No - you need the contrast to see if you have active lesions. He may have done it without contrast because he doesn't know any better or insurance reasons. Get in the neuro's face about this and ASK WHY without contrast.

yes you definetly want it done with contrast no if and or but about it. You may also want to request that they do a full MRI neck back and brain. You might as well get the full work up while your there why have to come back and do it in sessions if you know what I mean. Keep us posted we're here for you. God Bless

you need to ask your dr if you are concerned about his choice. they absolutely can diagnose MS with an MRI w/out contrast. w/out contrast will show scarring in the brain and with the contrast is to show actively inflamed areas so if you are flaring right now w/out contrast may not be able to pick it up. Your dr may be following your insurance procedures. CALL YOUR DR if you think it isn't right.

With Contrast---Active Lesions only. Doesn't even show that an inactive lesion is there.
Without contrast - Both active & inactive lesions--but doesn't show the lesion's state if its active---just that a lesion is there.
If 1 active lesion is found it likely diagnosis MS as the cause.

A lesion remains active when it is formed on average for 30 days, then it will leave an inactive lesion. The inactive lesion can heal to the point after a while of not showing on an MRI that a lesion was there--even without the contrast..



An MRI can't totally rule out MS as a small % will have MS without lesions and those people struggle to find a cause for their symptoms. In the 2009 International Diagnosing guide, it says there is a 20% probability of MS without lesions and an 80% probability with lesions.

For those that have lesions- BOTH INACTIVE AND ACTIVE lesions will show without contrast.

Only active lesions will show with contrast as inactive lesions will not show at all as if nothing was there just normal brain tissue.

So the scan without contrast is the more important one if a person has to select which one.

It has been reported that a person with MS will have about 10-15 asymptomatic active lesions a year. Neither the doc or the person suspects there are active lesions possibly present.

A single active lesion will diagnose MS if the clinical symptoms are consistent with MS. As not many disease cause active lesions, but there are many possible causes of inactive lesions.

If inactive lesions are found with out contrast additional testing will be needed to find a cause for them-it would identify that something was not right. If the contrast had been used and it happened to catch a lesion in the active state, fewer to no additional testing would be needed to determine the cause.

Some times the additional testing is just another MRI 3-6 months later to see if the lesions have changed. MS lesions should show change-more of them, less of them, smaller or larger. MS lesion change over time.

If no lesions are found it would mean MS is a lower probability of being the cause of your symptoms & additional causes would be considered first. I don't think the MRI can totally rule out MS as a cause,with or without contrast, just reduce it probability of being the actual cause.

A lesion will remain in the active state, when it is newly formed- then often it will leave an inactive lesion for a while or permanently- or it can heal to the point the MRI can no differentiate it from normal (brain)CNS tissue.

There is an argument for doing just with out contrast if the purpose is to rule out MS as a cause but to diagnose it as a cause, its much better to do it with contrast.

That's 2x the cost, as 2 MRI scans have to be done for each view. But its not an inexpensive test with only 1 scan---the single scan he ordered will identify that something is not right-and you will be left wondering if any one of those lesions were active when the MRI was done. It only remains active for about 30 days, so you wouldn't ever know. And it would most likely have been the diagnosing determination if it had been caught.

To scan for the possibility of MS, his order is logical.

Cost would be a big factor in choosing both with & without contrast.

MS lesions most commonly form in the brain first, move down to the cervical & thoracic spine. But that's another one of the "typical in MS" and "not untypical in MS either" of MS in that lesions can form in the spine first. its just more common to start in the brain.

The spine does not pick up the contrast reliably. I had 1 doc order a thoracic spine lesion with contrast & one didn't.

The cervical spine MRI picks up the base o=f the brain & the brain does reliably pick up the dye. So the neck should use the contrast if its being used in the brain.

MS lesions are small-it is better to get the MRI in a closed MRI than an open MRI scanner. The closed(tube) MRI have a higher magnet strength than the open MRI.

But I was diagnosed on a Open MRI, so the do work.

Medicine & diagnosis is about probabilities and the only thing 100% probable in medicine is death, after that everything has some uncertainty.

Your best chances of resolution toward finding a cause..
1. closed "tube" MRI scanner
2. Brain With & without Contrast
3. cervical spine with & without contrast
4. Thoracic spine without contrast...

Lower resolution but still getting an overall picture
1. Brain without contrast only in an open MRI.

