MRI with contrast question

[Jrasted79]

I had another MRI last week. I was a little on edge because the guy performing was a little jumpy/shaky. He fished around in my arm for a vein, he thought he had it and ended up injecting half the contrast under my skin. Holy BURN!! My arm was burning, swollen and useless all day. He proceeded to do the MRI.

Are you suppose to wait a bit after the contrast to go back in the machine or is going right back in ok? Does anyone else think because half the solution never made it into my vein that it could alter results? If my MRI came back fine should I tell my doc what happened to see if I should get another?

Thanks!!

[22cyclist]

Hi Jrasted! I will try to answer your questions.

First it wouldn't matter if you just got an MRI without contrast as it can see lesions just fine on the FLAIR section.

Secondly, sorry you got the contrast pool-I've had that, so uncomfortable. Now I have a port-a-cath so they never miss!
It doesn't matter that you went right back in, in fact you should go right back in as the contrast is absorbed pretty quickly.

The little bit that you missed will have no effect. No worries.
All the contrast shows is if your lesions are active or "lit up" with contrast, that's it. So no big deal.

Take care and feel better!
Lisa

[rdmc]

He fished around in my arm for a vein, he thought he had it and ended up injecting half the contrast under my skin. Holy BURN!! My arm was burning, swollen and useless all day. He proceeded to do the MRI.

Once, many years ago, I had an MRI and the tech missed the vein and injected the gad into my skin. I can totally empathize with the "Holy Burn" comment. I don't think
I've ever experienced anything quite like that. I couldn't believe that a little bit of solution could make my arm feel like that, and cause such an intense burning sensation.

As to waiting after the injection to have the rest of the MRI images. Well, there have been discussions for years on this board and within the MS community concerning what the protocol says should happen and what actually happens.

I've never had an MRI where they waited, just injection and right back into the tube. But evidently the proper protocol specifies waiting a certain period of time for the contrast to take "effect." I just don't think that happens much.

Here's a link to the proper protocol...you'll notice it says wait a minimum of 5 minutes (and that's the minimum...evidently longer wait is better, I've often heard the 10-15 minute wait time thrown out as the right amount of time to wait) But as Lisa said, it's not that the MRI isn't going to miss lesions without the proper gad protocol...it's just that they might not "light up."

http://www.ajnr.org/content/27/2/455/T1.expansion.html

[Myoak]

Having been in the MRI room for approximately 30 MRI’s at 6 different facilities I can definitely state I have never witnessed one done correctly. Time is money; they get you in and out as quickly as possible so they can do more in a day. They should wait several minutes after injection before doing the repeat scan. Virtually no one waits.

A study was done to find the best time to detect MS plaques on MRI after Gadobutrol injection. Here is the link: http://www.ncbi.nlm.nih.gov/pubmed/23975149

Quote from the study:
“Sixty-two relapsing-remitting type MS patients, (56 women, 6 men) with the mean age of 31 ± 7 years were enrolled into this study. The patients underwent T1-weighted MRI scan without contrast agents. Subsequently, Gadobutrol was injected (0.1 mmol/kg) and MRI scanning was repeated after 30 s, 5, 10, 15, and 30 min of Gadobutrol injection. The size, signal intensity, and enhancement pattern were determined for each plaque by contrast-enhanced T1-weighted images.

RESULTS: Enhancing plaques were seen in 42 out of 62 patients. The mean number of enhancing plaques was 4 ± 8 plaques after 30 s of contrast injection. This figure increased to 7 ± 13 plaques after 15 min and 6 ± 10 plaques after 30 min. The signal intensity and size of plaques increased progressively, and the maximum signal intensity and plaque size were seen after 30 min (P < 0.001).

CONCLUSION: The maximum number of enhancing plaques in MS patients was detected 15 min after contrast agent administration and the size and signal intensity of the lesions also increased remarkably at this time.”

Lisa and rdmc both make important points worth reading again. Lisa was a bit off target on time but this is a relatively new study which was available Aug 2013 ahead of publication in March of 2014. So it is understandable many might not be aware of it. And those who are ignore it, professionals anyway.

Normally, they don’t wait 10 seconds let alone 10 minutes. But it is important to remember that much of what they are looking for can be seen w/o contrast, as Lisa said.

Could they do better? Sure. Will they? No. Time is money. Hate to be so sober about it but it’s the reality we live with.

[22cyclist]

Yea, Myoak, I really don't believe the protocol is 10 seconds either, and thanks for the post, but that is sometimes the reality. I do think they check the first shot or two and see if the contrast is everywhere else and think its fine. I've been waiting in lots of MRI control rooms with patients getting MRIs, most not with MS, but some with. They sure aren't following any protocol at our hospital. Perhaps now they will start since this study came out...one can hope.

Take care
Lisa

[Jrasted79]

Thanks everyone. If there's a next time, which there probably will I'll just start rattling off questions to hold em off a minute lol. June 2nd is my big day where I see my doc because they are now saying it's "MS or something like it" my EEG came back abnormal, and don't know about my other tests yet. I don't know if I should hope for MS, who knows "what something like it could be" I've been having nightmares where my mom is asking what are the top 5 things I want to do. I know I'm not gonna die but I am scared.