I had my spinal MRI today and I have a question

[saveone]

So I go for the MRI of my c-spine and thoracic spine.  I am talking to the technician about the testing. He is explaining everything...even tho I have already heard it twice before.  Then he says Dr.A ordered the MRI without contrast.  I told him since we were looking for lesions I was surprised.  He then says that if they are there the dr should be able to see them without contrast.

Back to my appt where the MRI was ordered.  Dr A says You have had a brain MRI before.  Yes I tell him but it was not under MS protocol.  He then narrows his eyes and ask, Did someone tell you there was such a thing. Yes, I answered thinking how do I get out of this one without admitting I had be researching MS over the internet.  Then he says , there is no such thing....the hospital does it all...there is no such thing.  (sorry I am to tired to fool with the "".

Fast forward, I am signing out and the nurse hands me a RX for a MRI with a note that says ...patient will schedule.
I have never had to schedule my own appts.  I think I ticked him off.

Now I know that protocol is important on brain MRIs but is it the same on spinal MRIs and did I just waste my time?

I also found out the machine is a 1.5 Tesla.  So do you think they will show up, if there are any, without the contrast.  From what I understand the contrast lights up new lesions.  

Thanks

terry

[Quixotic1]

Whenever any of you get into a bind and don't want to mention learning stuff online - God Forbid! - just say you learned something from a family friend who is a doctor with MS.  That's true.  Your families like me okay, don't they?

Quix

[saveone]

Thanks Quix, that cleared some things up for me.  I have seen MRI from a 3T and boy they are so much better.  I am supposed to have a repeat MRI of my brain in Jan/Feb and I am going to schedule it in Lexington at a clinic affiliated with the University of KY.  They Have a 3t.  I am just going to hang in there with Dr A until after the next appt.  He will give me my orders for my repeat MRI, then I will have all the info and I will look for another neuro.  We have to play the game.

I had told GP that Dr A didn't seem to understand MS and that he didn't act like he had many MS patients.  GP said he better understand.  He was Harvard educated.  Maybe they forgot the course that instructed him to get his head out of his a**.  I think he was just ticked that I said something halfway intelligent.

I do believe that with my symptoms, my leisons, and my neuropsych eval he has enough info to at least make a dx of CIS.  That would be enough justification for starting DMD.  But hey what do I know...aren't you supposed to let your brain deteriorate some more before they do anything?
I will print that off and show it to him but not before I get a copy of my records.  I have been trying for the last 2 weeks and it is always they are not ready call back in  a few days.  I think that was another thing that ticked him off...me asking for my records.  Seems like I am very good at that lately.

As to the difference between a .25 and a 3T.  It is like light and dark.  You can see so much better when the light is bright and you see things you might not have seen otherwise.

Anyways, Thanks for the post, it helped a lot.  it reinforced what I already knew.

LuLu I think what that is called in Kansas or anyplace else is chasing your a**

[Quixotic1]

There is a lot of confusion about what role the contrast plays in showing up lesions.  In general a "new" lesion WILLl show up without contrast, but it will look the same as an old lesion.  No one will be able to see that it is new unless they have old MRIs done with the same protocol.

What the gad contrast does is show where the new inflammation has caused a leakage in the blood-brain barrier and has leaked out into and around the lesion.  Normally the gadolinium stays in the blood vessels.  It cannot penetrate the blood-brain barrier into the brain tissue.  But, in the inflammatory process of a new lesion or a newly enlarging lesion the barrier becomes leaky and the gad passes into the tissue and show up as extreme brightness.
  
So the contrast allow the neuro to say that it definitely is a new lesion.  If the docs are trying to establish "Dissemination in Time" in making the diagnosis of MS, then use of GAd is mandatory.

So, presumably they will not do gad if there are no lesions to be seen.  That does not agree with the MRI Protocol.  Yes, your neuro does, indeed, need to get over himself and begin thinking with his "big boy brain."

The vast majority of the 400,000 MS patients in the US were diagnosed with Tesla machines of 1.5T and lower.  But, there is a rising belief with some neuros, mine and NYU included that the 3T yield is superior for doing the spine.  This has not been proven. Bottom line is that if they see lesions, you're golden.  If they do not, then I would still have doubts.

I just listened to a podcast with Anthony Traboulsee, MD on "The Top 10 Things to Look for in an MRI."  This was fascinating

http://www.mscare.org/cmsc/index.php?option=com_content&task=view&id=737&Itemid=554

It discusses the use of Gad and also the need for real data on whether 3T MRIs are superior to the very-low resolution open-MRIs.  He stated at ta large meeting of MS Specialists only a small minority felt that the low power machines were just as good.  That made me wonder if they placed heavier weight on the clinical evidence or if they really thought that a negative MRI on a .25T machine means that it would also be negative on a 3T.

My case is a series of just 1.  That makes it almost anecdotal, but the attitude of my neuro and the amazing difference on my spinal MRI convinced me.

Here is the latest official " Standardized MRI MS Protocol"  from the Consortium website, It was published in the February, 2006 issue of the American Journal of Neuroradiology.  If you are considering changing your neurologist then you might want to print this off and send it to him.  He is either undereducated or he was lying to you.  Either worries me.

http://www.ajnr.org/cgi/content/full/27/2/455

Hmm, I always schedule my own appointment for tests.  Sometimes they have me call the office and other times the office calls me.

Quix

[Lulu54]

Dear Virginia,
My neuro told me to see my PCP for my throat.
My PCP sent me to my GI who wants to do the pH monitor implant but also sent me off to see an ENT since he can't look at the upper throat
MY ENT this week said we need to look at your vocal cords and order a video scope that I'm having done Monday

In the meantime I had my MRI yesterday, brought a copy home with me.  Looked at it myself and guess what?

Yes Virginia, there is a UBO on my throat in the spot that I have been telling everyone about.  

I do believe, I do believe... hmmm I am confused and not in Kansas anymore!
Lulu

[saveone]

LuLu, I do order up the works.  My GP is very good about ordering anything I need.  Last week he was looking at all my complaints.  When he came to the swallowing part he said, I just don't know what to do.  I said, you want me to tell you what I would do?  He answered yes.  Now isn't that neat.  I suggested a speech pathologist.  Then we talked and he said let's do the upper GI first.  Then we will see the Speech Pathologist as soon as we rule out that everything is functioning as it should.

If I spoke to Dr A like that he would go into spasms.  And I love the idea about him seeing a therapist.  When he told me there was no such thing as MS protocol I wanted to laugh.  Then I wanted to say Will someone forgot to the specialist or maybe they just lied to them.

But I didn't.  I was a good little girl because I knew there was a Santa Clause.

Signed Virginia

[Lulu54]

Terry,
My C-spine showed demyelination even though it was done on a 1.5T and w/o contrast in July.  So yes, it can be done that way.

The MRI  I just had yesterday was brain and C-spine with and without contrast.  And yes, Viriginia there is such a thing as MS protocol. Sorry its the season to pull out all the fun quotes.  

Your neuro obviously has security issues and could use a referral to a good therapist to get over himself.  

Since you have to schedule your own tests anyway, why not order up the works?  If you can, do it!

Feel your frustration, Lulu