Q. Can scattered white matter lesion of unsure etiology be suspected for MS?

Answered by
Dr. Vivek Chail
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 01, 2020

Hello doctor,

The radiologist stated scattered white matter lesions but does not tell the location, or size. They state as unsure etiology or clinical significance. The ordering physician suspects MS due to symptoms like disorientation, incontinence, and body pain.

If the radiologist suspected MS would not they state the size and location? And diagnoses suspected disease or kind of lesion? Was this a poor report? Or was he basically not sure of what is going on? I leave it up to the ordering doctor. I have done blood for lupus, arthritis, Lyme disease, and complete blood test.



Welcome to icliniq.com.

The few scattered white matter lesions could mean that there are areas in the white matter of brain which are seen as small pinhead size on T2 and flair sequence. This is commonly from small vessel ischemic changes and is seen usually in older age and slightly uncommon in the young population. The cause is sometimes unknown.

Suspicion of MS (multiple sclerosis) is by diagnostic criteria and matching it with clinical examination. There is McDonalds criteria for imaging in MS and if the radiologist did not mention any findings which are under these criteria then it is unlikely to be MS from this scan. The criteria specify that the patient might require a subsequent MRI scan and the new scan is compared with the old one to make a probable diagnosis of MS in you.

It is clear that the findings are less likely to be from MS on this scan. Talking about radiologists, every person has their comfortable style of reporting and I feel mentioning the location of the larger white matter lesions would have been good for your ordering doctor. I will not say this is a poor report but surely it can be improved by providing the size and location of the larger white matter lesions.

I hope this helps.

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