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MRI no contrast for detecting MS
My family physician suspects I have MS, so am scheduled for an MRI this week. It is without contrast (allergies) and I'm concerned it won't show what is necessary to detect MS. Is it a reliable way to look for lesions (without contrast). If nothing shows, what is the next step. I will not have a spinal tap. This is all so unexpected and the symptoms I've had for about 3 or 4 years I would just dismiss as individual symptoms until they progressed and became annoying. Any suggestions would be greatly appreciated - this is all scary!
You are the first person I have seen mention no reflexes in the legs before. All have always heard about hyper reflexes only. But like you I have no reflexes in my right leg. I'm not sure if it is a symptom or not though as I have never bothered to ask. I just figured it is just another weird thing about my body as I have so many of them (nerves in wrong places, caffeine puts me to sleep, hyper sensitive to many medications, etc).
Hopefully you will get some answers on Wed.
Dennis
Hopefully you will get some answers on Wed.
Dennis
HI and thank you for the clarification, although I don't really understand it all. My concerns with pharmaceuticals is my history of being allergic to SO MANY drugs. I have my appt with my physician on Wed., so will find out then what, if anything, the MRI showed. Guess will have to take it from there. I think I said before, that up until now, I took each symptom as an 'individual' symptom - not putting everything together, until I had a tremor in my left hand and found myself stumbling a lot. The fatigue and heavy legs I thought was just normal for me. When I saw my physician last time and he put me through some tests - balance etc, I didn't do well, so that's why he thought I may have MS. Also not having any reflex in my legs??? Is that a symptom - I've not seen anything mentioned? Thank you again for explaining that - really do appreciate it and please don't think I'm completely down on pharmaceuticals - they have their place and have saved many people --- Just nervous for 'me' because of my experience in the past.
Hey there. Congratulations on getting the MRI done! It's such a big chunk of the diagnostic process. I'm so sorry your experience was unpleasant at times. But you did it!
To clarify, what I meant re: pharmaceutical interventions versus alternative interventions, the disease modifying treatments available to us now (if the diagnosis is relapsing-remitting MS) do not themselves treat symptoms. A patient may also choose to have their symptoms addressed with medications as well, but that's not what the DMDs are for. They play the long game.
They are proven to reduce relapse rates and there is evidence of reduced disease activity (even when relapses are not manifest, it's still going on in our brains). This is what I intended to say.
I think most of us are happy to take a multifaceted approach to our symptoms. For example, I use mindfulness exercises to be more in tune with my body and manage anxiety, etc. I've cut some of the junk our of my diet. These things make me feel better which helps in my day to day. But the distinction for me is, they do nothing about the disease itself, rather my relationship *with* the disease.
This is important to me too, but it's an area of "non-overlapping magisteria" with the actual business of directly treating and affecting change in my pathology and disease course. This is where I call in the pharmaceuticals that I accept are science-based and evidence-based.
To clarify, what I meant re: pharmaceutical interventions versus alternative interventions, the disease modifying treatments available to us now (if the diagnosis is relapsing-remitting MS) do not themselves treat symptoms. A patient may also choose to have their symptoms addressed with medications as well, but that's not what the DMDs are for. They play the long game.
They are proven to reduce relapse rates and there is evidence of reduced disease activity (even when relapses are not manifest, it's still going on in our brains). This is what I intended to say.
I think most of us are happy to take a multifaceted approach to our symptoms. For example, I use mindfulness exercises to be more in tune with my body and manage anxiety, etc. I've cut some of the junk our of my diet. These things make me feel better which helps in my day to day. But the distinction for me is, they do nothing about the disease itself, rather my relationship *with* the disease.
This is important to me too, but it's an area of "non-overlapping magisteria" with the actual business of directly treating and affecting change in my pathology and disease course. This is where I call in the pharmaceuticals that I accept are science-based and evidence-based.
Kyle, Thank you for clarifying that! I'm always nervous of all the pharmaceutical drugs because of the side effects. When I was younger never had any problems with anything I had to take, but in the past 5 years or so, I have a reaction to almost everything! - That's why I always 'try' to choose alternative treatments. May I ask how long you have had MS and are you on any specific diet? ZZ
Hi ZZ-
I'm glad your MRI experience wasn't too bad, although it sounds as if it could have gone better :-)
I think the reference to alternative therapies was made by immisceo rather than Sarah. It's important to distinguish between treating MS and treating MS symptoms.
