is lesion atrophy visible on an MRI?
– Is cerebrospinal fluid visible on MRI? The article mentions lesions being replaced by this.

The researchers suggest that accelerated volume of brain lesion atrophy might be a new imaging biomarker, which is very interesting.

I do have some worry that my ‘fading’ lesions’ might not be the good news I thought. I’m going to drop my neurologist a line, but interested in any information people might share in the meantime, or to hear from anyone who has also had fading lesions.

Thanks

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mamawals
1 week ago

Interesting article but I also don’t really understand it. Maybe someone on here can explain it? Does this mean lesions fading is a bad thing?

@beefree I have read that article many times and wondered many of the things you are wondering. How do you classify your ms? Ppms, rmms, spms? My sense is fading lesions with rmms seem like to be good. With longer term ppms more likely to be bad but this just a high level guess on how I interpret it.


beefree
1 week ago

Hi @mamawals, that is exactly what I’m wondering.

It could be that fading represents healing and remyelination. The difference between healing lesions and atrophying lesions is whether they turn into cerebrospinal fluid.

The method given in the published academic paper is “atrophied lesion volume was calculated by combining baseline lesion masks with follow-up SIENAX-derived cerebrospinal fluid partial volume maps” So the volume of lesions is determined at baseline and monitored but I’m not sure that the equipment and process used is what we can expect in annual check ins.

Does fading indicate the process of atrophying into cerebrospinal fluid, or is it clinically known to show demyelination? If the latter, fading is still our friend. If it is not certain, then we at least can’t take for granted that fading is a good thing.

Hi @californiadreamin, I’ve been diagnosed with rmms.

I was circling this too. It isn’t very clear. The article above says patients with rrms have the highest number of new lesions, while those with ppms have the most pronounced atrophy of brain lesions.

The researchers webpage clarifies that patients with progressive MS had the most accelerated rate of brain lesion atrophy, that the biomarker could be important for identifying the likelihood/occurrence of transitioning between relapsing and progressive MS (http://medicine.buffalo.edu/news_and_events/news.host.html/content/shared/smbs/news/2018/07/zivadinov-ms-brain-lesions-8803.detail.html)

Unhelpfully, it doesn’t say whether the study participants were on treatment or not.

I’d really like to get to the bottom of whether this fading might be brain lesion changing into cerebrospinal fluid. If it is, in the future when practice catches up, the implication might be that instead of disappearing lesions being good news, a change of medication is needed.


andysshere
1 week ago

hi thanks for the post . have read the article and now have changed my wish on hoping that my next scans show changes and no lesions to hoping there is no change . this is all very worring and confusing .


mamawals
1 week ago

Definitely very worrying. I had an MRI in The spring that showed several large active lesions. Went back recently and they have all shrunk and are hardly noticeable, but there are a bunch of new active ones. I was hoping at least the smaller, barely noticeable ones meant some sort of healing had occurred. Definitely need to ask my neurologist. Thank you so much for posting!


stumbler
1 week ago

arknat
1 week ago

@beefree,

I’ve seen this and was wondering about it myself. I thought fading lesions is a good thing but this piece doesn’t think so.

A recent MRI interpretation of my brain revealed unchanged lesions that are about 4 years old. The time when I was diagnosed. I asked my Neurologist for what he thought and he told me this ‘Lesions are basically bruises that heals and leaves a scar. You must have remyelenated underneath them else you would have had more serious issues than what I’m seeing now’

@stumbler, that was a good article, btw.


lightning87
1 week ago

I think I got new lesions just trying to understand that article 🙈😂


lightning87
1 week ago

I would take it as a good sign though @beefree stay positive. I’d had thought them fading would be the scars healing. You’ll read lots of different things suggesting the opposite – I think they just still do not know.

Xx


beefree
1 week ago

Thanks all for great comments and advice. And for the encouragement @arknat and @lightning87.

@andysshere and @mamawals, lesions disappearing can definitely also be a good thing. I guess until this article I hadn’t considered that it could be anything other than good. The article @stumbler shared helps with our conundrum. It suggests that lost tissue shows up as dark areas or black holes that can be picked up on a T1 weighted scan. I’m going to ask my neurologist about it, and about whether there were any dark spots. If I didn’t have a T1 weighted scan I might ask for one next time to put my mind at rest.

@stumbler, the article you shared had exactly the detail that was missing. I feel a lot better knowing that whether it is healed or lost, it is something that can be picked up on the MRI, rather than another item for limbo land. Thanks for that.


mamawals
1 week ago

Yes, my neurologist did discuss black holes last time I saw him, implying that they’re bad at least.


nutshell88
1 week ago

I panicked the same way you did once my neuro said i developed atrophy and they showed me
It was in 2014
And ive had MS for 14 yrs no treatment no disability and i have a job
I heard the news about atrophy when i was studying in the uk
My parents are strongly denying the results untill today

Personally i dont get relapses so often my MS is too polite to make a noise while eating my brain cells 😉


beefree
1 week ago

Hi @nutsehll88, your final sentence made me laugh out loud. My neurologist didn’t quite say that I have atrophy, but that some of the lesions had faded. I was taking a look at some recent studies to discuss what is known about whether fading lesions is a good thing, or indicative of lesion atrophy. And we potentially figured it out, although I’ll be checking it with my neurologist. That said, MS has most certainly been feasting on my brain.

It’s a shame that your parents are denying the results. I’ve lived in the Middle East and can imagine the situation. Do put your health first, whatever that means for you. My parents are good but there are things that I keep to myself too. You’ve got support here.

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