Brain MRIs are among the most powerful tools in modern medicine. They provide detailed images of the brain’s anatomy and help detect a wide range of conditions, from tumors and multiple sclerosis to small vessel disease and strokes. But while the technology itself is advanced, its interpretation is still a human skill and that’s where things can go wrong.

Unfortunately, misdiagnoses on brain MRIs are not uncommon. Studies have shown that even experienced radiologists can miss subtle abnormalities or misinterpret findings, especially when they're not specialized in neuroradiology. A second opinion from a neuroradiologist, a radiologist who has undergone additional fellowship training specifically in brain and nervous system imaging, can mean the difference between an accurate diagnosis and months or even years of ineffective or harmful treatment.

Here are some of the most commonly misdiagnosed conditions on brain MRIs and why a neuroradiologist’s expertise can drastically improve the outcome:

Common Brain MRI Misdiagnoses

1. Multiple Sclerosis (MS)

MS lesions can mimic many other conditions, including migraines, small vessel ischemic disease, or even normal aging. Misdiagnosing MS can lead to unnecessary lifelong immunosuppressive treatment or, worse, missing an early opportunity for intervention if it's wrongly dismissed.

Why a neuroradiologist matters: They are trained to recognize the pattern, location, and evolution of demyelinating lesions that are characteristic of MS versus other similar-appearing pathologies.

2. Small Vessel Ischemic Disease vs. True Stroke

White matter changes from aging or chronic hypertension are commonly mistaken for strokes, or vice versa. This can lead to incorrect management, such as unnecessary anticoagulation.

Why a neuroradiologist matters: They can accurately differentiate microvascular changes from acute infarcts by analyzing subtle differences in signal intensity, diffusion patterns, and clinical correlation.

3. Brain Tumors vs. Non-neoplastic Lesions (Infections or Demyelination)

Tumors like gliomas can mimic abscesses or demyelinating plaques. Conversely, infections such as neurocysticercosis or encephalitis can be mistaken for neoplasms, leading to drastic differences in treatment.

Why a neuroradiologist matters: They are skilled at evaluating enhancement patterns, mass effect, edema, and other characteristics that help differentiate between malignant, infectious, or inflammatory lesions.

4. Normal Variants Mistaken for Pathology

Cavum septum pellucidum, mega cisterna magna, or prominent perivascular spaces are normal variants that can be mistaken for cysts or hydrocephalus.

Why a neuroradiologist matters: They understand the spectrum of normal anatomical variation and can prevent unnecessary alarm or intervention.

5. Mild Traumatic Brain Injury (TBI)

Small hemorrhages, shear injuries, or contusions are sometimes missed or underreported, especially if imaging is subtle and done on an older scanner.

Why a neuroradiologist matters: They know how to optimize scan protocols and interpret subtle trauma-related findings that may explain symptoms like memory loss, headaches, or dizziness.

6. Pituitary Lesions

Microadenomas are frequently overlooked or misinterpreted, especially in cases of hormone imbalance or vision changes.

Why a neuroradiologist matters: They are experienced in dedicated sellar imaging and identifying even tiny abnormalities in the pituitary and surrounding structures.

7. Chiari I Malformation

This condition, where the cerebellar tonsils extend into the spinal canal, can be missed or mistaken for a normal variant.

Why a neuroradiologist matters: They recognize key measurements (like tonsillar descent over 5 mm) and correlate these with clinical symptoms and CSF flow studies.

8. Encephalitis and Autoimmune Conditions

Conditions like limbic encephalitis or neurosarcoidosis can be subtle and easily misinterpreted as psychiatric disorders or early dementia.

Why a neuroradiologist matters: Their familiarity with uncommon inflammatory patterns allows them to flag abnormalities that might be missed by general radiologists.

The Cost of a Missed or Incorrect Diagnosis

The impact of a misdiagnosis can be catastrophic. A missed brain tumor may delay life-saving treatment. An incorrect MS diagnosis can cause years of unnecessary therapy. Misreading a post-concussion injury can keep a patient in pain without validation or proper care.

Misdiagnoses aren’t always due to negligence, they often arise from the inherent complexity of brain imaging. A radiologist may read hundreds of scans per day, many of them involving different parts of the body. A neuroradiologist, in contrast, focuses exclusively on the brain, spine, and nervous system, making them far more attuned to the nuances of neuroimaging.

Why Seek a Second Opinion from a Neuroradiologist?

• Specialized Training: Neuroradiologists complete an extra year (or more) of fellowship dedicated solely to neurological imaging, or have devoted their careers in daily practice focused on neuroradiology exams.

• Focused Experience: They interpret thousands of brain MRIs every year.

• Subspecialty Insight: They can correlate findings with clinical scenarios more precisely and suggest further steps, such as advanced imaging or specific lab tests.

When Should You Consider a Second Opinion on your Brain MRI?

• Your symptoms don’t match the reported findings

• The diagnosis is vague or unclear ("non-specific white matter changes")

• You're facing major treatment decisions like surgery or chemotherapy

• You’ve had multiple scans without answers

• Your MRI was not read by a fellowship-trained neuroradiologist or a radiologist who is focused on neuroradiology imaging.

Brain MRI Second Opinion for Peace of Mind

Brain MRIs are not just pictures, they’re complex diagrams that need expert interpretation. If you're uncertain about your results, don’t hesitate to seek a second opinion from a neuroradiologist. It could be the most important step toward the right diagnosis and peace of mind.

At MDView, we connect patients directly with board-certified neuroradiologists for expert second opinions. When it comes to your brain, every detail matters.

Need clarity on your brain MRI? Get a second opinion from a neuroradiologist now at https://app.mdview.com. Just upload your Brain MRI, complete the questionaire to provide the expert radiologist with context about your clinical symptoms and your concerns, and you will receive your report fast, typically within 72-hours or less, unless you choose an expedited read (when available) to have your Brain MRI second opinion within 24-hours. 

Don't have your imaging available to upload? No problem! MDView can get your exam at no cost to you directly from the imaging facility or hospital, typically within 2 business days. Just click the button on the homepage of your MDView account that says Have MDView Get My Exam and we can get started on getting your Brain MRI images.