Is it possible for a MRI with contrast to miss an AN?

[kdc]

Hello All,

Over the last six or so months, I had noticed hearing loss, continuous tinnitus, facial numbness and most recently, I was diagnosed with binocular diplopia. This is caused by vertical muscle weakness in the orbital eye muscles. I had an audiogram done in October and I don't know all of the details but I have unilateral hearing loss in my left ear (3-8k hertz) and right ear (3-4k hertz).   I did have issues recognizing speech mainly in my left ear.  I am realizing now that I need a copy of the audiogram results.  The major hearing loss, tinnitus,  facial numbness and diplopia are all on my left side. I don't have right side tinnitus or other symptoms.

I saw my ENT at the end of October and he mentioned the possibility of an AN and that he would order a MRI of the brain.  I told him that I already had one ordered by my Neurologist for the diplopia. He said that I should have them check for an AN or another type of benign tumor.

I had a combined brain and orbital MRI at the beginning of November and the results came back with five short lines of incomplete information.  The MRI was done by my neurologist's office since they recently purchased and installed a new MRI machine.  I indicated hearing loss, diplopia, and facial numbness and tingling on the left side when filling out the patient questionnaire.

However, I have had three other brain MRIs in 2016, 2018, and late 2021.  All of these MRIs were done by the same imaging center so the radiologist had access to the previous MRIs.  The radiologist that read the most recent MRI did not have access to the previous ones so he didn't "notice" as much detail in the new MRI that had been documented previously.  He missed several documented issues, including a subarachnoid cyst and dehydrated fluid persistent in teh mastoid cells posterior inferiorly consistent with chronic mastoiditis. I had ear infections for much of my childhood.

There is another catch.  When the MRI tech injected the Gadavist (7.5 cc) she actually pierced the back side of the vein and possibly injected some or all of contrast into my arm.  I think this is called Contrast Extravasation.  I had a really ugly hematoma that still hasn't completely gone away four weeks later.  My vein at the injection sight is still bulging more so that it did previously and in comparison to the other arm.

My real question is, is it possible to miss a AN with an MRI with contrast and possibly not catch the AN, if it exists, especially if the majority of the contrast didn't make it into my blood stream?

And, can I request a new MRI based on the possible low contrast level, and/or the incomplete reading by the radiologist? In reviewing the T1 Axial images pre and post contrast, there really is no significant difference in the brightness of the tissue that should have increased dramatically with contrast.  Also, the brain was only a partial scan after the contrast except for one coronal view and it was not a thin dissection imaging of the brain.

If it is pertinent, the previous MRI findings indicated some levels of white matter disease (WMD), uncharacteristic for my age.  However, I believe this might be  genetic because I have had issues with peripheral neuropathy since I was in my late 20s.  I'm 55 yo as of last week.  The WMD was on my MRI from 2016, 2018, and 2021.

My 28 yo daughter also has peripheral neuropathy and has some areas of white matter disease in her brain MRI.  Thankfully, her blood test and CSF test were negative for the markers for MS.  I will be having my full exome tested as soon as the doctor can finish the paperwork.  I also have had some cognitive issues that have since gotten better over the last year.  This was the main reason for the MRI in 2021.

I have an appointment with the RPN at my Neurologist's office on Friday.  She told me months ago that the hearing loss was age related. And, she said the cognitive issues were age related. For which I call BS. My other doctors that I have discussed this with have as well.

Thanks in advance for your insight and input.

This morning, I sent the four MRIs over to my ENT.  I am hoping he can review it before my appointment on Friday.

Keith

[donjehle]

First of all, Keith, let me state that I am not a physician so I am not able to give you medical advice.  What I can do is share my experience and make a recommendation based on that, not upon medical knowledge.

When I had my MRI done with contrast, the radiologist initially missed my acoustic neuroma.  The ENT took a look at my MRI images, and he spotted it.  Then he sent it back to the initial radiologist who took a second look at it and then saw the acoustic neuroma.  As a side note, the radiologist then sent me a second bill (one for his initial reading and a second one for his revised reading).

Then later a specialist at the Mayo Clinic advised me to have another MRI done on a different MRI machine with a different radiologist reading it.  I did my second MRI at Emory University Hospital, and the MRI looked different.  So, yes, I would recommend another MRI for you at a different location using a different MRI machine.

The only problem I experienced is that my insurance company would only cover one MRI every six months.  So, I had to wait six months before I had my second one.

