MRIs.. Might be a good idea to have them rechecked

[rdmc]

I'm more than a little disgusted because I've been having cranial nerve problems and had an MRI back in October...nothing new reported. so the problems are just getting worse, my tongue and speech are in a bad way...so my neuro orders a 2nd MRI. The MRI tech asked me what the neuro was looking for and fortunately I knew enough to tell her the hypoglossal nerve (that nerve controls motor function of the tongue.)

So I get the MRI report today...there's a good sized lesion on the medula...but the disgusting part is they admit in the report it was "possibly overlooked" in the Oct. MRI. In other words I had to tell them where to look in order for them to find the lesion.

Well this probably explains why my BP has been
uncontrollable of late...my GP said he thought it was my MS...guess he was right.

Just seems to me that my older MRI reports were so much more detailed that the recent ones...almost like somebody takes a quick glance and writes a report. My present neuro doesn't read them, but I'm soon changing to an MS
specialist...so that should change.

I should have learned my lesson years ago, the neuro that diagnosed
me sent my MRI to be read by a neuroradiologist after she looked at it and found more than was reported in the original
Report.

Well enough ranting ..just wanted to remind everyone you might need more than one person to check your MRI...if your neuro doesn't read them, you can get your films read by another radiologist for a second opinion.

Please excuse any typos, I'm on my iPad...and it makes it hard to go back and check.

[poohb3ar]

bless your heart!

rdmc,
that's terrible about your MRI. i've had too many to count and a too many different places. besides neuros and others reading them differently, i learned that there are bad, good, better and best ways and machines to do them with.
one of my best neuros MRIs took a lot longer than others. the tech explained that Dr. C always wanted his done in slices or layers to better find everything.
to his credit, he did an MRI 5 mos. after another neuro at a different hospital who saw NOTHING wrong with my MRI. Dr. C found that the front lobel (sp?) tumor they'd been watching had more than double since one MRI taken over a year before the other neuros.
if it wasnt for him, MS wouldn't have killed me but a brain tumor about to tangle up in a lot of nerves and blood vessels.

sorry long story to TOTALLY AGREE with you. drs. and techs are humans and the machines and methods they use are different. shop around and if you're not comfortable with dx ask for another opinion.

praying that you're doing better now.

[Shashi]

Gosh, that's awful that they missed the lesion the first time! It just goes to show that, in spite of what some may say or think, radiologists DO make mistakes and do miss things.

I have had many MRIs over the last six years. The reports never come back the same way twice. Either one doctor will see five lesions and another will see three or they don't see them at all, even though I and my neurologist can see them clearly.

Plus, I have a tumor in my parotid salivary gland that only one radiologist has ever mentioned, even though it can clearly be seen on the sagittal images on every MRI that I've had since 2009.

I've often though that maybe I should go to school to be a radiologist, just so I can read my own MRIs!

I hope you're doing better soon, now that the cause of the problems has been properly diagnosed.

Hugs,

Lisa

[kingrex]

Plus, I have a tumor in my parotid salivary gland that only one radiologist has ever mentioned, even though it can clearly be seen on the sagittal images on every MRI that I've had since 2009.

As you might guess, Lisa, I hate this thread It's because there is so much more to this than patients realize and most are working with misinformation about both the process and all aspects of the technology. But I do want to say something about the point you made above.

The reason a radiologist will not discuss your parotid "lesion" - and I quote it because we really don't know what it is - is that he can't read it without having the proper pulse sequences performed in the necessary orientation, both pre and post gadolinium. It's not enough to just see it on one sequence.

When I see something like this (a possible neck lesion seen incidentally on a brain exam, in your case), I make a note to the radiologist and hope that he will then suggest that the clinician order an MRI of the neck with and without gadolinium.

Again, the only way you'll get a reading on that parotid is if a dedicated neck scan is performed. If you're concerned about it, speak to your neurologist about it and ask him/her to order an MRI. Can something be felt there on a physical exam?


rex

[Shashi]

Thanks, KingRex. My parotid gland has been enlarged and slightly painful since 2009, and there is a lump in that area. But the radiologist doesn't feel that it is related to the 1-cm lesion that is in the parotid gland. He believes it is a lymph node that is enlarged. I was actually scheduled and prepped for a fine needle aspiration of the lesion when the interventional radiologist talked me out of it because it's too near the carotid artery, and it hadn't changed from the previous MRI. So, while it's still there, I have no clue what it is or why it's there or why it's still there. My ENT ended up diagnosing the pain and swelling in the parotid gland as chronic parotitis back in 2010. My PCP wanted me to go back this month for yet another follow-up with the ENT about the lesion, but I can't because my insurance deductible just rolled over again and I can't afford it right now. I'm going to have to wait until summer before I can have it checked out again.