Current Disease Modifying Drugs (DMD's)are aimed at slowing, if not halting, the forward progress of MS. MS is a progressive disease and if unchecked it will march forward. Each step causes a little more damage. These DMD's include Copaxone, Rebif, Avonex, Betaseron, Tysabri, Tecfidera, Gilenya and Rituxan. None of these meds are designed to treat symptoms.
There are proponents of diet as a means to combat the progress of MS. These dietary changes, notably a paleo diet or a gluten free diet. There are fabulous claims as to the results achieved by adopting various diets. To my knowledge there is no peer reviewed scientific evidence to support these claims.
Symptoms are the result of nerve inflammation or nerve damage. Individual symptoms can be treated with traditional pharmaceuticals or alternative therapies. I am not familiar with many of the alternative therapies for my personal symptoms. I take Lyrica + Elavil to relieve neuropathic foot pain. I take Flomax to alleviate urinary hesitancy and incomplete bladder voiding. Neither med has any impact on my MS. They deal only with specific symptoms.
Kyle
I'm glad your MRI experience wasn't too bad, although it sounds as if it could have gone better :-)
I think the reference to alternative therapies was made by immisceo rather than Sarah. It's important to distinguish between treating MS and treating MS symptoms.
Current Disease Modifying Drugs (DMD's)are aimed at slowing, if not halting, the forward progress of MS. MS is a progressive disease and if unchecked it will march forward. Each step causes a little more damage. These DMD's include Copaxone, Rebif, Avonex, Betaseron, Tysabri, Tecfidera, Gilenya and Rituxan. None of these meds are designed to treat symptoms.
There are proponents of diet as a means to combat the progress of MS. These dietary changes, notably a paleo diet or a gluten free diet. There are fabulous claims as to the results achieved by adopting various diets. To my knowledge there is no peer reviewed scientific evidence to support these claims.
Symptoms are the result of nerve inflammation or nerve damage. Individual symptoms can be treated with traditional pharmaceuticals or alternative therapies. I am not familiar with many of the alternative therapies for my personal symptoms. I take Lyrica + Elavil to relieve neuropathic foot pain. I take Flomax to alleviate urinary hesitancy and incomplete bladder voiding. Neither med has any impact on my MS. They deal only with specific symptoms.
Kyle
All went quite well with the MRI. The first 20 mins was without contrast - then I was slid out and got the injection. I was thinking - this isn't so bad and then all of a sudden, felt soooo sick and broke out in a sweat. The nurse said I was white as a sheet - was I ok - I said 'no' I feel very sick. She called another nurse and they put cool cloths on my head and chest - the put me on oxygen. Waited a few mins - kept me on oxygen and then slid me back in and took more pic for another 10 mins. I was a bit dizzy, but ok - til later in the evening when I went to make myself a cup of hot tea and felt like I was going to pass out - sooo dizzy. Sat down and about 30 mins later had to vomit. Kinda yukkie most of the night but ok this morning. Anyone have this happen to them?? I don't regret having it done with the contrast, as at least I am done with it for awhile now. Re more natural alternatives - Yes, they can "just" make you feel better but do nothing to 'cure' the disease --- Yet, how is that any different from drugs - they don't cure the disease either - just help to manage the symptoms - I don't understand the comment. A matter of choice, I guess. IF I do have the disease, I think my choice would be alternatives... Anyone familiar with this? Thanks again SO much to all of you for your support!!!
I've had the LP and it was like a mosquito bite. I worried about it for nothing. I have MS but no O bands showed up for me. My lesions are in my brain and spine.
The contrast does NOT contain iodine and sometimes makes you taste or smell something funny and it isn't in your system very long. It's a very small needle. Sometimes they will give you headphones with music, it depends on the facility.
You've been given some good advice but think outside the box and let the doc do his work before you worry yourself!
The contrast does NOT contain iodine and sometimes makes you taste or smell something funny and it isn't in your system very long. It's a very small needle. Sometimes they will give you headphones with music, it depends on the facility.
You've been given some good advice but think outside the box and let the doc do his work before you worry yourself!
Hi ZZ- That you had a bad reaction to the IVP dye does not mean you will have a reaction to the MRI contrast agent; gadolinium. As the nurse said it does not contain iodine, which is like what caused your reaction.
The testing done in conjunction with an MS diagnosis usually includes:
MRI - Brain, c & t Spine with and w/o contrast.
Blood tests - TO rule out MS mimics like Lyme disease.
Lumbar Puncture (LP) - aka spinal tap, to look for oligoclonal bands unique to spinal fluid.
Nerve conduction and or evoked potential tests - To evaluate the transmission of info along nerve pathways.
Keep us posted.
Kyle
The testing done in conjunction with an MS diagnosis usually includes:
MRI - Brain, c & t Spine with and w/o contrast.
Blood tests - TO rule out MS mimics like Lyme disease.
Lumbar Puncture (LP) - aka spinal tap, to look for oligoclonal bands unique to spinal fluid.
Nerve conduction and or evoked potential tests - To evaluate the transmission of info along nerve pathways.
Keep us posted.
Kyle
What is 'all the testing' once the MRI is done? I'm don't know why, but I am so nervous about the contrast. The radiology nurse said especially if they are looking for MS their protocol is using the contrast, so my doctor changed the order. I am VERY allergic to the IVP dye they use for kidneys - I literally coded and was warned never to have that again, but the nurse said this contrast doesn't contain any iodine, so hope that's what it was that caused that terrible experience. The side effects to the contrast are: nausea, vomiting, rash and worst - heart attack! Very comforting!!! But it will be fine. I'm taking a small dose of Klonopin about an hour before the procedure. Thanks for your info and will check back in later. What an awesome group!!
Good luck with the MRI. :-)
Interestingly I have only had 1 MRI done without contrast or MS protocol because it wasn't even being considered at that point. My results helped narrow things down enough that I needed to get referred to a neurologist.
My neuro did not require another one once we got through the rest of the testing and he prefers to rely on changes in symptoms and major relapses before he will order another.
Corrie
Interestingly I have only had 1 MRI done without contrast or MS protocol because it wasn't even being considered at that point. My results helped narrow things down enough that I needed to get referred to a neurologist.
My neuro did not require another one once we got through the rest of the testing and he prefers to rely on changes in symptoms and major relapses before he will order another.
Corrie
MS is not a diagnosis made by a primary care physician, or I've never heard of it occurring. Often, they are the first to mention it or suspect it and refer someone on to a neurologist, but it is outside of their area of expertise to diagnose.
When someone is diagnosed with MS, they then pick out a disease modifying treatment (often shortened to DMD). These are the drugs the specifically work on altering the disease course (not treat symptoms). They are our best weapon at present, although it is a personal decision to use them or not.
Please be aware, that if you do have MS, you will be able to discuss all of your options with your diagnosing doctor or an MS nurse. Patient programmes from the pharmaceutical companies make these drugs affordable for most people (in other words, if you're googling, don't get sticker shock. This is a price they ask for from insurance companies, not from us).
There is no evidence that any natural methods can alter disease course. They may make you *feel* better (by alleviating stress, helping to manage discomfort, etc) but the disease itself marches on.
But all of those thoughts can wait until you get your results. As you say, take it one step at a time.
When someone is diagnosed with MS, they then pick out a disease modifying treatment (often shortened to DMD). These are the drugs the specifically work on altering the disease course (not treat symptoms). They are our best weapon at present, although it is a personal decision to use them or not.
Please be aware, that if you do have MS, you will be able to discuss all of your options with your diagnosing doctor or an MS nurse. Patient programmes from the pharmaceutical companies make these drugs affordable for most people (in other words, if you're googling, don't get sticker shock. This is a price they ask for from insurance companies, not from us).
There is no evidence that any natural methods can alter disease course. They may make you *feel* better (by alleviating stress, helping to manage discomfort, etc) but the disease itself marches on.
But all of those thoughts can wait until you get your results. As you say, take it one step at a time.
