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Old 12-19-2009, 10:47 AM   #1
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MRI without contrast

I recently had an attack of papilloedema which my consultant ophthalmologist thought likely to be a symptom of MS. Consequently he put me on a three-day course of IV SoluMedrol 1g and subsequently sent me for an MRI scan. At the start of the scan, the technician explained that they would inject me with contrast medium half-way through the process. However, after leaving me for about 15minutes after the basic scan, another technician arrived and told me it was all over. I asked if they had forgotten the contrast medium and she said no, it wasn't necessary. Later that day, I saw a neurologist who told me I do not have MS. Good news but it left me wondering why they would have decided after the first scan that a scan with contrast was not necessary.

Does anyone have any idea?

Last edited by TopGeek; 12-19-2009 at 10:57 AM. Reason: detail

 
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Old 12-19-2009, 01:58 PM   #2
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Re: MRI without contrast

Hi Geek. My first idea is that unless a DOCTOR ordered the MRI to be stopped without performing the contrast injection, a technician cannot make that decision.
Techs always seem to think they saw all they need to see, without contrast; however without contrast, if there are any small lesions on your brain/ spine, they wouldnt have shown up.
I would definately be asking the person who ordered this test why they didnt feel it was necessary to have the contrast done- and be skeptical as to what they answer you with.....its your RIGHT to have the contrast, so that the films dont miss what could very well be important clues as to what is going on with you.
Its wonderful - if you dont have MS....but are you back to the drawing board wondering what you DO have?
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Old 12-19-2009, 03:05 PM   #3
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Re: MRI without contrast

Ditto with a caveat to Nikki- you should determine what the medical procedural rules are in Belgium. Also, ask your neuro to show you why he thinks you do not have MS. If he is basing his opinion solely on the MRI, find another neurologist and arm yourself with the McDonald Criteria for MS diagnosis- this is just a guideline, but it is pretty standard to allow for a competent diagnosis.
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Old 12-19-2009, 04:11 PM   #4
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Re: MRI without contrast

Yes, these are indeed questions that, on reflection, I should have asked at the time but I was so wound up about the diagnosis that I didn't think about it until later. I do have to go back for a visual evoked potentials test in January so will ask then.
This is one of the top university hospitals here and I have been extremely impressed with their thoroughness so far.

 
Old 12-20-2009, 06:29 AM   #5
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Re: MRI without contrast

TopGeek, papilloedema is usually caused by only a handful of things, one being a intercranial pressure. This can be caused by a auto-accident, a hit on the head- or, SWELLING OF THE OPTIC NERVE.

Because the optic nerve is associated with MS, its better to question this and have it discussed then to wonder. You said a opthamologist consulted on this. Thats a decent start, but normally a Neuro-Opthamologist would consult.

Do you have a history of headaches? Was any other test ordered, like a visual field test or EEG?

As happy as I am to hear that you like this hospital center and that you feel they have been thorough- Im seeing a hole (gap) in this picture. Papilloedema can be very serious; and can definately be the missing link to your dx. Your eye doctor thought so. Who didnt agree?

Keep us posted.
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Old 12-20-2009, 09:56 AM   #6
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Re: MRI without contrast

The sequence of events was that I had some strange peripheral visual effects in my right eye and went to my local ophthalmologist. She said I had papilloedema and sent me straight to the emergency opthalmologist at the hospital. He immediately sent me for a whole series of tests, including a CT scan, visual field test and a lumbar puncture. Apparently the CT scan, all blood test results and the lumbar punture were clear so they admitted me and put me on a 3-day course of SoluMedrol 1g with the gentle warning that, because I had a similar attack in the other eye two years ago, the most likely cause was MS. For that reason, I was also booked for an MRI.
I doubt the technician would have taken the decision to skip the scan with contrast. I presume the 15-minute pause was for discussion with the neurologist. The scan images go directly on line so the neuro would have been able to analyse them immediately. I will anyway ask when I go back in January.
I saw the neuro-ophthalmologist last week (head of eye hospital), had another visual field test and he just said the course of recovery looked good and that it was often impossible to find the cause of papilloedema.
I did suspect cranial hypertension myself because, although I had no headaches, it did seem that my occipital region was very sensitive for a week after the treatment. (The opening CSF pressure was normal.) My blood pressure was also higher than usual (160/90) before going to the hospital, although it did come down to 130/80 during the SoluMedrol treatment and has stayed down ever since.