Oh, that reminds me too, I have empty sella syndrome, which shows up on every MRI I've ever had done. Only three radiologist in the last six years have ever mentioned it and recommended a follow-up with an endocrinologist, which I had after the first one mentioned it. (And I've had at least 10 MRIs of the brain, with and without contrast, in that time.)

I know radiologist are good at what they do, but like everyone else, they are human; and they can and do make mistakes and miss things, just like the rest of us. No one is perfect (except God.) Like we often recommend with neurologist, sometimes it doesn't hurt to get a second opinion.

[MSW1963]

I had a similar experience with +2yo MRIs reviewed by my then new MS specialist.

The pathologist for the 2yo mri was the new MS doc's perfered, go-to person for her patients. The doc requested a correction to the MRI report, which was issued. I didn't think the phrasing was particularly transparent that it was intended to correct a prior overlooked enhanced lesion. I was floored that several subsequent neuro didn't detect it sooner.

It also confirmed my MS dx for my doc. There were about 3-4 neuro in the interviening years who reviewed the report, maybe the mri too, who didn't detect the enhanced lesion on the film, maybe relied on the report.

No substitute for well trained highly skilled MS Specialist, imho.

[MSW1963]

Forgot to mention the helacious +2yrs of sx's the overlooked enhanced lesion, along with the 20+ 'old' lesions, added to the diagnostic experience. My child was 3yoa when I took sick full time, she was 7yoa when I was diagnoised.

[rdmc]

Forgot to mention the helacious +2yrs of sx's the overlooked enhanced lesion, along with the 20+ 'old' lesions, added to the diagnostic experience. My child was 3yoa when I took sick full time, she was 7yoa when I was diagnoised.

Sad part is it's emotionally exhausting to go through seasons like that. The physical is one thing, the emotions that go with it are another.

With this lesion I was having symptoms that were very specific to that area...complaining about them, and when the first MRI came up with nothing in that area...I started to doubt my own perception of the problem. Add to that the fact that the neuro seemed to dismiss the symptoms because they couldn't be imaged. Fortunately my complaining did eventually lead to another MRI, so now I feel vindicated Not that it helps a bit with the symptoms...except maybe there will be better symptomatic meds Rx'd to address the problem now that we understand the origin.

[MSW1963]

rdmc, I know what you mean. I got to the point I was willing to admit full blown insanity, to point out to docs that mentally ill people get sick too, with MS and other illnesses, so just get the straight jacket out, explain the 20+ lesions, the optic nerve, chronic bladder infections and other sx's, and get this over with, please.

[kingrex]

I had a similar experience with +2yo MRIs reviewed by my then new MS specialist.

The pathologist for the 2yo mri was the new MS doc's perfered, go-to person for her patients. The doc requested a correction to the MRI report, which was issued. I didn't think the phrasing was particularly transparent that it was intended to correct a prior overlooked enhanced lesion. I was floored that several subsequent neuro didn't detect it sooner.

It also confirmed my MS dx for my doc. There were about 3-4 neuro in the interviening years who reviewed the report, maybe the mri too, who didn't detect the enhanced lesion on the film, maybe relied on the report.

No substitute for well trained highly skilled MS Specialist, imho.

I think you meant to say radiologist, not pathologist.

The truth is, gadolinium enhancement is pretty hard to miss. The fact that the radiologist didn't comment on what your neurologist thinks is an enhanced lesion leads me to believe that this area of enhancement may actually be a benign collection of gadolinium, such as might be seen in a venous sinus or in the choroid plexus of the ventricle.

I've said this many times, maybe to the point of annoying some here, but neurologists learn what they know about MRI from radiologists, not the other way around. A neurologist may label himself an MS specialist, but that does not make him more familiar with the appearance of MS-related lesions than a radiologist, and it certainly does not make him more apt to notice contrast enhancement. I mean, gimme a break. Visualization of gadolinium does not automatically indicate the presence of pathology.

rex

[rdmc]

Rex,

Isn't there a distinction even among radiologists? Aren't there radiologist who specialize in neurology (neuroradiologist) but not ever brain MRI is read by a neuroradiologist?

