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As the intervertebral disc degenerates, the normal white signal darkens (figure B) and narrows (figure C). MS lesions can appear in both the brains white and gray matter. Disc Bulge/ Annular fissures Disc Herniation/ etc . Is the ketogenic diet right for autoimmune conditions? 7 Foods That Support Brain Health, According to a Dietitian. A 23-year-old female asked: Is it normal for a mri to show white spots on spine not the spinal cord but by the discs in between them Dr. Daniel Clayton answered Specializes in Neurosurgery It can be: It is difficult to answer this without seeing the MRI or at least knowing more about the MRI. The facets are the joints in the back that help the spine move. Surprisingly, severe central or foraminal stenosis can be asymptomatic. Some injectable treatments include interferon beta-1a, interferon beta-1b, and glatiramer acetate. That being said, more than 20 percent of patients in the no back pain group were found to have at least one high-intensity zone during the imaging exam, so being pain free doesnt necessarily mean you are also high-intensity zone free. However, the longer a person goes without developing a lesion, the more important it is for a doctor to rule out other conditions. For resources, research, and news for people living with MS, visit our dedicated MS hub. People with primary progressive MS (PPMS) tend to have fewer brain lesions, and the lesions tend to contain fewer inflammatory cells. The way we accurately treat patients is by correlating their symptoms to specific changes in their MRI. There are no known risks associated with exposure to these types of strong magnetic fields. C.T of the Lumbar Spine. Our team will be in touch within 24 to 48 hours Mon-Fri (but often much quicker), The Future is Now with Regenerative Medicine, How To Read An MRI of the Lumbar Spine Introduction. We avoid using tertiary references. Infusion medications include Tysabri, Ocrevus, and Lemtrada. We know that about 350,000 people in the United States have MS, about 1 in 1,000 people. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Clinically-Isolated-Syndrome-(CIS), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141305/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5353226/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7583110/, http://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-MS, https://www.ncbi.nlm.nih.gov/books/NBK482487/, https://www.nationalmssociety.org/Treating-MS/Managing-Relapses, http://www.nationalmssociety.org/Treating-MS/Medications, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477770/, http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms, https://rarediseases.org/rare-diseases/neuromyelitis-optica/, https://www.va.gov/MS/Veterans/about_MS/Understanding_Your_MRI_Report.asp, https://my-ms.org/anatomy_spine_damage.htm#:~:text=Paralysis%20and%20loss%20of%20sensation,and%20in%20the%20upper%20arms, https://www.ncbi.nlm.nih.gov/books/NBK499849/, https://www.nationalmssociety.org/What-is-MS/Types-of-MS. Best food forward: Are algae the future of sustainable nutrition? We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. New or expanding lesions captured by a T-1 scan might indicate that a persons MS is worsening. We no longer use the term annular tear as trauma or external injury has not been associated with them. They can also get worse if your risk factors for strokes aren't treated,leading to more lesions on the brain. Avoiding very heavy meals may help. Again, many patients may have even large herniations, without nerve inflammation, and therefore no symptoms. An MRI can show where MS has damaged the myelin sheath because the fat is stripped away in those areas. In any case, it can be treated. The spine specialist should review the actual images with you and answer any questions you have about your report. Policy. CIS causes numerous MS-like neurological symptoms that in many cases are precursors to the development of full MS. About 50% of people diagnosed with RIS go on to develop MS within 10 years. These two terms refer to bones slipping over one another. Low back pain is one of the most common diseases in the United States. Bladder problems in MS may range from being a nuisance to being a major problem that needs to be addressed. Its imperative that you discuss the MRI report with a spine specialist to see which, if any, of these findings, are important and need to be addressed. In fact, large bone spurs/ osteophytes may stabilize the spine and autofuse a spinal level. Spine Injections- Part 4- Facet-Directed Cervical Injections, Spine Injections- Part 3- Cervical Epidural Injections, Spine Injections Part 2 Facet-directed Lumbar Injections, Spine Injections Part 1 Lumbar Epidural Injections, Happy Holidays and Happy New Year from Rocky Mountain Brain and Spine. Very often the lesions themselves don't cause any noticeable problems. Weidauer S, Wagner M, Hattingen E. White Matter Lesions in Adults a Differential Diagnostic Approach. Cardiovascular health: Insomnia linked to greater risk of heart attack. Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. 2023 Dr. Stefano Sinicropi The information contained on this site is intended to provide only general education about spine surgery and conditions. In addition, identify the space between the vertebral bodies for the intervertebral discs. Medication may help with this. You can't always prevent white spots on the brain but there are some steps you can take to protect your brain. In MS, patients develop various areas in the brain and spinal cord where the myelin is stripped off of the nerves. Neurologists will occasionally use gadolinium, a heavy metal dye, to look at the brain more carefully. Extrusions described a tear in the disc wall in which the fluid squeezes out into the central canal (figure E). The most important anatomical parts of the sagittal and axial images of a normal MRI lumbar spine are pictured below. Signs of vision loss or other symptoms that may be the result of neuromyelitis optica include: Lesions on the spine and brain indicate damage to the myelin that protects nerve cells. Two Basic MRI of the Lumbar Spine Images (T1 AND T2 Images), Basic Anatomy of How to Read an MRI Lumbar Spine, How to Read an MRI Lumbar Spine in 8 Steps, 1. However, many neurologists will repeat an MRI about a year after starting treatment for MS, or when there are unexplained changes in the patient's course that make it important to take another look. However, this is not a cure, and it cannot prevent the symptoms from returning. As a result, I can only offer a few possibilities in general for things in the neck that are round and bright on some sequences for MRI--this is not to say those are what you are seeing. A small disc herniation (figure C) may not produce symptoms. Spinal fluid helps to diagnose other diseases such as Lyme disease and lymphomas of the nervous system. The S1 nerve to the outside and bottom of the foot. An international panel of experts developed a classification of MS in 1999 that most neurologists use today: The term, "benign MS," is not part of the international classification. There may be a loss of brain or spinal cord volume, a change which is called atrophy. This slows down the nerves impulses, causing symptoms that may either worsen steadily (known as progressive) or come and go (known as relapsing-remitting). When your doctor takes an MRI of your spine and sees one or more white spots in your spinal discs, they diagnose them as spinal high-intensity zones. The information contained herein is subject to change without notice. This may represent musculoskeletal pain or persistent abnormal signal from nerves that may have been divided during the surgery. This is not true for most people with MS. A recent study of people with MS in the Olmstead county area near the Mayo clinic showed that most people did well even without treatment. 5 Look at the space available for your nerves. In its early stages, it can be easily mistaken for MS due to similarities in symptoms. A person living with MS may have lesions in parts of the brain, spinal cord, or optic nerve. Let your doctor interpret it . We do not endorse non-Cleveland Clinic products or services. Is the ketogenic diet right for autoimmune conditions? These actions help to strengthen our spine and prevent us from overloading certain spinal segments. Some people develop back or neck pain, similar to the pain that many other people get. The MRI is very useful in ruling out many other disorders that could be confused with MS, and the blood tests and spinal fluid may also be helpful in diagnosing other diseases. These are also known as black holes or hypointense lesions. The pattern of T1 lesions with contrast changes from month to month. In some scenarios, surgery may be beneficial. The L1 and L2 nerves tend to go to the groin region. neuro says white spots benign, but what exactly causes them? Multiple sclerosis is a long-term disease that attacks the central nervous system. A contrast MRI can help doctors discover if there are active lesions. Damage to the Corona Radiata After Stroke, Understanding Migraine-Related Brain Lesions on Your MRI, Diagnosing Primary Progressive Multiple Sclerosis, What It Means If You Have a Silent Stroke, How Radiology Is Used to Diagnose Multiple Sclerosis. It causes the immune system to attack and destroy myelin protective fatty tissue that surrounds nerve cells. While patients with spasticity may be weak, the two are not the same, and strength may be preserved in someone with spasticity. It is possible that a person may not have lesions on either the spine or brain during their initial diagnosis. While we try to limit ordering MRIs for everyone with low back