Last edited by TopGeek; 12-20-2009 at 10:37 AM. Reason: detail

 
Old 12-20-2009, 12:22 PM   #7
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Re: MRI without contrast

Well, TopGeek-- no one can say you arent on top of your game. You seem to have a clear analysis of what is happening and what they are doing to treat it, even if the root cause is still unknown.

Follow up in January, and let us know what is said at that time....and in the meantime, keep a journal of all unusual symtoms and things you experience; from nerve tingling to weakness and everything else.

MS, as you know, presents very slowly in some people, and this might be a warning sign of things to come, or it might be nothing- a freak thing. The fact that IVSM helped, is a blessing. Ive had similar experiences with optical neuritis, which has also responded well to IVSM.

I wish you a good rest of the month, and very happy holidays!!
Nikki
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Old 01-03-2010, 02:44 PM   #8
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Re: MRI without contrast

Hmmm............ My doctor ordered an MRI of my brain with and without contrast (last week, no report yet). The technician explained to me that after the first set of scans she will determine if contrast would be necessary or not. I thought too, that the technician shouldn't make that decision but do what was on the order. Another technician arrived after the second set of scans and did inject the contrast. I would have insisted. I didn't want to have to go back later, and do it again, in case the contrast was needed after all. With health care costs increasing, patients will become more and more involved and outspoken.
Maybe a second technician needs to be present?

 
Old 01-04-2010, 07:31 AM   #9
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Re: MRI without contrast

I had an MRI scan two years ago when I had my first attack of papilloedema and that time it was done both without and then with contrast medium. This last time was done at a very large and reputable university hospital and, the technician told me I would have a second scan with contrast. However, after the scan had completed, I was left in the machine for about 15 minutes wondering what was happening.
On reflection, it seems likely that the Professor of Neurology was looking at the results and decided that the scan with contrast was not necessary. (I am sure the technician would not have made that decision.) As she is reputedly one of the top specialists in MS, I have to presume that she knows what she's doing.
I any case, I will ask when I go back for my evoked potentials test next week.

 
Old 04-15-2010, 04:22 AM   #10
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Re: MRI without contrast

I had the visual evoked potentials test and, frankly, forgot about about it because they didn't ask me to come back. However, I recently had a call from the hospital in which they said they had detected a delay in both optic nerves and would like me to come back at some convenient time (no hurry) for a blood test. They were evasive about what they were looking for.
I made an appointment for earlier this week and asked specifically what they were looking for and they told me - neuromyelitis optica. I had no idea what this implied so probably didn't ask the right questions. They checked my reflexes and took a blood sample.
Naturally, when I got home, I called my family doctor to tell him what had happened and he said he had never heard of this condition. However, I then researched it on the Internet and found that it is also known as Devic's Disease. As it has similarities to MS, I guess the MS sufferers here are probably familiar with it, although I cannot find any recent postings on this topic on the forum.
It seems the blood test shows positive in only 70% of cases but spinal lesions show on an MRI scan, whereas the brain scan is usually clear.
They did not tell me if they found any lesions on my spine so all I can do now is to wait for the report of the blood test to reach my doctor.
So, I have gone from being told that I don't have to worry about MS to now being worried sick that I have Devic's.

 
Old 04-15-2010, 05:46 AM   #11
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Re: MRI without contrast

If you have MS, there is nothing to indicate MS in any blood tests.

The VEP can indicate things that are happening neurologically that may or may not yet be indicated in an MRI. Due to my positive VEP, they did another MRI further south and found lesions on my thoracic spine. Whenever I need an MRI now, they scan my head, cervical spine and thoracic spine.
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Old 04-15-2010, 06:33 AM   #12
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Re: MRI without contrast

First, be very careful about what you read on Devics....there is so much FALSE and exxagerated information on the web about this disease, do yourself a favor and stay away from it.

Secondly, as Jayhawk said, the only thing they could possibly be doing with blood work is ruling out other things. You cant get a dx of either MS or Devics from a blood test.

Next, I know 3 people who have Devics. We have exactly the same symptoms. I started out with a pretty bad case of Optical Neuritis, which led to additional testing which led to ruling OUT Devics, because I have no spinal lesions, only brain ones. However, my pals who have Devics, have almost identical challenges and symtoms as I do. Fatigue, some cognitive issues- left side or right side weakness. Truthfully, you cant tell who has MS and who has Devics, unless you look at our films (MRIs). The idea of being terrified that you have this disease is a waste of energy.