That being said, I do think MS specialist are better at reading MRIs than some radiologist just because all they see all day are MS, or suspected MS, brain images. Plus they are able to look at the clinical picture in relationship to the image of the brain.

A little off topic, but twice in my life I've been in the ER with an injury...plain films were taken, and the report said no break. when the pain didn't subside I went to an orthopedist who looked at the films and found a break. Now he wasn't a radiologist...but he picked up a break the radiologist had
missed.

Not all radiologist are created equal...maybe you work for a
great facility but you can't deny what others have experienced.

[BigA]

Rex,

thank you. It's so great to have someone who knows about these things to ask. I go to a very professional radiologists and my doctor's office people seem perturbed that I don't do the MRI downstairs in their facility, saying they have a very good machine. I've had experience with the hospital the clinic is attached to and they're not very good. At my Radiologist clinic, the tech told me that the hospital has a large turnover of employees.

I feel even more comfortable with my decision to stick with the same radiologist. Thanks for confirming who the experts are here in the matter.

BigA

[MarkLavelle]

... my doctor's office people seem perturbed that I don't do the MRI downstairs in their facility ...

Gee, do you think they have financial connections?

[MSW1963]

Kingrex, you sound knowledgable and well trained. I do appreciate your input on a topic you appear to be well qualified to comment on. I couldn't be more unqualified on the topic other than my experiences and observations as a patient and consumer of medical services.

I know a few neuro specialist who've treated me were particular when ordering test; that the test be performed by someone the neuro specified, or at a facility that met the doc's specifications.

I have a litany of tests and treatments that were substandard. In one case a written report admitting a sleep study didn't provide sufficient info because I coughfed through the night resulting in less than 2.5 hrs of sleep, too few to analyse, although I was there coughfing for 8 hrs., no one stopped the test although I did mention it when I scheduled the test, for the 3rd time, with a 3 month delay after the original test was rescheduled because the sleep center was installing new equipment. Taking the test again was not offered or ordered. In the course of this one sleep study there were a couple of other mishandled steps, but you get the picture.

I had a general neuro dx ms, reverse the dx when he realized my case manager arranged a referral to his MS specialist medical school professor and current medical school lecture colleague. These things happen to us as consumer's and patients and we become skeptical about the care we receive and pay for. I know this example is unrelated, but I think it's an example of patients' less than ideal experiences; based on my experiences these are far from atypical.

I'm going to have to go with the opinion of my then MS specialist and my current one.

[kingrex]

Rex,

Isn't there a distinction even among radiologists? Aren't there radiologist who specialize in neurology (neuroradiologist) but not ever brain MRI is read by a neuroradiologist?

That being said, I do think MS specialist are better at reading MRIs than some radiologist just because all they see all day are MS, or suspected MS, brain images. Plus they are able to look at the clinical picture in relationship to the image of the brain.

A little off topic, but twice in my life I've been in the ER with an injury...plain films were taken, and the report said no break. when the pain didn't subside I went to an orthopedist who looked at the films and found a break. Now he wasn't a radiologist...but he picked up a break the radiologist had
missed.

Not all radiologist are created equal...maybe you work for a
great facility but you can't deny what others have experienced.

Although is seems plausible to MS patients that the MS “Specialist” has an edge when it comes to reading MRI scans, it really only seems that way. In fact, his preoccupation with MS is detrimental, as there are hundreds of structures to be seen and evaluated, most of them non-pathological and unrelated to MS. MS plaques themselves are pretty distinctive and not difficult to see, and contrast enhancement is pretty obvious, too. Then, of course, there’s the matter of training, which neurologists don’t have. What they do know about MRI, they learned from radiologists.

I’ve known many renowned oncologists, each of whom wanted the radiologist’s CT report before treating patients. I also know a very prominent MS specialist whose name has been discussed on these very boards, and he also leaves the interpretation to the professionals.
The notion that since the neurologist knows the patient, that "insight" will lead to a more comprehensive report is nothing more than a nice theory. It has no basis in fact.

Regarding fractures…I had a patient recently who’d jumped off the top of a fence and whose films were read as negative at the local urgent care clinic. He then had more films with his orthopod, who also declared them negative and told him to start walking on the sore ankle. His pain was only getting worse, so he had an MRI of the ankle. From his scout image alone I was able to see a spiral fracture of the tibia which extended halfway up to his knee.

Yes, a neuroradiologist is normally more skilled at reading neuro exams, but again, MS isn't exactly a puzzler.

rex