Thank you again to all of you (sorry I'm a newbie at this and don't know how to comment to all). It is so comforting being able to talk to you all about my concerns and fears.. Just knowing someone is there is a help. Tomorrow is my big day.. Going to take Klonopin about an hour before. Since the hospital is 100 miles away, have a friend driving me. No future appts yet -- taking it one step at a time. Can my family physician not dx me with the disease if it shows positive or is it necessary to go to a neurologist? This is all adding up and I have no insurance. Has anyone used 'natural' methods to control their MS symptoms? I've read about Tyrosine and a few other supplements? Thanks again and YES, my eyes will be closed!!! : ) ZiggyZig
I'm sure you'll do fine. I just close my eyes before the slide me in, and don;t open them again until they slide me out. Keeps me from "knowing" I'm in the machine :-)Keep us posted.
Kyle
Kyle
Thank you so much to all of you that have replied. Well, the hospital that is going to do the MRI will not do it without contrast, so going to give it a try. I spoke with the nurse and she assured me it is not contrast with iodine (that's what I'm allergic to) so should be fine. I am taking something beforehand for the clausterphobia but still nervous about the contrast. It is their protocol and they say it's a waste of money to have it done w/o contrast - especially if looking for MS. Again, thank you!!!
Hi ZZ - Welcome to the forum.
All visible lesions will appear on an MRI done without contrast. As JJ said, the contrast allows the lesions to be "time stamped". Lesions that have been active within the last 30-40 days will light up in the presence of the contrast agent.
One of the components of the McDonald Criteria for diagnosing MS is Dissemination in Time, meaning that the MS has been active at at least 2 distinct points in time. If, on a single MRI, you have some lesions that enhance (light up) and some that don't, you satisfy this part of the criteria. The bonus is that you can see it in one MRI, as opposed to having to come back in 3-6 months for a follow up MRI.
Is your GP/PCP going to refer you to a neurologist?
Kyle
All visible lesions will appear on an MRI done without contrast. As JJ said, the contrast allows the lesions to be "time stamped". Lesions that have been active within the last 30-40 days will light up in the presence of the contrast agent.
One of the components of the McDonald Criteria for diagnosing MS is Dissemination in Time, meaning that the MS has been active at at least 2 distinct points in time. If, on a single MRI, you have some lesions that enhance (light up) and some that don't, you satisfy this part of the criteria. The bonus is that you can see it in one MRI, as opposed to having to come back in 3-6 months for a follow up MRI.
Is your GP/PCP going to refer you to a neurologist?
Kyle
when i had my last MRI 9/18/13 i had an allergic reaction to the Gadopentetate (Magnevist) contrast and they said if i have to have a MRI in the future i would need to be pre-medicated first
so if u would need to have a MRI w/contrast ask ur Dr. about pre-medicating first . hope this helps u and goodluck with your MRI
so if u would need to have a MRI w/contrast ask ur Dr. about pre-medicating first . hope this helps u and goodluck with your MRI
COMMUNITY LEADER
Hi and welcome to our little MS community,
Contrast lights up new and active lesions and it's helpful in identifying older prior demyelinated lesions, from new or still active lesions, but there is a time limit of only 30-40 days so they don't always get caught in time. Your MRI (MS protocol?) with out contrast will still pick up any visible lesions, but it just won't separate the new from the old, so yes without contrast is reliable.
MS has many mimics, and there are a lot of sx's on the list for MS, that are also on the lists of other conditions, and they will need to be investigated and ruled in or out. MS is suppose to be a clinical dx with your sx's, medical history, clinical signs of lesions and MRI, LP, EVP etc test result backing it up.
Try to take one step at a time, and not thinking too far ahead with the what if's...
Cheers..........JJ
Contrast lights up new and active lesions and it's helpful in identifying older prior demyelinated lesions, from new or still active lesions, but there is a time limit of only 30-40 days so they don't always get caught in time. Your MRI (MS protocol?) with out contrast will still pick up any visible lesions, but it just won't separate the new from the old, so yes without contrast is reliable.
MS has many mimics, and there are a lot of sx's on the list for MS, that are also on the lists of other conditions, and they will need to be investigated and ruled in or out. MS is suppose to be a clinical dx with your sx's, medical history, clinical signs of lesions and MRI, LP, EVP etc test result backing it up.
Try to take one step at a time, and not thinking too far ahead with the what if's...
Cheers..........JJ
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