Then anything between the 2 possibilities.

hi i had a spine and brain mri with out the dye and she said i had ms i had 2 in the spine and 2 in the brain i started on avonex and dont have any side effects this been my fourth shot and i feel my self getting better i dont stress out any more and live my life love april

Considering the toxicity of the contrast material, Id be thankful the doctor ordered it without contrast, so I didnt have to fight to get it that way. Anything a person can do to lessen any further load on a body that is already under siege seems like a good thing, especially if you have any liver or kidney problems. If you have MS, they will figure it out eventually, even if contrast is never used for your MRIs. The treatments are practically worse than the disease anyway, so why rush it? Maybe better treatments will be available in the future. An MRI without contrast may yield evidence of MS in any case.

You can kill flies in your house with a shotgun, but a flyswatter does a lot less damage to your home.

It is best to have it w/ contrast. Why - 1) It will show active lesions and 2) if you go to the next specialist and you have not had it done, they probably will request another MRI. Contrast is done last to compare it to the control MRI which is performed first and takes much longer. (Contrast decreases the proton (on the water) relaxation time and that is why it is quicker - and they do a shorter sequence.) Depending on your insurance, that can get very expensive very fast. I have to pay 20% of the cost on an MRI with my insurance. For a brain, neck, and thoracic spine w/ contrast - that is a 2+ hr imaging experience and ~ $4800.

Do not go to a fly by night MRI place. Ask your neurologist or PCP which imaging center has the highest field strength magnet. You want one that is 1.5 Tesla or greater. Our little city of only 65K people has a new 3.0 T instrument. Many of the fly by night places have 0.3 and 0.5 T instruments. Don't use that one. The resolution is awful in those. If you have the beginnings of lesions, they will not show up on the lower field strength magnets.

If your neurologist tells you that "it doesn't matter which MRI you use," find a new doc. Any neuro should understand how field strength affects resolution. If you just have minor symptoms, it is possible you have very small lesions if you have them at all. Best to use the highest field strength instrument available to find them.

If you do the imaging with contrast, be sure to drink lots of water for several days afterward.

I once had a MRI without contrast. My Neuro had to be out of town, so left me in care of another Neuro. She failed to order with contrast. When the results came back, is when we found out that she had not requested the contrast. Consequently i had to have redone. He said the contrast is required to show MS lesions. I was DX 5 yrs. ago. .

Every MRI that I've ever had has been done in two stages. First it's run without contrast, then the contrast is administered and a second run is done. I had assumed that they were all done that way. It only makes sense as each shows different things.

You don't need contrast to rule out MS. At a later time depending on your symptoms, he may order one with contrast to see what lesions are active.

Some doctors are finding out that ordering contrast on a patient with MS can cause a disease they want to call Nephrogenic Systemic Fibrosis and your doctor is wise to keep you away from the toxic contrast they inject you with. He/she knows this and protecting themselves and their practice as I am part of the lawsuit and it is one of the questions they ask you. Who ordered your MRIs. Any doctor that orders an MRI with contrast opens themselves up to being sued if the patient gets this disease.

I am probably going to die from this disease. It is worse than having MS and if you have MS you are at higher risk for getting this disease.

Be thankful to that doctor that did not order the MRI with contrast, he/she is a keeper.

Your doctor obviously does not know how to check for MS and therefore doesn't know much about it. If he or she is looking for MS the MRI should always be with contrast. I would recommend getting a new doctor. Are you seeing a neurologist or just a general practitioner? A neurologist that specializes in MS is best if you can't find one in your area call around and see if you can find a neurologist that has at least dealt with patients with MS before. Wishing you all the best. -Crystal

Hi

My doctor always does with and without contrast. I thought it had to be done this way. I would definitly ask him about it. Tell him what you read, etc. Tell him you would feel more comfortable with what you have read to have with and without contrast.

Much good luck yo you.

Lorrie

Compare & Contrast:

Lorrie: "My doctor always does with and without contrast. I thought it had to be done this way."

FichenDich: Every MRI that I've ever had has been done in two stages... I had assumed that they were all done that way.

hmmm...

Bump!...It's a very interesting subject & something to ask your Neuro. about before you get your MRI's & see what he or she thinks...

If you have a truly smart, caring Neuro. I'm sure you'll get a very informed answer on the subject. What do you all think?

Take care,
Stay sane!