ANA Discussion Forum
General Category => AN Issues => Topic started by: EJTampa on February 27, 2009, 10:27:12 am
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This has been a hot topic lately, so I post this here for everyones benefit. My doctor says he prefers the no contrast, but can use either one for AN's. I'm posting a side by side picture of my scan to show you all what to look for in case you are afraid your doctor may have missed something.
(http://i395.photobucket.com/albums/pp31/flessanguam/MRI.jpg)
Contrast is on the left, non contrast is on the right. You see the bright area surrounding the brain on the right image? That's CerebroSpinal Fluid. Notice the dark mass interrupting the CSF? That's the tumor. I don't know why he prefers one over the other, but I can clearly see the mass on both images. Don't know if this will help anyone or not, but it doesn't hurt to post, right? :)
Ernie
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There is a document comparing MRI's with an without contrast at the following location:
http://bjr.birjournals.org/cgi/reprint/73/867/242.pdf
I believe the big problem with doing an MRI without contrast is that it can miss small tumours, especially if they are in the IAC.
Thanks for posting your MRI's. It's interesting to see the comparison. I never did see my scan from 2005. Actually, the report from the MRI was just type written and neither the Dr. or the ENT got a copy of the actual scan. How did you manage to get a copy of your scan?
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Well, I think they "have" to give you a copy if you request it (the imaging place you had the MRI done at). You did pay for an MRI, after all. My ENT told me to have it done where ever my insurance would cover it, then pick up the films and carry them to my appointment. Later, months later in fact, I called the imaging place and told them I wanted a CD. It was ready for me the next day. There were no further costs involved either.
I can see how small tumors would be easier to miss without contrast, although mine was only 1.3 cm at the time of the image. Certainly some of those 2 to 5 mm ones would be tricky, perhaps even with contrast as there are other things that get picked up with contrasts.
Then, there's the obvious, it certainly "stands out" better to me with contrast, but I think a "trained" eye would have no trouble with AN's that exceed a certain size.
Ernie
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I'm not sure what the rules are up here in the Great White North. The MRI is done at the hospital, and there aren't any private labs doing them here. The Provincial health care (OHIP) pays for the MRI. I'll ask the Dr. on Monday when I go to get my referral for the MRI. I'd be interested in seeing my scan just to see what's actually inside me head! :D
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I live in the Great White North too (which is not white today - just muddy).
You can request the CD containing your MRI scan from the hospital/clinic where the actual scan is taken. I shouldn't say "can". You "must" request the CD, so that you can bring it along for consultations etc. and you will also have it for your records. I found that you cannot just rely on the radiologist reports, because they may interpret the results/sizes a bit differently.
I had MRIs at three different places, and in all cases it was no problem getting the CD - for free.
Marianna
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Thanks so much for your reply, Marianna! I guess you have to know what to ask for! I never thought about this before, but when I go for my next MRI, I will be sure to ask for the CD. And, yes, muddy here. Lots of rain. I much prefer snow over rain, though.
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Ernie ~
Thanks for the comparative MRI images. Although many of us have seen our own MRI, some folks (such as our mutual friend, 'ScoobyDoo') have not, and so, your contribution is valuable.
I can't help but note that the scan taken using the gadolinium contrast seems to highlight the tumor to the point that even a non-physician can see it. Unless the patient is allergic to gadolinium, which is rare, I can't imagine why any doctor involved in AN treatment wouldn't prefer the MRI to be taken with contrast. It makes his job easier and certainly doesn't cost the doctor anything. The photos you've posted emphasize the difference and verify why an MRI with contrast is considered the 'gold standard' for diagnosing an acoustic neuroma.
Jim
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I agree - great images!
The one without contrast, to my untrained eyes, certainly shows up the CSF blockage better. It's interesting that the tumour in this image is dark, with everything else around it light. With contrast, it's the reverse. I guess if you knew what you were looking for, you can see the CSF is dark on the contrast-image, and the tumour is white, so it's the same result. I'm assuming (again, to my untrained eye - I'm not a doctor, don't play one one TV, and haven't stayed in a Holiday Inn for a long time) that the tumour going to the left heads into the IAC. Is it actually in the IAC? I can't tell on this one. It certainly does stand out more with contrast.
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I am fellow Great White Northerner ... I should ask for mine as well. Scooby Doo - I am also from Ontario but I am in Toronto and work right downtown so am just about in Hospital Central. [For the non-Torontians/Canadians - Toronto is the biggest city in Canada - and one street University Avenue has five major world class hospitals within 2 subway stops - so we call it hospital row. There are several others within a couple of miles.]
I had no contrast - and should ask for my MRI on disk. Could I ask for them now - a few months later?
My small IAC tumor was so visible - perhaps Ernie's MRI isn't as clear on the internet, but you could so clearly see the nerves in the ear, that contrast was so not needed. My blob also showed up so bright white, there was not mistaking it. The doctor showed my husband and I the MRI - and we didn't need any explanation - one side was 'empty' and the other side had a CLEARLY visible blob.
I will try and get a copy of the CD soon for my own records and see if I can upload to the site - it was crystal clear, I was impressed given the contrast versus no-contrast discussion here.
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My blob also showed up so bright white, there was not mistaking it.
Ann,
Are you sure it was with no contrast? Usually the tumors will be dark if you don't have the dye. I suppose it could be reversed using software as well, kind of like a "negative" image.
The Surgeon rated my scans a "B+". He's seen worse, but also some very much better ones as well :). The machine I was put into looked like it might be one of the first ones ever built, possibly even before man walked upright.
Ernie
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You could EASILY be right - I saw the MRI once, partially in shock way way back in early in December.
I know it was extremely obvious and tremendously clear but I guess I may think it was white.
I will try to get a copy - and we will see how well one's memory serves them.
I am curious now - what does one remember!
Ann
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How many sleeps until the big day, Ernie?
And how are you holding up?
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Hey Scooby :)
I'm holding up pretty well since I've been working, but only a few sleeps left :). I'm working tonight (graveyard shift) then will sleep a bit Monday. I'll sleep again Monday night, Tuesday night, and Wednesday night, so we'll callit 4 more sleeps :)
Ernie
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I can't help but note that the scan taken using the gadolinium contrast seems to highlight the tumor to the point that even a non-physician can see it. Unless the patient is allergic to gadolinium, which is rare, I can't imagine why any doctor involved in AN treatment wouldn't prefer the MRI to be taken with contrast. It makes his job easier and certainly doesn't cost the doctor anything. The photos you've posted emphasize the difference and verify why an MRI with contrast is considered the 'gold standard' for diagnosing an acoustic neuroma.
I'm obviously no doctor, but I agree with Jim 100%. IMO since the images are black and white, the highlighted tumor shows up so much better than the non-highlighted one.
Why forego the gadolinium unless there is a specific medical reason to do so?
Jan
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FYI: I have to have MRI's without contrast since my 1st year post op when there were 2 hives on each of my thighs after having the gandolinium dye.
My neurosurgeon is able to read the results, no problem.