second MRI ordered without contrast???

[tenai98]

Even thu I asked for contrast, the hospital is saying I dont need contrast.  I am getting a copy of the cd so how hard is it to read the images without contrast?  I am going to ask the tech to show me when I'm there this thurs.  I thought AN needed contrast??
JO

[Jim Scott]

JO:

In my experience and from everything I've read on medical websites (authored by doctors), an MRI with the gadolinium contrast is the 'gold standard' in discovering skull/brain tumors.  I would certainly make an issue of this with your doctor.  An MRI is expensive and if it isn't done correctly, that is, without contrast, it can be useless.  My neurosurgeon wouldn't even look at an MRI without contrast.  The tech only does what is ordered by the doctor.  I usually try not to second-guess medical professionals but in this instance, I would question your doctor's judgment. 

Jim

[tenai98]

Jim, I called the doc's office and he is out. So his secretary will contact him and get back to me...The ENT told me he would leave it up to the radiologist to use contrast or not...but since doc didnt order contrast, i'm not schedule for it...so we'll see what happens on thurs.
JO

[mk]

Contrast is useful to detect the AN, especially if it is small. Once you know it's there though, you can definately see it even without the contrast. Most of my MRIs were done with contrast, but my 3 month follow up without, because all they were worried about at that point was swelling. I guess it is good to avoid all this gandolinium, if at all possible, especially when having multiple MRIs throughout a year. I could see my AN just as well, and could measure it. You can also do a small test with your previous CDs: The first series of images is always without enhancement, and the last few are with  contrast. If you look at the first ones, you can definately see the AN.
I know of another forumite, who had almost all her MRIs taken without contrast and she could see her AN clearly.

Marianna

[leapyrtwins]

Jo -

I think checking with your doctor was a wise decision.

Most of us had our diagnostic MRI with gadolinium contrast which enhances objects like an AN, but maybe your doctor has a reason for not requesting it.

Although I'm not a doctor - or any other kind of medical personnel (nurse, etc) - I think it is possible to spot an AN without contrast; it just doesn't show up as well.

If you are given the option, IMO you should ask for the contrast. 

Jan

[tenai98]

Marianna, I did check my cd and sure enough one can see it without the contrast...now that makes me feel better about thurs.  You have to know what to look for but it is there...
Thanks a bunch
JO

[NE Farmwife]

I am new here.  I was diagnosed a couple of weeks ago with an AN.  My lucky day I guess.  I think that I have found the best support group though for getting me through this.  Anyway, I have my MRI and had really only looked at the side with the contrast but after reading this this morning, I went back and looked at my non-contrast MRI and you can definitely see where the AN is. What is confusing to me is that in looking at my MRI on the computer screen, the AN appears to be on the right side and my AN is on the left side.  Am I looking at it wrong?

[tenai98]

Farmwife, It will appear to be on the wrong side...when the radiologist takes pics you are opposite him...look close at the MRi and you can see the R and L on the pictures....My MRI shows my AN on the right but is on the left and is clearly printed on pic which side is which
JO

[Jim Scott]

Jo:

FWIW: I've undergone 8 MRI scans in the past 2½ years and every one used gadolinium to enhance the contrast.  I've never suffered any ill effects, other than a slight 'warm' feeling for a few minutes following the injection.  While your doctor may have a perfectly logical, medically reasonable explanation for not using the gadolinium for contrast on your upcoming MRI, were I his patient, I would certainly be interested to know what it was.  Let me be clear: I don't wish to dispute your doctor, who knows more than I do about these things, but I would hate to see you undergo this procedure and not have a viable scan that confirms or excludes an acoustic neuroma because it is not translucent.  I've read posts from AN patients who were mis-diagnosed because their MRI was taken without contrast.  That mis-diagnosis wasted valuable time and could have been avoided with a sharper MRI, which is what the gadolinium contrast offers.  There is a reason it is recommended by most doctors in this field.  However, If your doctor is content with an MRI taken without contrast, that is certainly his prerogative.  I trust that the MRI will go smoothly and give your doctor the information he needs and you want.

Jim

[mk]

Just as clarification, Jim is correct about the need for contrast in the first, diagnostic scan. However for subsequent scans, like in Jo's case, the need for contrast depends on what the doctor needs to see: If they are just looking for measurements, then they can tell the size even without contrast. If they are looking for things like darkening after a radiation treatment, then they need the contrast. Also, contrast is necessary when planning for the treatment, since they need to have a clear view of the nerves etc.
 My undertanding is that they avoid to do gandolinium injections if they are not necessary.
Jo, in your case I guess they are just looking for changes in size, right?

Marianna

[Keeping Up]

Thought I would revisit this thread.  I read it before my first MRI - the one that found the AN just a few days ago.

I didn't have any contrast, my AN is quite small 5mm x 8mm and it is clearly clearly visible on the scan.  Perhaps, you can't see the the nerves or structures as well defined (you can certainly see the nerves on the good side though - pretty impressive) without contrast, but even my mini AN was so so visible.

[leapyrtwins]

Good to know.

I wonder if the age and or quality of the MRI machine has any bearing on whether an AN would show up without contrast.

Lots of the newer machines have incredible features - for example, the last MRI I had they were able to suppress the fat in my head so it didn't show up on the scan - but I wonder about the capabilties of older (maybe "lesser") machines.

Anyone know if this is relevant?

Jan

[Keeping Up]

I don't know the answer - but the hospital where this MRI was done 'appeared' to have top-notch machines - and a really nice hospital building (for Canada, that says something - many hospitals are pretty dodgy in Toronto) so they may better funding to have better equipment!  This one is a world class cardiac centre (and I think transplant centre) so it might have great stuff.