MRI's and gadolinium (contrast)

[Lulu54]

Today was a wonderful panel discussion with two neuros, one MS RN and the local NMSS president.  All of them are women, and it was an open session to discuss whatever topics we wanted.  It was absolutely the BEST MS presentation I have been to yet. The one neuro is the head of the Waddell MS Clinic at the university of Cincinnati.  

Some of the questions dealt with MRI technology - strength of machines, software development etc.  

There was talk about the use of contrast agents in MRIs (gadolinium) and both neuros were emphatic that timing with the contrast is everything  .They talked about technicians rushing to finish the MRI's, but it is important to wait long enough for the gad to circulate and enhance active lesions.

When I asked how long that wait  should be, the answer was unanimous that it should be 10-15 minutes after the injection before the next series of images are taken.  

The techs have NEVER waited more than a minute or two with me - I'll be mentioning that when I go for me next series.

When I get a few quiet moments I will put together a journal entry on the past two MS talk I attended - quite a difference and lots of useful information to share.  

be well,
Lulu

[Lulu54]

GG,
I like that bathroom excuse - or perhaps everyone just needs to take a copy of the MRI protocol with them and bring up the subject before the MRI even begins .... set the expectation that the scan will be done correctly.

Heather, thanks so much for checking this all out further.  Its great to have confirmation from several sources to add to the ammunition.  

Lu

[Guitar_grrrl]

I brought up waiting at least 5 minutes to the tech last time I was in there, and she said it was not necessary.  I believe it is.  Maybe I'll conveniently excuse myself to the bathroom after the next injection :^))

[Heather3418]

I just checked this out with my Neuro.  She said that you and the doctor's that told you this, is EXACTLY the way it is preferred by all Neuro's.  She said that no matter how many times she has instructed for MRI tech's to wait a FULL 10-15 minutes after contrast administration; they seem to do what they want to do.  They are more interested in getting the scan finished, so they can get to the next patient.  

She said ALL scans done after injection of contrast dye, should only be done after ten to fifteen minutes.  PERIOD.  She did say, that the last of the scans that were being done, WOULD have contrast dye fully in the system, (if they didn't wait to start re-filming after the injection) to show if there was any penetration of the blood brain barrier.  She also told me that in cases of her patients with known MS, she relys on the patients reported symptoms and physical exam, to determine if they were in an active attack and paid little to no attention to enhancement of lesions on an MRI.

So with that said, I think we all should ask our MRI tech's to wait at least ten minutes after injection of contrast, to start taking the films again.  Hopefully we have a Neurologist that does not depend on seeing enhancement, to know his/her patient is in a full blown attack.  What lesions are there are going to show up, no matter if the contrast is given or not.  Like I said, she knows if I am in an active attack, but we discover that during my appointment.

I would feel that contrast enhancement would be extremely important to anyone that is going through the diagnostic process.  Especially when the doctor is trying to identify 2 distinct relapses to meet the McDonald Criteria evidenced not only by physical exam but followed up by proof on MRI.

Thank you again, for bringing this information to us, Lulu.  I now have a third Neurologist that totally agrees with what you have heard the Cincinnati MS conference.

Heather

[Lulu54]

My question then would be how long does it take to run the T1 post-gadolinium scans?  
Because when I have had gad, I've been out of the tube pretty quick afterwards.

I'll ask my neuro this week if I remember!

[sllowe]

Good solid info here! Thank you Lu!

I've never experienced the 10 minute wait either, and though I read it while reviewing the protocols, I didn't include the recommendation on Gad in the protocol HP. I'll work on something simple to add.

Here is the recommendation:

*  From the 3 source docs (referenced on the HP) each year 2003, 2006 and 2009 recommend a minimum delay of 5 minutes for post gad T1s. You remembered correctly Lu because it's the FLAIR and T2 can be done DURING the 5 minute minimum delay.

This could very well explain why we all have not experienced the delay. But, they could run the T1s right away too and we'd not know it. I suppose.

-shell

[momto2grls]

Interesting, the techs definitely did not wait, they completed the test immediately after injecting the contrast.