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Old 06-14-2009, 09:26 AM   #1
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Red face Why MRI w/and w/out contrast? Necessary?

I had my last MRI (for MS) in December. I was recently having vision problems and the dizziness going on, so the neuro ordered MRIs to be done. I'm better now. I have that gut feeling that it was MS related, and nothing new. Just lying in that tube for close to two hours with claustrophobia is ridiculous. Why would the neuro want the MRI with and without contrast? If I show lesions in the MRI then what? There's nothing I can do about them; right? The MRIs just see where the lesions are; right? If the lesions show up, they show up. I know what symptoms I feel, so I know where I'm at physically. I'm thinking these MRIs are a waste of time and money, but don't get me wrong, I love this neurologist. I guess I'm just angry because I got my first insurance bill for an unrelated lumbar MRI that was done w/and w/out contrast in March. My portion was $110, so this one will be doubled. I could have bought myself a couple shoes or clothes with that. I know; your right. It could've been worse if I hadn't had insurance. Thanks in advance for your responses.

 
Old 06-14-2009, 02:30 PM   #2
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Re: Why MRI w/and w/out contrast? Necessary?

Im not 100% sure Im understanding your dilemma here. To have the MRI done with and without contrast will not double your insurance....the contrast part, actually cost me $9.50 last time in addition to the $25.00 co-pay that MRIs cost me. In general, Contast costs about 21.00 per syringe, and only one syringe is used.
The reason they want to see if you have lesions, is not only to check the placement and size of them, but to make sure they are MS related. You can have traumatic head injury, or serious eye issues, and have that show up on an MRI and it wont look anything like an MS lesion.
MS lesions are distinct in size, placement and shape...which is why "just having a lesion or two" doesnt necesssarily mean its MS.
If I were developing new lesions, and thus developing any kind of symtoms, Id sure want to know first what is causing the symtoms and second if these lesions can be seen and how they should best be treated. Yes, in some cases, a good 5 day dose of IVSM will treat the symtoms and its over, whereas, ignoring it can cause permenant damage.
Hope this helps.
Nikki
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Old 06-16-2009, 06:34 PM   #3
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Re: Why MRI w/and w/out contrast? Necessary?

I am an MRI tech and not a radiologist or neurologist so I am not an expert in diagnosis or even the billing. In the brain, contrast does not help distinguish MS lesions. Usually it is pretty obvious. It is suppose to tell if the lesions are active MS or not. Out of the many brain sequences (set of pictures) we run, something called the FLAIR will show MS best and it doesn't matter if you use contrast or not. The lesions are bright and easy to see. We will run another sequence called T1 and normally you cannot see these lesion or they are very difficult to see. Contrast will enhance these lesions if they are active otherwise they remain darker and difficult to see. Years ago, we never used contrast on brains as we could tell if it was MS or not without it. Now it is part of our routine but that will vary from hospital to hospital. I'm not sure about how treatment changes if the lesions are active or not. For spinal MRI's, the FLAIR sequence doesn't work well. I'm not why. I read in a book that doctors are not sure why. In these cases, contrast can really help in seeing MS lesions in the cord which are much harder to see than in the brain. Usually lesions are in the cervical or upper thoracic spine. I hate doing lumbar cases on MS patients because the spinal cord ends at about the the L1 level so it seems like a lot scanning for nothing. Contrast is given approx 1 ml per 10 lbs up to a max of 20 ml's. We charge per ml but I am not sure exactly how much. I am sure it is pretty expensive. The cost of a exam with and without contrast vs without will be several hundred dollars more. If you get a brain and entire spinal cord with and without contrast, I am guessing that it cost about $6000, not that the hospital would be reimbursed nearly that much. Also, if you are claustrophobic, tell your doctor. He/she should be able to give you a prescription for Xanax which will help. No sense torturing yourself. Sorry this is so long, just wanted to give as much info as I could.

