Why do I need a second MRI?

Here is my question:
​I just had an MRI done two weeks ago. It was open MRI without contrast. When my GP got the result he told me he doesn't think that it's big deal. He was not agreeing with the radiologist. But I insisted to see a neurologist so I saw one last week. He checked on my reflexes then made me walk back and forth and told me no he also doesn't think that I have MS because the images and symptoms should match. He also told me that he'll take a look at my MRI and call me. After a day he called me to tell me to do another MRI with contrast this time. But still he told me people with headaches can have white spots. Here is my MRI result. Findings: Normal Configuration of the intracranial compartment and posterior fossa. There is no hydrocephalus, intracranial mass, hemorrhage, diffusion restriction or significant abnormality demonstrated extracranially. Several nonspecific punctuate FLAIR in distribution. In patients of this age, these are atypical, and could be inflammatory-infections, demyelinating, chronic migraine, vascular, and not completely excluding Vasculitis. Intracranial dominant flow-voids are identified in usual fashion. Impression: Tiny scattered frontoparieatal FLAIR hyperintensities are distributed largely peripheral. In a pationet of this age, with this MRI appearance, it could be due to variety of etiologies. Further work up is therefore recommended clinically. Further radiographic work up may include MRI using Gadavist, cervical MRI if indicate, and follow up MRI for stability advised. The thing is that I had headaches but I don't remember I had migraines. So how and why I got third spots I don't understand and how they can be normal. If they are nonspecific then why did he ask for a second MRI? I am 37 years old and based on my age both my doctor and the neurologist dismissed other possibilities that the radiologist suggested. My doctor ran many tests for inflammation and ANA test. ESR, C-receptive and many others and they all came back negative.

Answer:
Non specific T2 hyperintensities (white spots) of the type described in your MRI report are very common and usually of no consequence. They are often a marker of migraine, the most common neurological problem in the western hemisphere (estimated 25-30 million migraine patients in the US). They can occur before or after the onset of migraine and in people with very infrequent migraine symptoms. By the way migraine symptoms can include things other than headache.

MS is a clinical diagnosis associated with neurological symptoms and findings. MRI helps support the diagnosis of MS but is not a diagnostic of MS by any means in an individual without typical symptoms and findings.

Revere Kinkel MD
Director of the MS Program
University of California San Diego