First Post: Open vs. closed MRI for MS

Hi all:

First post that I'd appreciate if anyone knows if Open MRI can be used to diagnose MS or do you have to have the closed type for better resolution.  Not real happy having the mask on your face to lock your head down in the regular MRI, but I don't want to waste money if it's not specific or clear enough for the doc to dx.   Thanks all

[borntolose102]

Mine have always been closed but I am unsure if the exacts as far as a open one goes and also how accurate they are...sorry for not being of any help but my hands were jonesing to type!!!

[Deb61]

I would not waste your time with an open MRI machine.  My first MRI was completed on an open MRI and revealed no lesions.  Subsequent MRI on a 1.5 closed MRI machine with contrast revealed lesions.  

In my case, the open MRI hindered my diagnosis and was quite expensive.  They were not strong enough for a doctor to use to help with a diagnosis of MS.  My first neuro (not so great of neuro) said I couldn't possibly have MS because I had no brain lesions.  He didn't even bother to see what kind of machine the MRI was done on.  When I showed my second neuro (the one I have now) the results of the MRI, he handed the report back to me and told me that it was completely bogus and ordered another MRI.  So I had to pay for another one (which was worth it because it lead to a diagnosis).  

My suggestion is to get sedation if you have to, but get your MRI done on the strongest machine available with MS protocol.

Welcome, by the way.  I'll bet you'll love this forum.  Share your story and stick around.  We'd love to get to know you.

Deb

[ggoccmed]

Thanks Deb-  That was helpful.   Do you happen to know if they use the evoked potentials and LP for OC bands I read about to help with the dx if someone just can't tolerate the MRI.  They should make one where you can sit in it instead of lying down in a small cave--freaks me out. Thanks

[ggoccmed]

Hi born

thanks for responding.  You see Deb's response above that its not very accurate, but do you know about the other tests I mentioned above or is it always all about MRI?  

[Fluffysmom]

Hi there, and welcome!

It truly is better to get a MRI in the strongest machine available to you.  Open MRIs have a strength of .7 tesla, or some of the older ones are only .3.  This really wouldn't show much unless you had really large lesions; some people have had lesions show on an open MRI, but it would be unlikely.

In my pictures I have a couple of slices from my brain MRIs; one from a 1.5 T machine, and one from a 3 T machine about a year later.  The difference in resolution is amazing.  If you want to check them out, just click on my screen name and check out my photos; there are a lot, but my MRI pictures are in there!

If you're thinking you can't tolerate a closed MRI, you might  consider some light sedation and a ride home afterwards.  I once drove a friend who couldn't tolerate a closed MRI but needed one, and she was totally sedated.  

As for the LP and evoked potentials, I think they are usually ordered to help support a suspicion of MS because of MRIs or symptoms that suggest possible MS. I don't think they are definitive, though I'm no expert.

There's a lot of information in the health pages about all that stuff written by people much more in the know than I am.

Consider getting a closed MRI with sedation; the resolution really can make a big difference.

Hope to see more of you around,

Kathy

[Deb61]

I really can't tell you for certain if you can get a diagnosis without an MRI, but I have never heard of anyone getting a diganosis without it.  Your neuro may have a very difficult time with a diagnosis if the evidence of lesions in your central nervous system aren't there for him.  It is possible to have OC banding and neurological symptoms without MS.   The locations of the lesions on an MRI is an extremely important tool to help with the diagnosis of MS.  

The LP will help with diagnosis, if it's positive with the OC banding.  However, if it's negative it doesn't rule out the possibility of MS.  I'm not sure if it can be the only diagnostic tool.  From what I understand of the guidelines for diagnosis of MS, it can't be.  Of course the EP's are helpful.  I never needed it for my diagnosis, but it may help your doctor figure out where your nerves are having problems but it can't rule in or out MS either.

See the following sites for more info:

http://www.aafp.org/afp/20041115/1935.html

http://www.geocities.com/hotsprings/3468/diagnosis.html

I wouldn't try to do an MRI without being sedated, though, if you're really nervous.  Maybe others on this on this forum who were nervous about the MRI will have some helpful pointers.  Perhaps if you call the place where you will be having your MRI.  Maybe they can give advice.  They may be able to do parts of the procedure in segments.  I really don't know . . .  

[Fluffysmom]

My brain MRI pictures are on page 2 of all my photos...

[borntolose102]

it seemed when i was diagnosed i was freaking poked and prodded...i know i had two mri's one for the brain and the spine...spinal tap...and i kept going to eye specialist because all of the geniuses couldnt figure out my optic neuritis for the millionth time...the banging on the mri machine and the feeling of being buried alive..this was like 88 so the machine seemed freaking ancient....once again sorry for not being of much use...:(..:)

[jensequitur]

Unfortunately MS is a diagnosis made with MRI at this time.  I think eventually we'll have a simple test for it, but for right now we're stuck with the big magnet.

They're talking about optical coherence tomography being an alternate test for MS - it's a way of measuring the thickness of the optic nerve in your eye, and doesn't involve the hour of scanning and gadolinium contrast.  But it's not widespread yet.

