For the experts - a question about MRI protocol & MS

In reading the Health Pages, I learned that it is part of the diagnosis protocol to have MRI's with and without contrast, when MS is suspected. (I hope that how I read & understood the article is correct)

I wonder then, why do neurologists order MRI's without contrast?  I have had 2 neurologists order MRI's without contrast - when they told me that they specifically wanted to rule out MS.

Is it laziness?  Lack of knowledge of the protocol? Can a radiologist "see" something when performing the MRI & then decide to use contrast?  I didn't think that the radiologist had that kind of discretion.

I apologize if this has been covered at some point on the forum and I missed it.

Still searching for some answers,
Chrisy

[Sarahsmom46]

You are asking a very good questions.  

I think it is absolutely unconsciouable  (sp?) for a neuro to order a brain MRI without contrast if he/she is considering a diagnosis of MS.  But, I wonder if it is as important for a spinal MRI.  I had a spinal MRI recently and the doctor was called in before I was finished to look at the images.  He told the technician that we didn't need to use the contrast because he was able to see what he needed to see and that spinal lesions don't necessarily "light up" with the contrast for some reason.  But, a brain MRI is different because if they don't use contrast then if they see lesions they may not know how active they are.  I hope it is not lack of knowledge, but you never know.  It never hurts to ask the doctor at the time he is writing you the script for the MRI whether it will be with contrast or not.  That might job their memory that they need to do it with contrast for MS studies.  

I hope others in our forum will come forward, and they likely will, with other explanations.

Thanks for presenting an interesting questions.

Julie

[uk2]

Hi

I too have had MRI without contrast, and not done on MS protocol, i think its more cost then anything with the UK not sure why in america.

maybe others can answer.

sam

[Heather3418]

The best thing for you to do, is ask your doctor why your MRI was not done using the MS Protocol.  When using the MS Protocol, the radiologist sets the MRI machine to take thinner slices of the brain and different angles to see what he needs to see for an accurate diagnosis.  This is all used based on your symptoms and history as well.

Contrast should be used for the brain and the spinal MRI.  I frankly do not know why your Neuro did not order contrast.  In my experience the radiologist can call your doctor's office for orders using contrast dye, but does not have the authority to use it without a doctor's orders.

Lesions can be seen without contrast.  The dye can tell them if they are recent lesions.  You have what is called a Blood Brain Barrier surrounding your Central Nervous System.  The brain and the spine.  The dye will not cross this barrier at all, if you are not in a current attack.  Oherwise contrast dye will be taken up in the CNS to show that there is a "leak" in the BBB and what causes this is active demylination.  Contrast showing up in the brain or spine can tell your Neuro, that you are in an active stage, to let him guage about using steroids to calm the "attack" down and get you started on the disease modifying drugs.  Called DMD's.

Call your doctor Christy and ask them why contrast dye was not used, if they were looking for MS.  They may or may not repeat the MRI's.  My guess they will not.  Maybe at a latter time.  But if you have another one, I would insist on them using the MS Protocol, which will include the contrast dye.

Good luck to you sweetheart,
Heather

[goofysmom1]

thanks for your replies.  It is frustrating to know that these MRI's should be done with contrast and they still don't do it!

Hugs to you both,

Chrisy

[goofysmom1]

Heather,

Thank you for the information - it is very helpful.  

I wonder if they don't see any lesions on the MRI - do they think that contrast won't add anything?  I have seen many posts & info on this (wonderful) forum that talk about "invisible" lesions.  Also, I have seen info on lesions that are only seen with contrast???


Hugs,
Chrisy