Should I be concerned about my level of atrophy?

​Here is My Question:
I'd like your opinion about the findings from my latest MRI. These are from the radiologist at the hospital, not my neurologist. I'd like to know how concerned I should be about the level of atrophy (I am a 52 yr old female) and whether I can interpret the note about imaging stability to indicate that my DMT (Ocrevus, started 2 yrs ago, about 9 months post diagnosis) is working. Also, does the location of the subtle T2 signal indicate what functions might be / become impaired? Here are the findings:
FINDINGS: The brain is mildly atrophic. There is no diffusion abnormality indicative of no acute ischemic infarct. Redemonstrated is subtle asymmetric hyperintense T2-FLAIR signal in the periventricular white matter of the left frontal lobe. There is no new signal abnormality. There is no evidence of acute or chronic extravascular blood products. There is no mass and no mass effect. Corpus callosum and pituitary gland have a normal appearance. Following gadolinium administration, there are no areas of abnormal enhancement. There is no cerebellar tonsillar ectopia with the craniovertebral junction normal. Orbital structures are unremarkable. Paranasal sinuses and mastoid air cells are clear.

IMPRESSION: MR imaging of the brain shows no acute neuroimaging finding with imaging stability when compared to the exam 26 months ago.

Answer:
It is hard to provide an opinion about an MRI based on a radiologists report. I can however provide some explanations

1. The radiologist could see no changes since the last scan 26 months ago. This is a qualitative judgement and generally means there has not been a big enough change for the eye to perceive.
2. The comment about mild atrophy is meaningless without quantitative measurement; mild compared to what? 
3. The report does not provide enough information about the location of “lesions” to make any comment regarding associated symptoms. Generally speaking there is little if any relationship between the location of “lesions” in the cerebrum (main part of the brain) and symptoms or exam findings

I would emphasize the lack of change over 26 months as good news.

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

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