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My understanding is that contrast really highlights "active" lesions. That does imply "new" lesions. I had brain MRIs 3 months apart - both with and without contrast. None of my lesions glowed with contrast, but there were more on the second MRI than on the first. They were done at the same place, in the same machine. Either new (active) lesions can appear and transition to "inactive" within a short period of time OR the two MRIs got slightly different "slices" of my brain. Whatever the case, the report strongly suggested demyelinating disease, it helped me get a fairly speedy diagnosis.

I did some web searches on brain MRI images when I started the dx process. I found images where a lesion was hard to detect without contrast but it "lit up" with contrast. It isn't easy to find them, but do go looking, it will help answer some of your questions. Also, I have copies of my MRIs. The first set are films, the second set (which included full spine) are on CD. I'd recommend getting copies. Yeah, it is a little freaky to be studying your own brain, but I took plenty of time to look at them before I took them to my neuro. I was able to see that SHE saw what I saw. (She actually saw some I had missed.) I took them to a second neuro, he glanced at them and declared, "These are completely normal!" I kicked THAT jackass to the curb!

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