First of all, you might not have it. And, all this worrying isnt going to change anything. Also, if you do have it, you cant take a pill and get rid of it, so better to make up your mind now that youll live with it and do whatever your doctor tells you to do and move forward. Al of us have had panicky days and nights worrying about MS and every single one of us has dealt with it. Look at me- full time job, grad school, mother of 3. Husband who has been laid off for almost a year. Female problems, surgical candidate for neck pain (herniated discs) the list is endless. Notice the one thing I didnt mention is MS. Thats the least of my problems! Im not trying to diminish your fears- Im trying to show you that what has you so upset right now isnt anything more then the "not knowing" grey area you are currently in. If you DO FIND OUT that you have either MS or Devics, youll deal with it and we will all be here to help you sort it all out.

By the way, the statistics on Devics are almost 1/1000 times LOWER then of having MS. That guarantees nothing, but it certainly reduces the liklihood.

Hang tough. Youll get answers and youll deal with it. Another way to look at this is, even if you find out tomororw that you have Devics- you also would have had it last week, last month and probably last year. So, does it make you any different tomorrow then you were then?? Its going to be ok. Breathe. And, then go do something which makes you laugh or relax. Stupid TV, good movie, get lost in a book. Take a walk. Do something to relax your brain. and, stop reading things which will scare you. Its not worth it.

Hugs
Nikki
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Old 04-15-2010, 09:06 AM   #13
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Re: MRI without contrast

Quote:
Originally Posted by MSJayhawk View Post
If you have MS, there is nothing to indicate MS in any blood tests.

The VEP can indicate things that are happening neurologically that may or may not yet be indicated in an MRI. Due to my positive VEP, they did another MRI further south and found lesions on my thoracic spine. Whenever I need an MRI now, they scan my head, cervical spine and thoracic spine.
Oh they already convinced me that I don't have MS because I have no trace of lesions in the brain. They haven't mentioned whether or not they saw any spinal lesions and I didn't know to ask at that time. My opthalmologist says there are bound to be abnormalities in my VEP test because I've had papilloedema in both eyes, although two years apart. It's just that the neurologists are now running the blood test to see if I have Devic's antibodies.

 
Old 04-15-2010, 09:18 AM   #14
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Re: MRI without contrast

Thanks for your customary detailed response Nikki. I'm not as worried as I may have sounded but there has to be something behind these two instances of papilloedema and it is a bit of a roller-coaster ride trying to find the reason. We have friends and marital relatives who have MS and they have much the same 'devil may care' attitude as you do and I admire your spirit.
In fact, I am doing my best to convince myself that I don't have Devic's. For a start, I had papilloedema but no indications of optic neuritis (no eye pain). I've also had none of the physical symptoms that are frequently mentioned (numbness or tingling sensations) but I do know that it hits people in different ways.
I will let you know when I get the final report.

Last edited by TopGeek; 04-15-2010 at 09:40 AM. Reason: detail

 
Old 04-15-2010, 09:34 AM   #15
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Re: MRI without contrast

TopGeek, just want to throw this out there. Not having lesions in the brain RIGHT NOW doesnt rule out MS if you have any of the other symptoms. Unforutnately, what might be too small to pick up on a MRI today, might show up in 6 months if you repeat it.

As for not knowing what to ask the doctor at the time, now you do. SO, this is all a learning experience for each of us. We can help you to know what to ask and what to look for- but ultimately you have to be your own advocate and keep after your docs until you get satisfactory results. Are you happy with your doctor and do you feel you are getting the proper tests and answers? You can always get second opinions, which is why I harp on everyone to keep copies of EVERYTHING and always have them on hand. Docs hate to give up their copies, make copies and even worse feel that they are losing a patient; so its so much easier to continuously have copies of all blood work, tests and films on you so you can just make another appointment and take them with you. Saves time, money and often hurt feelings. I work with docs all day long- Ive seen it all!

Youre going to be okay. They thought I had Devics because of the duration and complications which came from the ON which took 3 rounds of steroids to finally clear up. My first MRI wasnt conclusive either. My second one makes me wonder how they could have missed so much in the first one! My Neuros explanation is that over 6 months, an awful lot of answers came to light. So, knowing what I know about my history, you have to also realize that anything is possible and all of it is out of your control. Breathe Deep. Your friends with MS have the right attitude!
Nikki
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