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MX, SX & Off-Road Discussions
General Moto | Off-Topic Posts
MRI with or without contrast?
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[QUOTE="nephron, post: 709418, member: 23759"] 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. [/QUOTE]
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MX, SX & Off-Road Discussions
General Moto | Off-Topic Posts
MRI with or without contrast?
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