or leg pain until the symptoms are persistent for weeks to months, conservative options such as physical therapy have failed or weakness/ numbness develops, many people have MRIs. With a fracture of the end plate, degenerative disc disease occurs as the fluid within the disc leaks out. A person with clinically isolated syndrome (CIS) is experiencing the first episode of symptoms that occur due to inflammation and demyelination in the central nervous system. The powerful magnet combines with computer-generated radio waves to create detailed images of the bodys soft tissue and organs. A healthcare professional places a padded covering partially over the persons head to help keep it from moving during the scan. A silent stroke may not cause symptoms if you have enough healthy brain function to make up for the small area of brain damage. Treatment may include prescription medications, surgery, or lifestyle strategies to build a healthier brain, such as a nutritious diet and exercise. Generally, the lesions remain bright for only 1-2 months. . on last echo doc said he see a bright area in septal.. i am 90%recovered. The two facets are the two back legs. Tonic spasms are a tightening of limbs in place. Find out more about MS, including what. MS varies from patient to patient so that each individual has their own set of symptoms, problems, and their own course. I assume your doctor has sat down with you to discuss the results of your mri? Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. of their symptoms and the treatment options. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. pjr. Hi everybody. Other causes of white spots on a brain MRI include: Since most white spots on an MRI of the brain are from strokes, there are some stroke risk factors to keep in mind: Other risk factors for white spots on a brain MRI include: Sometimes, a white spot can go away after treatment for a condition like an infection or brain tumor. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. It causes the immune system to attack the protective layer of fat, called the myelin sheath, around nerve cells in the brain and spinal cord. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. The following are answers to some commonly asked questions. RFo - Fortschritte auf dem Gebiet der Rntgenstrahlen und der bildgebenden Verfahren. If youve recently undergone an MRI of your spine, your doctor may mention that you have one or more high-intensity zones in your back. My arm has been hurting since July. What You Should Know About White Spots On Your Spine MRI Sohrab Gollogly, MD is a board-certified orthopedic surgeon and Fellowship-trained spine surgeon who also performs scientific research and participates in several volunteer surgical organizations. To avoid misdiagnosis, a persons doctor will need to follow clinical guidelines to diagnose MS. 2017;120(3):472-495. doi:10.1161/CIRCRESAHA.116.308398, Beecham A, Dong C, Wright CB, et al. I did. Some people with MS will have problems with bladder function due to injury to the nerves that tell the bladder and the sphincters what to do and to the nerves that help the bladder sense when it is full. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. White spots on your MRI can show up even if you have no symptoms of illness. Some people think extrusion implies a more significant entity, but this is not necessarily true. Fluid-attenuated inversion recovery imaging reduces interference from the spinal fluid to help view the effects of MS. Working with your healthcare provider can help you understand your brain MRI findings and create a treatment plan to address the underlying cause of the white spots and prevent more from occurring. We will not send you spam. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Healthcare professionals use MRI scans to confirm a suspected diagnosis of MS. These foraminal canals allow individual nerve roots to exit from the spine. Studies have shown that about 30% of completely pain-free (asymptomatic) people undergoing a lumbar MRI have abnormalities detected. In most cases, there is a history of neurological symptoms that come and go over years. This process, called demyelination, forms lesions in areas of the central nervous system, including parts of the brain and spinal cord. In the past, physicians thought that MS did not cause pain. Each of these things may happen and not cause any symptoms. The spine is essentially a three-legged table. can put finger on sore spot? Learn more. No two people have the same combination of MS symptoms. Dr. Sinicropi performs surgery in the following Minnesota cities: Edina, Burnsville, Roseville, Woodbury, Maplewood, Stillwater. Thank you, {{form.email}}, for signing up. In a typical fatty myelin sheath, the areas hold more water. Multiple sclerosis (MS) is a central nervous system disorder-that is, it affects the brain and spinal cord and