MRI with or w/o contrast - plz help asap

[Squirt13]

I am finally having another evaluation of my spine since my pain has gotten worse in the last 6 years. I have moved and therefor am seeing all new doctors also.
This new doctor ordered a full MRI from lumbar to cervical. BUT he did not order it with pre and post gadolinium contrast and MPGR like my prior doctor did six years ago. I did not think to ask when I was with the doctor and now I cannot get past his personal assistant who insists that the doctor ordered it the way he wanted it. She said contrast is for seeing scar tissue and since I haven't had surgery there the contrast is not needed. I told her that while I have not had surgery, I have had 20+ epidurals for other surgeries and 12-15 lumbar block injections all in the same site. The last few epidurals had such difficultly getting around the scar tissue that the anesthesiologist that placed it had to do it under fluoroscopy and had to go higher up in the spine. Still she said epidurals are "not invasive enough to cause scar tissue and the doctor will not order your scan with contrast even though your last doctor did".
Sooooo, my question is - how important is the contrast? Is it important enough to cancel this MRI all together and go see another physiatrist? I have no loyalty to this one because I am a new patient. I wish I could speak with him directly, but his assistant isn't going to let that happen. I do not know if my insurance will pay for more then one scan, so I'd really like it to be done right the first time.
Thanks,
Steph

[Squirt13]

Thank you for your feedback.
Kickback for referrals...grrrrr. I know it happens, but man I wish people went into medicine for the right reasons.

Any opinion onthe MPGR

[caregiver222]

You ask some excellent questions. Yes, the way the scan is ordered does matter. And this comes out to two people called "Mr. time and Mrs. money".

There are many "missing pieces" to the story, most involving the treating physician.

It is very difficult to get physicians to do exactly what you want.

It should be no surprise to you that physicians get kickbacks for referrals, and that may be the missing piece as to why you were referred to a specific person.

I would go a step further and suggest that instead of an internist you require the advice of a pain specialist. A long time I ago I had "level ten" pain secondary to a cervical injury, and I lucked out in finding a pain specialist in spinal injuries who knew exactly precisely what to do.

[Squirt13]

Thank you for your responses. I actually called my doctor of 15 years - where I just moved from and he was a little surprised I was sent to a physiatrist instead of a neurosurgeon to begin with. But this internist here said "why see a neurosurgeon unless your having surgery, a physiatrist will run the same tests"...anyway, my doctor of years that I really trust, but now lives too far away, questioned that. Is it sort of like seeing a podiatrist instead of an orthopedic doctor?
Anyway, the other question I wanted to ask about was the MPGR. Is it important to include this type of slicing in the scan? The reason I wonder is because I once had a foot MRI that was about 17 pages of very thin slicing and a follow up scan (ordered from a different doctor) that was 2 pages. So isn't the WAY the scan is ordered in terms of how thin it's sliced also matter?

Thank you again!
Steph

[toolmaker]

holdout for contrast it could save time and money.

[selmaS]

Hi..since u do not have ne attachments or committments to the new dr, can u get a 2nd opinion and see what they suggest?

I know what u mean about the insurance paying and having to go twice.This has happened to me...I was not too happy going in 2 x's bcuz the dr would not listen.I am over all that and have moved on to another dr.

Best of luck
"selma"

[caregiver222]

It's pretty important. You get a lot more information from the scan.

That being said there is hazard in a contrast scan. The hazard is not insignificant. The dye has some toxicity and there is a small group of people who get serious complications. And the dye is a bit more expensive.

There is a risk-benefit in the dye protocol.

The question is "Does the benefit outweigh the risk?"

Contrast is not only for "seeing scar tissue.

My gut feeling is that a dye contrast scan is not unreasonable in your situation.