Is Contrast Necessary for MRI?

[Joe23]

For the past year and half I have been experiencing sx that have me concerned about MS (urinary issues, tingling in all extremities, weakness in left leg).. had regular MRI of brain, c-spine, lower lumber--with nothing abnormal revealed. Also normal EMG's, blood work, etc. At my last neurologist appointment my neurologist basically told me that MS was "highly unlikely" but "could not be ruled out." He felt that since I MRI's done last year I didn't need them.

However, after seeking advice from other members on the forum I pushed for more testing and MRI's which he agreed to (this time checking thoracic, brain, c-spine)..stating he was checking for MS when ordering the tests..BUT then my insurance company denied the MRI's UNLESS I have them with contrast--stating that since only with contrast would these new sets of MRI's be helpful. However, after reading up on contrasts used for brain MRI's (gadolinium, and new FDA warnings)---I'm SCARED to get these MRI's with contrast since the FDA has basically said the contrast remains in your brain and body (albeit in trace amounts) but they don't know exactly what these trace amounts will do and has cautioned doctors from ordering MRI's with contrast.

While I know that generally others have had MRI's with contrast- I also have a family history of cancer/ kidney issues.. and am paranoid that foreign chemicals lingering in my body, even in trace amounts, cannot be a good thing.My question is--is contrasting agents NECESSARY to detect MS? Is the risk worth it if I've had a clean MRI in the past?

My neurologist basically told me he has no idea what is causing my symptoms (he is not an MS specialist/ just a general neurologist). While "unlikely" he did mention MS cannot be ruled out definitively. Would MRI's with contrast give me a more definitive answer? At this point, I am being forced to choose between MRI's with contrast or wait around until symptoms get worse and whatever it is presents itself more.

[KoKo]

For the past year and half I have been experiencing sx that have me concerned about MS (urinary issues, tingling in all extremities, weakness in left leg).. had regular MRI of brain, c-spine, lower lumber--with nothing abnormal revealed. Also normal EMG's, blood work, etc. At my last neurologist appointment my neurologist basically told me that MS was "highly unlikely" but "could not be ruled out." He felt that since I MRI's done last year I didn't need them.

However, after seeking advice from other members on the forum I pushed for more testing and MRI's which he agreed to (this time checking thoracic, brain, c-spine)..stating he was checking for MS when ordering the tests..BUT then my insurance company denied the MRI's UNLESS I have them with contrast--stating that since only with contrast would these new sets of MRI's be helpful. However, after reading up on contrasts used for brain MRI's (gadolinium, and new FDA warnings)---I'm SCARED to get these MRI's with contrast since the FDA has basically said the contrast remains in your brain and body (albeit in trace amounts) but they don't know exactly what these trace amounts will do and has cautioned doctors from ordering MRI's with contrast.

While I know that generally others have had MRI's with contrast- I also have a family history of cancer/ kidney issues.. and am paranoid that foreign chemicals lingering in my body, even in trace amounts, cannot be a good thing.My question is--is contrasting agents NECESSARY to detect MS? Is the risk worth it if I've had a clean MRI in the past?

My neurologist basically told me he has no idea what is causing my symptoms (he is not an MS specialist/ just a general neurologist). While "unlikely" he did mention MS cannot be ruled out definitively. Would MRI's with contrast give me a more definitive answer? At this point, I am being forced to choose between MRI's with contrast or wait around until symptoms get worse and whatever it is presents itself more.

Hi Joe

This article from the National MS Society magazine Momentum, called Demystifying MRI's, shows pictures of MRI's with and without contrast, taken at the same time, and then again 2 months later.

It looks like the MRI images without contrast do show both old and new lesions, while the MRI image with the contrast only show a lesion with inflammation (which shows up on the image without the contrast too).

So maybe, since some time has passed since your last MRI, they want contrast images to see if there is inflammation going on?

But it does appear, from this article, that lesions do show up, even without contrast. However the only way to know if there is inflammation going on is to use the contrast. That is my limited understanding, anyways.

http://www.momentummagazineonline.co...stifying-mris/

[JerryD]

Hi Joe,
I am the message board's curious MSer, JerryD. I read your post and I wonder why you don't want to get your MRI's with and without contrast ! Are you consulting with a bona fide MS specialist? I think that you need to let your doctor do his job and let him/her use the tools to do it ! Don't let the internet comments keep you from getting the best treatment you can get! Good luck

[pennstater]

My understanding is what KoKo posted. The contrast will show what is active inflammation, indicative of a relapse. This "active" lesion will show without contrast as well.

Part of the MS criteria for diagnosis is dissemination in space and time. So they look for lesions in more than one location and evidence they happened at different times.

If your MRIs were negative before and did not show any lesions, then if you get the MRI without contrast, your doctor can only tell there are lesions. If you get it with contrast, and there are some active lesions, as well as some inactive lesions, they can then tell there were at least two relapses, satisfying the dissemination in time criteria.

I think the guidelines now are that the contrast should be used when the outcome would impact how you treat a patient. So a diagnosis would fall into that category. But ongoing MRI studies to see if additional lesions once diagnosed do not need contrast.

You can call your insurance company and discuss with them why they feel contrast is necessary.

[KoKo]

Part of the MS criteria for diagnosis is dissemination in space and time. So they look for lesions in more than one location and evidence they happened at different times.

If your MRIs were negative before and did not show any lesions, then if you get the MRI without contrast, your doctor can only tell there are lesions. If you get it with contrast, and there are some active lesions, as well as some inactive lesions, they can then tell there were at least two relapses, satisfying the dissemination in time criteria.

Kathy ~ thank you for that excellent explanation.

[pennstater]

NP KoKo. That is how I was diagnosed, 1 active c-spine lesion and then other old lesions in brain and c-spine. Only reason I know!

[Joe23]

Thank you for the responses. Penn- your explanation makes sense but I will call my insurance company and see if I can get an explanation. If its something different I'll definitely post and let you know. Does anyone know any members who have reported ill effects from having the MRI's with contrast? I don't know how many on here have had MRI's with contrast, but if anyone who's been on here a bit longer can give me a general idea about how many here go the contrast route and have any stories/ reports, please do share. Thank you again.