spares the nerves and muscles that leave the spinal cord. is this significient? Pain is not specifically been linked to this condition. There is evidence that having infections makes having an exacerbation of MS more likely. These white spots may indicate a cause for concern, including strokes or multiple sclerosis (MS). Typical lesions that appear on a T-2 scan are oval in shape. In addition, the findings suggest that spinal cord involvement predicts worse neurological outcomes. Can poor sleep impact your weight loss goals? Patients are at risk of a pinched or irritated nerve with a disc herniation in the narrow foramen compared with the larger central canal. While fatigue in MS can be due to a lack of sleep or poor sleep, it is often just one of the symptoms of MS. What are the white spots on my MRI? The spots may also temporarily get smaller and worsen later. Secondary progressive MS (SPMS) is a form of MS that can occur in people who have had RRMS, and it features a general worsening of symptoms over time. The cervical region is the upper part of the spine found in the neck. Lesions show up as white or dark spots . If the disc herniation material remains viscous, it may disappear as seen in the picture below. This event may affect any aspect of central nervous system functioning, causing symptoms. Just like x-ray films and three dimensional x-rays called computed tomography (CT), MRIs are a great addition in the field of radiology. Other risk factors for white spots include getting older, race/ethnicity, genetics, obesity, diabetes, hypertension, and high cholesterol. T-1 scans can involve the use of gadolinium, which is a contrast dye, to look for new or growing lesions. Typical MS lesions tend to be oval or frame shaped. The lumbar spine consists of bones (usually five vertebral bodies) stacked on top of each other and separated by five discs. Magnetic resonance imaging (MRI). As we get older, changes occur naturally in the spine. This is often the case with chronic inflammatory conditions such as lupus or MS that flare up and then improve. This may, or may not, cause pain in the legs or back. You can learn more about how we ensure our content is accurate and current by reading our. Just as with disc bulges, these are very common and not typically a cause of symptoms in the lumbar spine. A person undergoing a scan will receive earplugs or earphones to help muffle the noise. Over time, a lumbar disc degenerates by first developing a disc bulge or bulging disc and/or an annular tear. CIS does not always progress to another form of MS. In the middle of my spine one thoracic vertebrae shows a bright white spot in the bone of the vertebra itself that last for three or four cross sections of the scan. Spasticity may be painful and may interfere with walking, transferring, and sitting; in general, this is when spasticity is treated. The technician obtains the scan using a large, tube-shaped magnet. These assessments do not indicate that Dr. Sinicropi has performed these specific surgeries. It is a demyelinating disorder because the myelin sheath that protects nerves is stripped off during inflammation. Other diagnostic tests may be used to determine the number of spots, their size and appearance, and their location in the brain. Axial MRIs allow you to see more detail of the nerve canal and nerves traveling down to your legs. In summary, the MRI findings do not determine whether or not symptoms are occurring. http://neurology.about.com/od/cerebrovascular/a/What-Are-These-Spots-On-My-MRI.htm Doctors can use distinguishing features of neuromyelitis optica to rule out MS or vice versa. The spots (called lesions) on the scan are areas of active inflammation. I think Alzheimer's causes plaques, which I think are spots, but you are probably much too young for that. A disc herniation can be either a protrusion or extrusion. While a persons symptoms become more severe, MRI scans will not tend to show an increase or growth in inflammation. Son Gncelleme : 26 ubat 2023 - 6:36. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. 2023 Rocky Mountain Brain & Spine Institute. Everywhere in the spine the bones should be aligned. MS lesions may appear as either areas of gray, white, or black spots on an MRI, depending on whether they are new or old. As they shrink, the discs begin to bulge into the central spinal canal. So are age spots. In MS, the MRI may not make the diagnosis, as sometimes the changes are not specific for MS. Other times the appearance may be characteristic of MS. Evoked potentials are tests where different sets of nerves are stimulated, and the activity of the brain, spinal cord, or nerves is measured electrically. This can also occur from a fracture, either congenitally or from trauma. The way we accurately treat patients is by correlating their symptoms to specific changes in their MRI. For potential or actual medical