I hope it goes well for you!
Don

[kdc]

Don,

Thanks for your input. I'm glad to know I'm not off my rocker thinking it is possible to miss the AN with an MRI with contrast.

And, actually, my cousin is a retired Radiologist and come to find out he retired within 20 miles of me.  I met with him on Saturday and based on the issues I indicated, the hematoma and the fact that the MRI tech did not specifically run the AN protocols, because they were concentrating more on my orbital MRI, and they only sliced the area in front of my ears forward, and did not do any thin slice image sets, he said it is possible an AN could have been missed if is smaller than the slice thinkness and doesn't fall along the slice perimeter.

Long story short, he said to request a MRI using the AN specific protocols which will call for a thin slicing of 1mm.

I have a Videonystagmography scheduled for Thursday so I will will talk to them the about doing another MRI.

I'm hoping the new MR is negative for an AN.  I just want to rule it out completely and I don't believe the neurologist, nor the MRI tech did their due diligence to rule it out with the previous MRI.

Keith

[alfred17]

useful information

[kdc]

I find it amazing that you can tell a doctor or RPN that your dizziness is getting worse and they say "That will have to wait for your next appointment." and then they tell you to make an appointment at the front desk.  I went to make said appointment and it is five months out. The RPN didn't put a note in my chart to work me i  even though I had just seen her and told her the issue.

I did call my ENT's office and get I to see him in early February.

How does the dizziness associated with an AN affect you?  I get dizzy regardless of my position, including if I move my head too quickly.  I haven't had the second MRI yet since I can't seem to get the doctor to listen long enough to have that discussion.  Even though she seemed to think that I would have had a problem with the MRI results while we were discussing it.  I don't know if she thought that I thought that they hadn't done the right MRI protocol or is she just thinks that I am always going to be difficult.  I decided not to say what I was actually thinking and that was probably to my detriment.

I did have  NVG and the test, according to the doctor, was normal.  That is all she said even though there was no initial response to heat in my right ear and the tech said the response was minimal on the second attempt.  She had warm air blowing into my ear canal for over a minute with no reaction.  I don't really know how much of a reaction she got with the second attempt. I didn't get dizzy at any point. However x they were watching for eye movement.

I've seriously thought about just paying full price to have an AN protocol MRI done so that I don't have to hurry up and wait.

I do realize that it is my responsibility to be my best advocate and that the doctor is too busy to be the advocate that you would expect them to be.

[donjehle]

I totally agree with you, Keith; it is very amazing!

The dizziness from my AN affected me very badly.  I had fallen a number of times and had to walk with a cane.  My neurosurgeon looked at my eye movement and could immediately verify my issue.  He even called over an intern and told him to watch my eye movement.  The neurosurgeon recommended vestibular therapy for me, and the first session I went to, I fell five times.  However, the good news is that the vestibular therapy worked for me.  In a few months, I was walking without a can, and have not fallen since.  The only times I become dizzy now is if I am extremely fatigued.

Best wishes on getting the care you need soon!
Don

[kdc]

I'm still waiting for my upcoming appointment with my ENT.  It was rescheduled for March 28th.  Since I posted last, my double vision has gotten worse.  I developed got prism glasses in November of last year. My prism prescription was 1 up and 1 down in my right and left eye respectively.  Last week I went back to my ophthalmologist and he said my prism prescription needed to be changed to 1.75 up and 1.75 down, right and left eye respectively.

So, it seems that since I was first diagnosed with diplopia that my double vision had gotten almost twice ad bad. That is in three months.  My tinnitus has gotten more prominent throughout the day too.  I'm not sure if my hearing loss is more severe.

Along with vertical diplopia, hearing loss and tinnitus in my left ear, I also have facial numbness on the left side.  I've always had migraines but I get botox for them. I have noticed an increase in headaches and I have been having muscle spasms and neck pain for about two months now. My GP prescribed muscle relaxers.

In preparation for my upcoming appointment, is there anything anyone can tell me that I need to point out that I haven't mentioned here?

I don't see my neurologist until April.  Is an ENT going to see the significance of the diplopia when considering a MRI with contrast?  I gave him the original MRI done by my neurologist's office where they didn't do an AN specific protocol.  At that time, he didn't see anything in the MRI and I'd like to do whatever I can to make him understand the significance of my combined symptoms.

Thanks,

Keith