Aa
MRIs
Things to ask the doctor when he requests a brain MRI for you, if he does.
I'll start with the most important:
1. Will the machine be a 3 Tesla (T) Machine? Sometimes called a 3T or a T3 machine.
(Your doctor probably won't know but you can call the magnetic radiology dept. of the hospital to find out. Be prepared to be passed from one telephone extension to another in order to get to someone who actually knows! The chief/head of the department might be the best one to talk to. Sometimes the web site will have the information----- but often the information on the web site is out dated.)
Another reason to have a high field MRI----"twice the strength of 1.5 Tesla machines and 10 to 15 times the strength of low field or open MRI scanners."
[The above needs to be investigated----- I'm not sure that an 'open' scanner will have less strength if they can use a 3-T machine.]
Another quote from a hospital which is proud of it's acquisition of 3-T machines:
"Insurance companies pay the same amount for an MRI, regardless of whether your exam is performed on a low-field or high-field magnet. Don’t compromise your health with a lower strength magnet."
Translation---- more bang for your buck.
Tesla (T) is the unit of measurement quantifying the strength of a magnetic field. Prior to the 3 Tesla Machine, the high-field standard was 1.5 Tesla.
[I just called the imaging centers in my town and found that out of about 3-4 only one had the T3. Another branch of the biggest imaging center here is 'getting one installed'.]
I'll start with the most important:
1. Will the machine be a 3 Tesla (T) Machine? Sometimes called a 3T or a T3 machine.
(Your doctor probably won't know but you can call the magnetic radiology dept. of the hospital to find out. Be prepared to be passed from one telephone extension to another in order to get to someone who actually knows! The chief/head of the department might be the best one to talk to. Sometimes the web site will have the information----- but often the information on the web site is out dated.)
Another reason to have a high field MRI----"twice the strength of 1.5 Tesla machines and 10 to 15 times the strength of low field or open MRI scanners."
[The above needs to be investigated----- I'm not sure that an 'open' scanner will have less strength if they can use a 3-T machine.]
Another quote from a hospital which is proud of it's acquisition of 3-T machines:
"Insurance companies pay the same amount for an MRI, regardless of whether your exam is performed on a low-field or high-field magnet. Don’t compromise your health with a lower strength magnet."
Translation---- more bang for your buck.
Tesla (T) is the unit of measurement quantifying the strength of a magnetic field. Prior to the 3 Tesla Machine, the high-field standard was 1.5 Tesla.
[I just called the imaging centers in my town and found that out of about 3-4 only one had the T3. Another branch of the biggest imaging center here is 'getting one installed'.]
Thank you very much and sorry about your accident too.
The first night I felt I was on fire it hurt so much.
The pain pills didn't do much so I got a shot at the doctor which was amazing.
I am more dizzy too. Sigh :(
The first night I felt I was on fire it hurt so much.
The pain pills didn't do much so I got a shot at the doctor which was amazing.
I am more dizzy too. Sigh :(
That's awful! My heart goes out to you. I was in a nasty total right after my Lyme dx, and I had a lot of soft tissue injuries that I'm sure felt much more painful from the Lyme. That and my vertigo got way way worse. I hope you'll be able to heal up quickly. I completely agree that trauma is even more traumatic she you have Lyme!
Thank you. I was rear ended by a truck Tuesday, the pain is triple from my regular Lyme pain.
I hope the open machine offers a more comfortable option for you. I hope the scans provide helpful information that will lead to ways for improving your condition.
The constrast or not decision can also be imposed by insurance. My first brain MRI order requested contrast, but my insurance wouldn't cover it unless the without contrast scan was abnormal, which it was. But as the radiologist's report wasn't read until after my scan, I had to return a few days later for the contrast study.
But yeah, when insurance doesn't interfere, going ahead with the contrast study at the same time seems desirable.
But yeah, when insurance doesn't interfere, going ahead with the contrast study at the same time seems desirable.
I found out today that I need an MRI of brain, hip, lumbar and cervical spine. This MRI is open and you can sit up while doing it. Sounds good since I am claustrophobic since getting Lyme.
" having the exam done with contrast does provide more diagnostic information."
Yes, it does. And I've 'lost' the reasons why in my brain but I'll try to find them to put on this thread.
Perhaps there's a reason for not providing 'contrast'---- some people are allergic to them. But I think there are 'work-arounds' for that also. Again, some surfing is needed.