emergencies, immediately call 911 or your local emergency service. It is possible that a person diagnosed with MS may have lesions on their brain but not on their spine. This can lead to narrowing of the disc space or bone on bone changes, however, this occurs in every person and this is not necessarily a cause of any symptoms. When your doctor takes an MRI of your spine and sees one or more white spots in your spinal discs, they diagnose them as spinal high-intensity zones. This imaging system opens a whole new way to look for abnormalities that may be the cause of low back pain, sciatica or leg pain. The Central Canal in the MRI Lumbar Spine. Fatigue, a sensation of being tired all the time, is very common in MS. Neuroscience Group 1.47K subscribers 335 71K views 8 years ago Nurse Practitioner, Penny Bernards, discusses what white spots on your brain detected. Visual evoked potentials are done by flashing a checkerboard image in front of the patient and recording the brain's response at the back of the head. A persons symptoms depend on where MS lesions develop. As we age, the ligaments holding the bones in place can loosen and allow the bones to slip. They also tend to have more lesions in the spinal cord than people with other forms of MS. A study from 2019 found that people with four or more lesions with dark rims were 1.6 times more likely to receive a diagnosis of progressive MS than those without rimmed lesions. MS is an inflammatory disorder in which infection-fighting white blood cells enter the nervous system and cause injury. Multiple sclerosis is a long-term disease that attacks the central nervous system. These areas are called plaques or sometimes lesions. We know that it is more common further north and south of the equator. MS causes the immune system to attack the myelin sheath that surrounds the brain and spinal cord. There are two basic types of MRI images that differ by the timing of the radiofrequency pulses, named T1-weighted images and T2-weighted images. Understanding multiple sclerosis, its symptoms, and how it can progress helps people to assess themselves for this condition. The disc is the largest leg in the front. Also, a persons symptoms can change from day to day or from flare-up to flare-up. In step 3, look at the alignment of the posterior borders of the five vertebral bodies (red line shown below). It is not contagious, nor is it infectious. Initial symptoms could involve unexplained weakness and sensory changes. Their function is to support and protect the delicate nerves that pass through to the pelvis and lower legs. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. In MS, the immune system attacks and damages the protective myelin coating that surrounds the nerves. Not everyone needs a lumbar puncture, but it can be very useful. Similarly, some patients may develop transient symptoms lasting only seconds such as twitching in an arm or a leg. The images produced allow doctors to see lesions in your CNS. The discs tend to lose their water content (desiccate). Identify the middle of the central canal where the spinal cord and nerves float in the protective cerebral spinal fluid (CSF). White spots on a brain MRI are not always a reason to worry. The ligamentum flavum is a tissue just behind the nerve sac. Clinic Locations. Making sure that night-time sleep is good is also useful. A persons MRI can appear fairly normal and they can be in terrible pain or even have weakness and/ or numbness. According to some researchers, chronic active lesions are very damaging to the brain. A person with MS may expect to have routine monitoring of their condition every 312 months. An older study showed that after 25 years without treatment most people were still able to walk. There are various ways a person can manage spasticity. If you think you may have a medical emergency or a major medical problem, call your doctor or 911 immediately. T2/FLAIR Many of these symptoms can be treated either with medication or with approaches such as self-catheterization, which allows the bladder to be emptied whenever it needs to be. Some research suggests that RRMS tends to cause the highest number of new lesions among MS types. Whats important to remember is that the report is made by a radiologist (a physician specifically trained to review these images) who reports everything observed. is this normal and what causes this? Some people with MS have a stable condition, others experience symptoms that worsen rapidly, while some have symptoms that resolve spontaneously. Both conditions can cause: myelitis swelling and inflammation on the spinal cord; and optic neuritis inflammation of the optic nerve that disrupts vision. Low back and leg pain can be caused by a spine problem such as a bone spur or disc herniation, but can also be caused by hip problems, pelvic problems, kidney problems, muscle problems or unknown reasons. Mri showed white spots, suspected ms, but spinal tap normal. sharp pain in buttocks 3" to the right. However all, none or some of these findings may explain your symptoms. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. thank you. Fortunately, some treatments can prevent up to 90% of these lesions from forming. Best food forward: Are algae the future of sustainable nutrition? There are many possible causes, including vitamin deficiencies, infections, migraines, and strokes. Learn more here. I have hypogammagobulinanemia, and a very week immune system. Some patients may get burning or tingling pain in the legs, arms, or body which may stay or come and go. T2 images highlight WATER >> FAT within tissues. It is used when people have had MS for many years without developing significant measurable disability. Circ Res. Cardiovascular health: Insomnia linked to greater risk of heart attack. Clinically isolated syndrome (CIS). Before undergoing an MRI scan, a person needs to remove any clothing or personal items that may contain metal. The L3 nerve to the front of the thigh. Genome-wide scan in Hispanics highlights candidate loci for brain white matter hyperintensities. Disruption of that smooth line by the vertebral bodies is a result of wear-in-tear of the bone, ligament or discs. Auditory evoked responses are stimulated with a clicking noise in the ears, recording the brain's response. Matt Jennings Former Youth Basketball Coach Updated 6 mo Promoted What is the best way to keep energy levels high throughout the day? On the other hand, a person can be asymptomatic with an MRI showing awful, nerve compression from a disc herniation, hypertrophy or spondylolisthesis. Cleveland Clinic is a non-profit academic medical center. The researchers also noted that those with more spinal cord lesions experienced greater physical disability. This pain comes in a variety of forms, including trigeminal neuralgia, a syndrome involving sharp, stabbing pain in the side of the face or the jaw. The opposite is also true. Multiple sclerosis: What you need to know, A comparison of systemic sclerosis and multiple sclerosis. In MS, these tests may be normal but may show changes such as slower electricity conduction along the nerve pathways. Multiple sclerosis and systemic sclerosis are two autoimmune conditions that affect different parts of the body. The most common symptom of bladder problems in MS is urgency, a feeling that "when you have to go, you have to go." Images of spinal instability are demonstrated in the pictures on right. Disc desiccation is a nonspecific term which describes natural aging of the discs. Discs have a great deal of fluid within them which allow them to act as shock absorbers. My mri & mra scan of brain w/contrast show several areas have very small,round, bright, lighter spots? Silent stroke. I don't know what else, but thought I would throw those out at you. Once the technician turns the radio waves off, the protons fall back to their original order. These changes may narrow the canal where the nerves reside in the spine (central stenosis). The symptoms may vary over time depending on how extensive the demyelination is and on factors such as fatigue and heat. As they return to their original positions, the protons release signals that transmit to a computer. Begin with the images of the lengthwise spine, also known as the sagittal images. Areas of new active inflammation in the brain appear white on T-1 scans. Anything that interrupts the smooth linear border of the central canal may be a potential problem. Females tend to get MS about three times as often as males, a rate similar to other immune diseases. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://jamanetwork.com/journals/jamaneurology/fullarticle/2747565, https://pubs.rsna.org/doi/full/10.1148/radiol.2018171829, https://pubmed.ncbi.nlm.nih.gov/27349475/, https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Clinically-Isolated-Syndrome-(CIS), https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Relapsing-remitting-MS/Diagnosis, https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Secondary-progressive-MS/Diagnosing-Secondary-Progressive-MS, https://www.ncbi.nlm.nih.gov/pubmed/29856910, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932576/, https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI, https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri, https://www.nationalmssociety.org/What-is-MS/Types-of-MS/Primary-progressive-MS, https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awab088/6164965, https://www.mssociety.org.uk/research/latest-research/latest-research-news-and-blogs/mri-and-ms-7-things-you-need-to-know, https://www.nature.com/articles/nrneurol.2015.157, https://www.sciencedirect.com/science/article/pii/S2211034819304407.
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bright white spots on mri lumbar spine