Two spots of scarring can look almost identical on a quick read. One may recover. One never will.
Part of the answer is myelin, the insulation wrapped around the brain's wiring. When a lesion has lost its myelin and turns dark on the right sequence, that is a harder, more permanent kind of damage, and it points more toward a true injury.
When the myelin looks preserved, the lesion is more likely reversible, and more likely the residue of everyday wear like chronic headaches or small vessel changes.
So I do not stop at counting spots. I try to characterize each one. Where is it, what does that region do, and does it carry the signature of something lasting or something that can settle.
That distinction changes everything for the person and the physician. A lasting lesion in an important region is a very different message than a fading one in a quiet corner.
Naming a finding is easy. Reading its future takes more.