Yes, it does. And I've 'lost' the reasons why in my brain but I'll try to find them to put on this thread.
Perhaps there's a reason for not providing 'contrast'---- some people are allergic to them. But I think there are 'work-arounds' for that also. Again, some surfing is needed.
Your are right, my warning to be prepared for the noise/discomfort may be off-putting, which was not my intent.
Now-a-days, I could get an MRI done with no problems. While I was very sick, I was hypersensitive to sound and staying still for long was painful due to the high levels of inflammation I was experiencing. So, to clarify, my warning of the possible discomfort of getting an MRI was directed at folks who are dealing with symptoms that may be aggravated by loud noises or the need to be still while flat in a tube.
I have 4 or 5 MRI's done (brain, neck, lumbar, some repeated) all while my symptom load was high, and it was difficult to endure and not knowing what to expect the first time added stress to the situation.
Oh, another thought of what to ask is whether the MRI should be done with or without contrast. The contrast test is useful again in terms of diagnosing/monitoring MS as opposed to Lyme, but ruling out MS is important for a lot of Lyme patients. I don't know the details well enough to feel confident in explaining it here, but having the exam done with contrast does provide more diagnostic information. If contrast is not used initially, it may lead to the need for a second trip into the MRI tube...And I for one like to minimize the number of times I need to go in for any sort of testing.
Now-a-days, I could get an MRI done with no problems. While I was very sick, I was hypersensitive to sound and staying still for long was painful due to the high levels of inflammation I was experiencing. So, to clarify, my warning of the possible discomfort of getting an MRI was directed at folks who are dealing with symptoms that may be aggravated by loud noises or the need to be still while flat in a tube.
I have 4 or 5 MRI's done (brain, neck, lumbar, some repeated) all while my symptom load was high, and it was difficult to endure and not knowing what to expect the first time added stress to the situation.
Oh, another thought of what to ask is whether the MRI should be done with or without contrast. The contrast test is useful again in terms of diagnosing/monitoring MS as opposed to Lyme, but ruling out MS is important for a lot of Lyme patients. I don't know the details well enough to feel confident in explaining it here, but having the exam done with contrast does provide more diagnostic information. If contrast is not used initially, it may lead to the need for a second trip into the MRI tube...And I for one like to minimize the number of times I need to go in for any sort of testing.
wonko said:
"It is loud, and in closed machines you need to be still in a small tube for what feels like a long time. I was experiencing some of my worst Lyme symptoms when I needed to get an MRI, and I recall the whole experience was quite draining! After the fact I learned that one can request something like Xanax to ease the tensions caused by the test. So, perhaps a second thing to consider asking a doctor ordering an MRI is whether anti-anxiety medication is warranted. "
That's scary! I hope that doesn't put anyone 'off' from having an MRI. But thank you for your unique perspective.
I didn't find having an MRI that bad. And I've had several.
"It is loud, and in closed machines you need to be still in a small tube for what feels like a long time. I was experiencing some of my worst Lyme symptoms when I needed to get an MRI, and I recall the whole experience was quite draining! After the fact I learned that one can request something like Xanax to ease the tensions caused by the test. So, perhaps a second thing to consider asking a doctor ordering an MRI is whether anti-anxiety medication is warranted. "
That's scary! I hope that doesn't put anyone 'off' from having an MRI. But thank you for your unique perspective.
I didn't find having an MRI that bad. And I've had several.
A second important thing to ask your doctor and/or imaging center is:
2. Do they use Fluid-Attenuated Inversion Recovery (FLAIR)?
"(FLAIR) Fluid attenuation inversion recovery is a special inversion recovery sequence with long TI to remove the effects of fluid from the resulting images. The TI time of the FLAIR pulse sequence is adjusted to the relaxation time of the component that should be suppressed. For fluid suppression the inversion time (long TI) is set to the zero crossing point of fluid, resulting in the signal being 'erased'.
Lesions that are normally covered by bright fluid signals using conventional T2 contrast are made visible by the dark fluid technique FLAIR is an important technique for the differentiation of brain and spine lesions."
http://www.mr-tip.com/serv1.php?dbs=flair&type=db1
2. Do they use Fluid-Attenuated Inversion Recovery (FLAIR)?
"(FLAIR) Fluid attenuation inversion recovery is a special inversion recovery sequence with long TI to remove the effects of fluid from the resulting images. The TI time of the FLAIR pulse sequence is adjusted to the relaxation time of the component that should be suppressed. For fluid suppression the inversion time (long TI) is set to the zero crossing point of fluid, resulting in the signal being 'erased'.
