MRI WITHOUT contrast?

[greenandchic]

Today, my insurance company approved my MRI, but its without contrast.  I read here that its crucial that contrast is used.  Is it even worth it to get one since the diagnosis inaccurate?  

[COBOB]

By the way, in my opinion, it is much more important that they do the MRI on a 3 Tesla machine.   The 3T will pickup about 25% more lesions than a 1.5T.  

That would be my bigger question:  "Are you doing my study on a 3 Tesla MRI?"

Bob

[COBOB]

Demyelination will show on T2 and FLAIR without GAD.  That seems to be where most lesions are seen.  GAD T2 shows new "Active lesions."  At least that is my understanding.  My info is pretty much 2nd hand.  I used to repair the machines and my knowledge is from talking to the Radiologists, Physicists, Techs and Sales People.

Bob

[jumpinjiminy]

That is very interesting COBOB. I had no idea that contrast only showed BBB leaks. I thought it showed areas of demyelination.

[COBOB]

Again, this is one Quix could weigh in on, but this is how I understand it.

Everyone is hung up on GAD contrast.  It is really good for visualizing blood vessels.  That is what it does. Gadolinium is is a rare earth metal with paramagnetic properties (Atomic Number 64).  That is where its usefulness with MRI comes in.  Its a little technical, but in the PSE (Proton Spin Echo) sequences (really any spin sequences) GAD spins faster and "enhances" more.  Abnormal tissues with lots of vasculature "enhance."  GAD does not cross an intact blood brain barrier (BBB).  Now if the barrier is not intact, like what they think happens when cytokines and other "agents of vascular inflammation"  break down the BBB, GAD leaks out out of the vasculature and enhances in tissue.  So if a new inflammatory lesion is starting to form, and the BBB is leaking, then GAD is leak across the BBB and light up the lesion.  After 4-6 weeks, the lesion is still there are will show up on a T2 PSE, but GAD will no longer leak across the BBB.  

Short answer is GAD helps tell is a lesion is less than 6 weeks old, and helps identify brain vasculature, but that is what you get from GAD.  Imaging, for lesions older than 6 weeks, don't benefit from GAD.  Medical Gadolinium is treated to reduce its toxic effects, but needs to be used with caution in people with impaired renal function.

[Viv05]

Hi Lulu
I had an incident 4 months ago, since then I have been having terrible headaches.  No one cares.  The neurologist order an MRI without contract at the same time that he told me that 95 percent of these MRI comes clear.  All I want them to know is to find out why I still getting this headaches, dizziness, blurred vision, nombness on the legs and arms sometimes.  All they can say is that it will go away.  This is not normal for me, still 4 months same symptoms.  I think that the MRI is going to be clear like the neurologist said and they are just going to closed my case and leave me like this.  Why should I do, when I don't have the power to order and MRI with contrast? I have no idea why this workers comp take so long to be approved and why the doctors  miss treat you like they don't care, all they want is to closed the case and leave you sick or they will jsut say" It will go away, that is normal.  

[greenandchic]

Thank you so much Lulu.  You guys are great here!

[Lulu54]

Dear greenand chic, It sure sounds like you are on the fastrack with a dx for MS - please allow yourself some time to process all of this.  And then keep us updated - we are here to travel this trip with you.  My best, Lulu

[greenandchic]

UPDATE #3

I had my MRI early this morning at 7:30 and my Neurologist office called not too long ago and told me that the preliminary report shows that I do have lesions, but I have a full appointment tomorrow afternoon.  


Wish me luck!

[Quixotic1]

Actually ALL of the people having the severe reaction (which is not proven yet to be from Gad) had renal failure before getting the contrast.  ALL.

Please see this post:

http://www.medhelp.org/posts/show/735607

So you can see that if your kidneys are okay you have no risk of this.

Good luck with the MRI.

Quix

[greenandchic]

Thats good to know.  Thank you so much for that bit of info.

I spoke to my doctors office again today and I should get the results about 24 hours after the MRI which would make it Friday morning.  

[essdipity]

Please don't worry about this outcome. The ads you see often are by lawyers and others trying to get money by upsetting people. Take a look at this site:

http://www.sciencedaily.com/releases/2007/12/071228215622.htm

You will find that the chances of having a bad reaction are tiny. A recent huge study showed that only 54 of more than 78,000 people had a problem in this regard. That amounts to less than .0006%. Quix has posted that gadolinium reactions occur almost entirely in people with other previously known conditions, and I think the big one is with the kidneys.

The likelihood of bad gad side effects is way outweighed by the info it can provide in the overwhelming majority of cases. But even if gad isn't administered, it is still worthwhile getting the MRI, as others here have described.

Good luck and don't worry.

ess

[greenandchic]

Thanks Jason,

I made the mistake of Googling the contrast and saw a bunch of Google PPC ads and links about Gadolinium side effects.  I dont even take over the counter drugs (havent in several years) so this will be new for me.

[jason80]

Every test has its trade offs. Occassionally people are allergic to Gd contrast.

[greenandchic]

UPDATE #2

My doctor's office called back and told me that I SHOULD get the MRI first without and then with the contrast.  

They are calling the insurance company now...

[Lulu54]

Did youget an answer about the contrast from the neurol's office?  be sure to check into that before tomorrow and if possible get it added to the orders. That will save you a repeat trip.  Good luck and keep us posted, ok?  - Lu

[greenandchic]

Update:  

The morning after I wrote this post, the imaging facility called me to set up an appointment, which will be tomorrow morning.  Wish me luck!

[greenandchic]

Thanks for the info!

Its hard to tell from the letter if the neurologist specifically ordered it without contrast or if this was the insurance company's decision now that I'm looking at the closely.  The letter didn't give any reasons why or  why not.

I will call my doctors office in the morning to see if I can get an explanation.  

[doublevision1]

Lulu answered your question very well.  For sure go ahead with the MRI, as even without contrast it may provide valuable information.

Did the insurance company state why they would not cover contrast?  Can this decision be influenced by your GP, neurologist or radiologist?  Given that the standard criteria for MRIs for suspected MS includes the use of contrast to detect enhancing lesions, why would this part of the testing not be authorized?  As Lulu said, this results in the test being incomplete.  Sorry for all the questions, just wanting to understand how this works in the U.S.  

[Lulu54]

Hi there, although contrast is the best way to go, an MRI without contrast could also be helpful in making the case to your insurance to allow another MRI series to be done with contrast.  

The MRI w/o contrast won't make a diagnosis inaccurate, it will just make it less than complete as a diagnositic tool.  Contrast allows the radiologist to see lesions in a different perspective and helps to determine the age of those lesions and the recent activity levels.  Older lesions that wouldn't enhance with contrast may or may not still be visible, depending on how well your system was able to repair the damaged myelin. I hope this makes sense - I'm a bit slow tonight so please let us know if you need to know more.

I would definitely go ahead and get the MRI done.

stay in touch,
Lulu