 
Old 06-16-2009, 10:29 PM   #4
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Re: Why MRI w/and w/out contrast? Necessary?

I guess the question I was trying to ask was: Wouldn't the MRI with contrast be enough to see everything? Miknan you seemed to answer exactly what I was trying to ask, and-some. I had it all wrong thinking that the contrast would/could show everything. I did have the brain and cervical done with and without contrast, so if there's something there, they're going to see it. For the claustrophobia, I covered my eyes with an eye mask, and they put a headset with music which helped tremendously. Next time I will dope up with some Xanax. I would have taken something, but the center I went to rescheduled my MRIs 2x, and by that time, I no longer had a ride. I had to drive myself there. Thanks so much for the lengthy explanation. It was quite informative. I am so new to this MS thing, and every bit of information helps. MSNik, I wish I had your insurance. What bargains on your MRIs. We didn't have a choice of insurance companies. We just had to take what the job offered. I still need to send in my payment of $110.00 for a Lumbar MRI done w/and w/out contrast performed back in March. Thanks a bunch and take care.

 
Old 06-17-2009, 05:09 AM   #5
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Re: Why MRI w/and w/out contrast? Necessary?

Plus1more-
I think you misunderstood what He was saying. He wrote "We will run another sequence called T1 and normally you cannot see these lesion or they are very difficult to see. Contrast will enhance these lesions if they are active otherwise they remain darker and difficult to see. " and here, he was talking about the spinal MRI, specifically the T1 sequence. Because (he also wrote) "For spinal MRI's, the FLAIR sequence doesn't work well."

What this means is that for the spine, Contrast is necessary. Otherwise, since the Flair sequence isnt accurate in the spine, you wont always see the lesions, and contrast will help them "light up" and glow, making them easier to see. It appears, from what he wrote that the FLAIR sequence is only used on the brain, and in this sequence, contrast is not as necessary in order to see lesions.

As I said formerly, MRI is to check to see the size, placement and shape of the lesions. From seeing them, a doctor can tell if they are MS related or related to some other head trauma or injury/disease. He seemed to concur with that and also went on to talk about how contrast can tell if a lesion is active or not.

YES its very important to know if a lesion is active, and of course the treatment is different. An old lesion, which can be seen by appearance, isnt treated and usually doesnt have any side effects or symtoms, unless they are residual from the attack...however, having a new set of symtoms, or even one new symtom, can be caused by a NEW AND ACTIVE LESION in which the treatment would more then likely be a round of IVSM, thus shrinking the nerve and reducing the symtom, and hopefully getting rid of it before it becomes a permanent symtom.

And yes, Contrast is billed by the ml and the normal dosage is 1 ml per ten pounds, up to 20 mls. All insurance companies cover contrasting dye, as it is medically necessary, and the dye itself is not teribly expensive- I have a book in front of me telling me what every major insurance company reimburses for it- there is no way this should cost you more then 100$ TOPS for the additional contrast.....the extra films which are done, are charged per SERIES, not film....and there is a basic flat rate for what insurance companies will allow to be charged, and what they will reimburse. It is pretty black and white.

You said you wish you had my insurance. It wasnt my choice to pick it, its what we get, thru my husbands union. I know for a fact that I have awesome coverage and Im aware of how fortunate I am (this is my business, health care) but I will also admit, there are times when I wish we didnt have the expense that comes with it and that we had choices, since Im the only one in the family using this insurance on a regular basis! What it costs us in benefits, we could own a nicer home, or take a really nice vacation twice a year, but we dont have that luxury. We have to pay for health insurance, and this plan is what they offer. In some ways, wonderful, in other ways, a real financial strain.

I hope that me pointing out the clarification makes sense to you. NO matter how you slice it, having it with contrast is important because finding lesions in the spinal area is ALLOT harder then finding them in the brain...and knowing if they are active or not, is critical to how they are treated...So, your doctor ordering it this way is the right thing to do. Hope this helps..
Nikki
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