Is my neurologist confused?

Here is My Question:
Is my neurologist confused? When my neurologist looked at my MRI he advised me that my MS was not active. When asked about my spine, he replied all was good but the radiologist were not sure. So I asked him again if it was not active and his response was again they were not certain. My diagnosis of my MRI 3 yrs before my recent one, was indeed just in my brain. Now I am wondering if in fact it is also in my spine? Can a Neurologist be confused????

Answer:
There is always a level of uncertainty about the outcome of any test in medicine. This uncertainty can exist on several levels

1. The test may have a high degree of normal variability in a population and is not very specific for any condition. A physician who does not take this into consideration may use the test incorrectly and create confusion regarding the diagnosis.

2. There can be technical limitations of a test. For instance, adequate interpretation of an MRI scan can be limited by artifacts from movement, pulsation or metal objects. This is particularly a problem when trying to interpret an MRI of the spinal cord. A poorly trained observer may interpret and artifact as an MS lesion or vice versa.

3. The test is obtained in the wrong population and interpreted incorrectly. For instance, white spots on an MRI in a elderly patient rarely means MS but is more often (but not always) associated with MS in people under 35.

The bottom line is that MRIs must be interpreted by experienced individuals and the interpretation must take into account an expert clinical evaluation.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego