MRI with or without contrast?

[Jon K.]

I finally have the MRI scheduled for my back. T-11, T-12, L-1, and L-2. I had planned to pay cash, somewhere around $1500.

Now I find out that the scheduling people have me scheduled for TWO MRIs. One with contrast, one without. Frankly; I don't have the $$!!

I have dug around a bit and basicly understand that the contrast shows different stuff.

So my question is: If it shows more; why would any MRI be done without contrast? Does the contrast lessen the effectivness somehow in other areas?

I am completely baffled.

 

[matt ruiz]

I am not sure about the MRI ?, but I do know if I had to pay for this stuff out of my pocket I would apply for medi-cal or some kind of financial aid. I had a moto accident once that put me in the hospital for a week and lots of post hospital visits with three different doctors. I had just started a new job and did not have my benefits just yet. I ended up qualifing for some kind of shared cost medi-cal and only had to pay a third of all my bills. Good luck

 

[maco]

I know some surgeons like a contrast myelogram before surgery even if an MRI has been done.This procedure gives a bit more info on a surgical level,I believe.You need more info.Are you a surgical candidate?Better to get a clearer understanding be fore the fact.Are you being referred for MRI by an Orthopedic or nuerosurgeon?If your paying out of pockect you might inquire about a cash discount.

 

[Jon K.]

Had it done yesterday. Without contrast. I was sent by my general physician, and what I needed (and never got) was a bit of control over the procedure and better communication with the techs. They seemed to assume that they were dealing with an idiot, and do not know how to respond to questions or requests.

The lady who took my money stumbled over dividing $1233 by two. I told her that half of 33 is 16.5, and she really got confused. :silly:

I did get to see the images, they looked fine to me.

The procedure was simple enough. They stuffed me in a pipe and played some of them "Close Encounters" tunes from the mother ship. Brooonk, Breeek, Brooonk, Breeek, Breeek, Brooonk. Kinda cool actually.

Maco; I do not know if I am a surgical candidate or not; the Radiologist is
supposed to get in touch with me today and share their findings.

Thanks guys.

 

[nephron]

Jon, what was your doc looking for?

 

[Jon K.]

Nephron; for two years I have had something going on in my back. Some days worse than others. Aspirin helps, but of course is just masking the problem. It has completely stopped me from riding at anything other than a leisurely pace.

If I bang my shoulder unexpectedly, or step in a little hole while walking; all kinds of muscles back there scream bloody murder, grab ahold, and will not let go for several seconds, leaving me trembling, sobbing and shaken. Well, maybe not that bad, but close. I walk around scared all the time. And I have to be very careful how I lay in bed. Any sudden moves will be paid for dearly.

I first noticed that I had a back, at the motocross track. I got a little out of shape over the "Roller Coaster"; and touched down a bit awkwardly. No big deal, and I can't believe that I injured it right there, but I did feel something during that episode that did not feel quite right. And it has gotten progressively worse.

The chiropractor tortured me for a few months before giving up and sending me away. Two chiropractors actualy. Their X-rays did not show anything unusual, other than a racing injury from twenty-five years ago, but that injury is much lower in my back. This problem is up around T-12 or so.

I am thinking a bulging disc, but do not really know. Lately the pain has been running around my right flank, almost into my belly. Weird. Sort of like an inflamation in the torso muscles.

Anti-inflamatories have never done any good, though. Muscle relaxers don't seem to help.

In short, I don't really know what to look for, and I don't suppose the docs do either. We are just hoping to uncover something that can be fixed.

I would be very happy to get your thoughts.

I have not heard back from the radiologists, I have a call in for them right now.

 

[nephron]

Sounds very 'disky' ;) ; typically starts with an unusually minor event, and is exaccerbated by similar movements. Relatively 'stable' or not bothersome until another freak movement causes it hurt like hell. Sharp, local pain? Lumbar or Thoracic? Either case, they're really not that dangerous--just a pain in the butt.

I wish I could draw you a picture, but discs reside b/t vertebral bodies. Consider that just posterior to the vertebra (and disc) is the spinal cord itself, which is surrounded by these things laminae and pedicles Every level, 2 nerve roots exit at either side b/t the laminae (which has formed a nerve exit opening). This nerve contains all connections needed to provide sensory and motor function to its distribution. Things are cozy until the nucleus pulposus decides to herniate out posteriorly from its lateral side to back, placing the point of maximum impact at the nerve trying to exit the neural foramina. As it herniates, it causes the fibrous portion of the disc to push hardly on the nerve root.

Depending on the severity, it can just be severe, intermittent pain, but might be as bad as to compromise motor function in that 'myotome'. Those people need surgery yesterday.

The best treatment (IF you have disc disease) for a case like yours would be steroid/marcaine injections directed right to the nerve outlet.

There's no way of telling that that's what you've got (without looking you over, etc.), but a noncontrast MRI would be the best test (you did right). Contrast is reserved for finding epidural abscess, malignancy, etc.