Lesions that are normally covered by bright fluid signals using conventional T2 contrast are made visible by the dark fluid technique FLAIR is an important technique for the differentiation of brain and spine lesions."
http://www.mr-tip.com/serv1.php?dbs=flair&type=db1
A person who is a bit claustrophobic can request that their doctor send them to an imaging center/hospital that has one of the 'open' MRIs.
I doubt if any doctor would react negatively to that request.
Xanax for MRI----- might be a good idea if you can arrange for someone to take you home afterwards. I'm not nervous about an MRI, nor does the noise bother me. I survived teenagers and their music! (grin)
Plus they give you ear plugs which dulls the noise a bit.
A friend of mine just had a spine MRI and the techs put music on REAL LOUD in the misbegotten idea that music would help!!! So he had the MRI clunks AND some very loud and awful music to contend with. Geesh!
I doubt if any doctor would react negatively to that request.
Xanax for MRI----- might be a good idea if you can arrange for someone to take you home afterwards. I'm not nervous about an MRI, nor does the noise bother me. I survived teenagers and their music! (grin)
Plus they give you ear plugs which dulls the noise a bit.
A friend of mine just had a spine MRI and the techs put music on REAL LOUD in the misbegotten idea that music would help!!! So he had the MRI clunks AND some very loud and awful music to contend with. Geesh!
I have to make a correction to my OP----- I said:
"Sometimes called a 3T or a T3 machine"
It should read "Sometimes called a 3T."
The T3 is another term used when talking about MRIs----- and unfortunate use of similar terms which I didn't catch right away.
"Sometimes called a 3T or a T3 machine"
It should read "Sometimes called a 3T."
The T3 is another term used when talking about MRIs----- and unfortunate use of similar terms which I didn't catch right away.
You are so right about the MRI. No fun and with mine came the misdiagnoses of MS until I got to an LLMD.
It is interesting to note that there are different strength MRI's available for diagnostic testing. A couple more thoughts for consideration:
I am not aware of MRI being a primary diagnostic tool for Lyme disease or co-infections. But it is, to my understanding, one of the biggest tools for diagnosing MS. Since Lyme and MS may have similar presentations, it's not uncommon for Lyme patients to get MRI's, especially prior to being diagnosed with Lyme. (I'm sure lots of people know the above already, just recapping a bit.)
It's been years, but I do recall reading in the past that there is insufficient information tracking if, or to what extent, brain MRI abnormalities ("lesions") caused by Lyme resolve with antibiotic treatment. It is my understanding that the jury is still out on that issue, as well as on the larger issue of why some Lyme cases do come with MRI lesions while others do not. I once read that European strains of the bacteria which causes Lyme are more likely to cause brain lesions, but I can't speak to how universally accepted or supported that claim is.
Following up the the MRI strength, once could take an opposing point of view of getting "more bang for your buck" by getting a 3 T scan versus a 1.5 T scan. Electricity and magnetism are fundamentally related, so I think a decent analogy to the stronger magnet would a brighter light. So, let's suppose one is looking for an object in a dark room. Say that a 25 watt bulb is shined in the room, and the object can be seen in that light. Then, a 125 watt bulb is shined in the room. The same object is detected, but now it can be seen in more detail. Is the 125 watt bulb better? The answer would depend on what level of detail or resolution is required. If you simply need to know whether or not the object is there, then the 25 watt bulb suffices.
3 T MRI's offer more sensitive detection of abnormalities on brain MRI's, and that probably is quite valuable in tracking the disease progression in patients with confirmed MS, as progression is correlated with the number and size of lesions. (Or such is my understanding.) But when being evaluated for MS, a lesion-free 1.5 T MRI might be sufficient to rule out MS, especially if other tests used in diagnosing MS, such as spinal tap and neurological exam, are negative.
Ultimately, while I can understand why some patients might have diminished confidence in their doctors, hopefully the doctor ordering the MRI can be trusted to recommend the appropriate strength MRI. I think it is worth pointing out that a doctor may react negatively to being questioned on their judgement. I'm not defending that attitude, I personally think that doctors need to culturally adapt to patients who are able to be more informed because of the greater availability of information. As another analogy, I've never met a car salesmen who took offense to me researching my next vehicle, but I've seen doctors cringe when I weigh in on their expertise! So I bring up the potential adverse reaction to questioning the doctor's orders in a precautionary way only.