[Lulu54]

The dx of MS COULD be made without an MRI - it should be primarily based onthe clinical observations of your doctor.  20-30 years ago all MS dx's were done without an MRI.

If a patient has a pacemaker or other metal implants, they cannont have a nMRI performed and the doctors find a way to work around this.

Talk you your neuro and explain your hesitation and concern(s).

my best,
Lulu

[Karen99]

Dr. Kantor at the MedHelp neurology forum had this to say about open MRI's:

http://www.medhelp.org/posts/Multiple-Sclerosis-MS/Absence-of-worsening-MRI/show/744310

If you are in need of an MRI, go for the closed type and 3T if possible.  Take a tranquilizer, keep your eyes closed (I put a washcloth over my eyes so I won't attempt a peek).  Do what you have to do to get the best images possible.

Good luck!

[sllowe]

Hi there,

Deb gives good solid info ref the tests and their significance.  

Personally, with the technology available, I can't imagine an MRI not being utilized to assist dx.  I'd not accept a dx without it (just my opinion).  Though in the end, it is a clinical diagnosis (as Lu mentions) and the test results are used to support it.

I've been in both open bore and closed and I found the images to be clearer with the closed, though the software used along with individual machines is a very important tool.

Your head won't really be locked down, and they have some really neat fans blowing.  Can you call to see what strength the machine is?

Thanks for joining us,
Shell

[ggoccmed]

Hi:

I saw the MRI pics and see the strength of the machine really does make a big difference.  Did I read right that even with the better MRI the doc can't give you a diagnosis.  I guess it is only suggestive criteria and it's better based on clkincal symptoms course and presentation.  Any thoughts?  Thanks again.

[ggoccmed]

thanks for the passing on the info.  Yeh, MRI and symptoms that Lulu and Shell mentioned above

[ggoccmed]

thanks for that link to Dr. Kantor and I saw the open MRI is bogus for a MS dx

[ggoccmed]

thanks for the info. and yes, everyone here seems to be very helpful and packed with good info.  I did go to a Neuro in my plan because I developed blurrred vision, unsteadiness, and intense lightheadedness and fatigue.  I thought it was all related to stress and went to my Internist who put me on Celexa, an anti-depressant.  I had a CAT scan-negative, and then he referred me to a Neuro because he said I should have MS ruled out.  The Neuro just did a quick exam and said let's see what the MRI shows.  He didn't even ask about my history or the specific sympotms I experienced, just found my exam was within normal.  The MRI freaked me out, but I guess I need a more cpomplete Neuro. and get sedated for an MRI with the best resolution (I'll ask them to tell ahead).  Thanks for the help.
gg  

[Karen99]

Hi.  MRI facilities do not administer medications.  (as far as I know)  Ask your doctor for a prescription ahead of time for something to keep you calm during the MRI.  

Remember that you can talk to the folks who are running the MRI through the entire procedure.  You can ask for a break if you need one.  They can communicate with you too.  

I've never heard of any type of mask being used.  They do have a gizmo that keeps your head in place but you are not strapped into it. You might call the facility ahead of time so you're not so apprehensive.  

When are you having your MRI?  

[Fluffysmom]

Hi again.

Sometimes we run into the bad luck of finding a neurologist that makes an assumption before they walk into your first appointment about one's diagnosis, and ignore all evidence to the contrary.

The neuro-radiologist that read my first brain MRI said the lesions were "far and away most likely to be multiple sclerosis".  My first neurologist said my tremors were from anxiety, the lesions were most likely from "chronic microvascular changes".

I went to my second neurologist, who ordered more tests, but decided that when my LP came back with no oligoclonal bands, that I had small vessel ischemic disease.  I assured her that I had no risk factors, showed her my medical records supporting that, but she wrote in her chart notes that I needed no further neurological work-up.

It took a while to get into my first MS specialist; I had requested to see a general neurologist, but that neuro said I needed to be seen by a MS specialist.

From day one, the MS specialist was sure that I had small vessel ischemic disease.  I had her refer me for more testing, consulted with my cardiologist whol thought her theory about my brain lesions being from small strokes caused by my benign arrhythmia was nuts, and sent her a professional fax attempting to clear up that misconception.

I finally got sent for those 3T MRIs, but she ordered them to "rule out demylenating disease vs. small vessel ischemic", and the reports were awful.

I got a second opinion reading of the MRIs done, and the neuro-radiologist and my PCP are convinced that I have an atypical presentation of MS.  I hope that my new MS specialist will be able to take an objective look at my MRIs, medical history, timeline of symptoms, and come up with a clear answer.

I wrote a letter of complaint about my last neuro and the bad radiology reports; it's in my journal if you are interested in reading about how bad neuros work.

My Timeline of Symptoms is in my journals, too, though I need to update it.

I've had over a dozen MRIs in the last year or so, and find that it gets easier each time.  Sedation can help a great deal.  Some places let you choose music to listen to.  I tend to just ask for ear plugs, and find a rhythm in the noises the machine makes.  Last brain - cervical - thoracic MRI, I even fell asleep and had cool dreams a few times, and I didn't take any sedation.  I was just fatigued, as usual.

I wish you the best of luck,

Kathy