 

[Jon K.]

Just got the results back.

"No abnormalty identified in T-11 - T-12, T-12 - L-1, L-1 - L-2, L-2 - L2-3"

"L3 - L4: Minimal facet joint hypertrophy. No evidence of disc protrusion."

"L-4 - L-5: The disc displays approximately 2mm of posterior protrusion with minimal deformity of the anterior midline aspect of the thecal sac. Neural foramina are minimally stenotic. Facet joints are minimally hypertrophic."

" L-5 - S-1: No posterior or posteriolateral disc protrusion is identified. Facet joints appear unremarkable. There is minimal neural foramen stenosis bilaterally. Note is made of anterior disc protrusion."

Impression:

1. L-3 - L-4: Minimal facet joint hypertrophy.

2. L4 - L-5: Minimal midline posterior disc protrusion without significant mass effect. Minimal facet joint hypertrophy.

3. L-5 - S-1: Anterior disc protrusion without posterior or posterolateral disc abnormality. No significant central canal or neural foramen compromise is identified.

Wow!

Anyone wish to translate?

Sounds like they didn't find much, and I am not having any symptoms in my lower back. My symptoms are somewhere around L-1 & T-12.

Shoot! Did I just throw away $1600? :whiner:

 

[maco]

You know when it comes to MRIs your looking at soft tissues. Nueral Foramin are the openings on the right and left side where the major nerve roots exit at each level of the spinal column.Having these clear with no protrusion would be very good on prognosis for compression there.MRI was really new when I graduated from Chiro college.I've seen MRI reports with disc protrusions and complete recovery.Hypertrophy suggests a build up of calcium around areas of increased stress.This would be visable on X ray if it's increased density.What else do you want to know?

 

[Jon K.]

Originally posted by maco
What else do you want to know?

Maco, Nephron; thanks for the info. Is a 2mm protrusion a big deal? It doesn't sound like much.

But what is really bugging me is that the L-5 is not where the symptoms are!

And a funny thing . . . . .for the last week or so the old back has felt really good! Maybe 80% or so!

If I can just get over this confounded cold, and my jaw will heal up from having a wisdom tooth blasted out :eek: ; I might would even consider going riding!

Merry Christmas!

 

[maco]

Jon-I should be able to give an opinion on the 2mm buldge but I'm not sure.Usually disc symptoms are unrelenting.You stuck it out for 2 months with Chiropractic.I hope the D.C.s did you right,I'm sure they did there best.Some times symptoms aren't the best barometer to the area of pain.But if your pain is focused at L-1/t/12 it would be hard to ignore that area.NOt sure what I'd do at this point because Chiropractic has always been the ticket for me.But obviouly the pain is telling you something is not healing.I'll look at your threads again.

 

[blackhawk468]

Hope you find your problem and get better Jon... I had an MRI last week and my cash discount was 1700, I only had to pay 300 bucks each for two MRI's. They said something about a charity helping me pay since I was a cash patient?? weird. Anyways, let your doctor explain the MRI's to you all that writing was foreign to me but my doctor was able to explain it better.

 

[nephron]

Is a 2mm protrusion a big deal?

No. MRI's have terrific sensitivity and horrible specificity in the sense that they seem to pick up way too much.

One of the most unbelievable studies came out a year or two after MRI came in as a useful tool. They did a randomized study of patients with known disc disease and back pain and compared these to randomly selected high school male athletes with no backpain. It turned out 30% of the normal 18 y/o's had disc hernation, volume loss, and foraminal encroachment. ;) Many cases were worse than those with pain. Hence, for me, I do not do an MRI on anyone unless they have REFLEX LOSS or pseudoclaudication after a neg vascular workup--a sign of spinal stenosis.

Doctors seem not to understand that these tests and their original sens/spec designation are dependent on the 'pretest probability' of a likely finding. A simple example: if you're looking for disc disease, someone would have a higher pretest probability (and therefore raise the sens/spec of the test) if they had loss of reflex, dermatomal anesthesia, or loss of foot dorsiflexion, than one who had bilateral paraspinous muscle spasm and no neuro findings. A more exaggerated example would be some millionaire paying cash for a "PAN-MAN" MRI. In these case, the pretest is zero, the indication is zero, so the likelihood of finding something useful is very low, and the likelihood of finding many 'incidental' and meaningless lesions is very high. What's the big deal? This sends that millionaire down the road of tons of tests, some of which could include invasive tests...some of which you can DIE from.

Until a year ago, men were as likely to die from treatment of stage B prostate cancer as they were from the cancer itself. Now we 'watch and wait' for stage B stuff. So far, outcomes are great, and people aren't getting radiation proctitis, GI fistulae, etc.

That said, you had a different presentation, and I think your MRI was helpful. Remember that a negative result is both helpful (particularly for the future) and good to know.