So, in evaluating the merits of 1.5 T versus 3 T MRI's, I'm admittedly taking the position of devil's advocate against the stronger magnet. However, I do think that while it is natural to want the best and latest technology, it is also important to note that stronger is not inherently better, and the best tool always depends on the details of the job at hand.
BTW, the experience of getting a brain MRI, which I thankfully have not needed to endure since '09, is no fun at all, especially if one has developed heightened sensitivity to sound as many with Lyme do. It is loud, and in closed machines you need to be still in a small tube for what feels like a long time. I was experiencing some of my worst Lyme symptoms when I needed to get an MRI, and I recall the whole experience was quite draining! After the fact I learned that one can request something like Xanax to ease the tensions caused by the test. So, perhaps a second thing to consider asking a doctor ordering an MRI is whether anti-anxiety medication is warranted.
I am not aware of MRI being a primary diagnostic tool for Lyme disease or co-infections. But it is, to my understanding, one of the biggest tools for diagnosing MS. Since Lyme and MS may have similar presentations, it's not uncommon for Lyme patients to get MRI's, especially prior to being diagnosed with Lyme. (I'm sure lots of people know the above already, just recapping a bit.)
It's been years, but I do recall reading in the past that there is insufficient information tracking if, or to what extent, brain MRI abnormalities ("lesions") caused by Lyme resolve with antibiotic treatment. It is my understanding that the jury is still out on that issue, as well as on the larger issue of why some Lyme cases do come with MRI lesions while others do not. I once read that European strains of the bacteria which causes Lyme are more likely to cause brain lesions, but I can't speak to how universally accepted or supported that claim is.
Following up the the MRI strength, once could take an opposing point of view of getting "more bang for your buck" by getting a 3 T scan versus a 1.5 T scan. Electricity and magnetism are fundamentally related, so I think a decent analogy to the stronger magnet would a brighter light. So, let's suppose one is looking for an object in a dark room. Say that a 25 watt bulb is shined in the room, and the object can be seen in that light. Then, a 125 watt bulb is shined in the room. The same object is detected, but now it can be seen in more detail. Is the 125 watt bulb better? The answer would depend on what level of detail or resolution is required. If you simply need to know whether or not the object is there, then the 25 watt bulb suffices.
3 T MRI's offer more sensitive detection of abnormalities on brain MRI's, and that probably is quite valuable in tracking the disease progression in patients with confirmed MS, as progression is correlated with the number and size of lesions. (Or such is my understanding.) But when being evaluated for MS, a lesion-free 1.5 T MRI might be sufficient to rule out MS, especially if other tests used in diagnosing MS, such as spinal tap and neurological exam, are negative.
Ultimately, while I can understand why some patients might have diminished confidence in their doctors, hopefully the doctor ordering the MRI can be trusted to recommend the appropriate strength MRI. I think it is worth pointing out that a doctor may react negatively to being questioned on their judgement. I'm not defending that attitude, I personally think that doctors need to culturally adapt to patients who are able to be more informed because of the greater availability of information. As another analogy, I've never met a car salesmen who took offense to me researching my next vehicle, but I've seen doctors cringe when I weigh in on their expertise! So I bring up the potential adverse reaction to questioning the doctor's orders in a precautionary way only.
So, in evaluating the merits of 1.5 T versus 3 T MRI's, I'm admittedly taking the position of devil's advocate against the stronger magnet. However, I do think that while it is natural to want the best and latest technology, it is also important to note that stronger is not inherently better, and the best tool always depends on the details of the job at hand.
BTW, the experience of getting a brain MRI, which I thankfully have not needed to endure since '09, is no fun at all, especially if one has developed heightened sensitivity to sound as many with Lyme do. It is loud, and in closed machines you need to be still in a small tube for what feels like a long time. I was experiencing some of my worst Lyme symptoms when I needed to get an MRI, and I recall the whole experience was quite draining! After the fact I learned that one can request something like Xanax to ease the tensions caused by the test. So, perhaps a second thing to consider asking a doctor ordering an MRI is whether anti-anxiety medication is warranted.
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