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Thread: Reason for routine MRI and questions to ask

  1. #1

    Reason for routine MRI and questions to ask

    On several occasions, I have recommended here that it is important to get routine MRI or CT scans of your spinal cord after injury, rather than wait until something happens or gets worse. Let me try to explain why. One of the most important reasons for regular MRI's or CT scans of your spine (every year or two) is to have a record of the changes in your spinal cord and spinal column. Almost everybody has an abnormal spinal and cord image after injury. The question that every clinician has is what has changed, how fast it is changing, and whether changes correspond to the appearance of symptoms. There are several changes to look for.

    <UL TYPE=SQUARE>
    <LI> Are there changes of the spinal cord itself that would indicate increased atrophy, development of a syringomyelic cust, an increase in signal intensity that would indicate swelling or other changes?
    <LI> Are there changes in the spinal canal? Is anything pressing of the spinal cord. Does the spinal cord look attached to the surrounding dura (tethering)? Normally, the spinal cord should be completely surrounded by cerebrospinal fluid (CSF). If the spinal cord is consistently against one side (particularly the anterior if the MRI is obtained in the supine position), it would suggest tethering.
    <LI> Is there degeneration or herniation of the intervertebral discs. These are located between the vertebral bodies to the front of the spinal canal. If you have had a fusion of two or more vertebral bodies, this transfers movement of the spinal column to the surrounding discs, increasing their wear and tear. Are there bony spurs developing and other changes suggestive of degenerative changes of the vertebral column (called spondylosis).
    <LI> Are there changes to the spinal curvature? Normally, the spinal column has a slight and gentle S-shape from the front to back when viewed from the side. If this is flattened, this should be noted. If the curve is too great or localized, it is called a kyphosis. If the curve is from side-to-side, it is called a scoliosis. Kyphoscoliosis is the combination of both and is common after injury, particularly when the injury occurs in people who are still growing.[/list]

    Ask about these questions when you talk to your doctors about your MRI scans. Even better, you can ask your doctor to point out relevant findings on the images so that you understand what is going on in your spine and spinal cord.

    Wise.

  2. #2
    Wise - your contributions are always so valuable; this is no exception. I hope everyone reads this..........and if they don't the SCI Nurse team can certainly refer people to it. Many thanks! CRF

  3. #3
    Senior Member smokey's Avatar
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    I had an IVC clip put in my vena cava in 1977 to reduce the incidents of pulmonary embolii that were occurring at that time. I don't know if it was made of titanium or steel. Correct me if I'm wrong, wouldn't an MRI pull and perhaps dislodge an IVC clip made of metal? Thank you.

  4. #4
    Member connman's Avatar
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    Q- not sure who to ask family doc or spinal doc
    for an M.R.I.

    i don't see either anymore.

    It's been three year's in May and i was woundering about what is going on in there.

  5. #5
    Senior Member wtf's Avatar
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    I read a post at NM about scoliosis awhile back so I asked my doctor if I could get an MRI done to see if I have curving. I figured I been in my chair 18yrs surely something must be happening. My tests came back with some curving but my doctor said it wasn't significant. But if you have curving what can you do so it doesn't get worse. BTW my doc is my family doc not a sci doctor, I don't even know if there is a sci doctor here in las vegas.

  6. #6
    Senior Member alan's Avatar
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    There are different types of MRI scan. Which is best? What dye is best?

    Scan the entire spine, or just the injured area?

    Alan

    "Was it over when the Germans bombed Pearl Harbor?"

  7. #7
    smokey posted Jan 11, 2004 04:45 PM
    I had an IVC clip put in my vena cava in 1977 to reduce the incidents of pulmonary embolii that were occurring at that time. I don't know if it was made of titanium or steel. Correct me if I'm wrong, wouldn't an MRI pull and perhaps dislodge an IVC clip made of metal? Thank you.
    Smokey, you had your inferior vena cava (IVC) clip placed in the pre-MRI era. It is very likely that the clip contains some type of ferrous metal, if not steel itself. Such a clip would not only distort the magnetic fields so that the magnetic resonance image would not be usable but, as you point out, may pose a significant risk of moving or shifting the clip as a result of the large magnetic field in an MRI chamber. Because this is over 25 years ago, I don't know whether you would be able to track down your records or that they would be reliable. There are probably ways that one can tell whether the clip is iron/steel but I am not sure that it is worth the risk or trouble. A CT scan can give a lot of the information that you would want regarding the spinal cord. If a syringomyelic cyst is suspected, a CT scan with dye enhancement should be able to show the cyst. A CT scan in fact will show the bony morphology as well or better than an MRI. The only disadvantage of a CT scan is that it may not be able to show herniated intervertebral discs.

    ====================

    conman posted Jan 11, 2004 07:04 PM
    Q- not sure who to ask family doc or spinal doc for an M.R.I. i don't see either anymore. It's been three year's in May and i was woundering about what is going on in there.
    conman, may I suggest that you find an experienced spinal cord injury rehabilitation doctor close to you. This is something that you should be doing anyway. Everybody with spinal cord injury should be seeing a doctor at least once a year for a checkup.

    =====================

    casper367 posted Jan 11, 2004 07:32 PM
    I read a post at NM about scoliosis awhile back so I asked my doctor if I could get an MRI done to see if I have curving. I figured I been in my chair 18yrs surely something must be happening. My tests came back with some curving but my doctor said it wasn't significant. But if you have curving what can you do so it doesn't get worse. BTW my doc is my family doc not a sci doctor, I don't even know if there is a sci doctor here in las vegas.
    casper, you don't need a CT or MRI scan to determine if you have scoliosis. A plain x-ray is sufficient. The thing to do is to follow it up regularly and make sure that it is not progressive. If it is progressive, your doctor may consider a brace or surgery to prevent further progression. I don't personally know an SCI doctor in Las Vegas but there must be one... Perhaps one of our SCI-Nurses or other members would know.

    =====================

    alan posted Jan 11, 2004 07:48 PM
    There are different types of MRI scan. Which is best? What dye is best? Scan the entire spine, or just the injured area?
    alan, much depends on the machine and the software available. This is a rapidly changing field and I am not expert enough in this area to be able to say. Gadolinium enhancement has long been used but this is not really necessary for routine MRI's of the spinal cord. You don't need contrast to see syringomyelic cysts, herniated discs, etc.

  8. #8
    Great post Wise, like me, not ever having a mri till 19yrs post sci, and find out I had a syrinx a foot long. I'm lucky, things could have been alot worse. Stay on top of it everyone. Thanx again Wise!

  9. #9
    Dr. Young,

    When I was younger, I was seeing a doctor who recommended I have an MRI done either annually or every two years. This was while I still resided in Manitoba. However, once I moved to BC, and I was switched over to the Adult SCI outpatient program, I asked my doctor about this, and she said they would not allow MRIs UNLESS any changes were noted, (ie) change of functioning, a higher level of paralysis experienced, etc. I have brought this up at every appt I have had since, and have received this same response. I'm concerned that because I have severe scoliosis, the condition of my spinal cord is something which should be monitored, but how can I hammer this point across, when it seems that I have tried repeatedly in the past? I don't really have the option of switching doctors as finding a doctor who specializes in, or is familiar with SCIs is rare.

    I will print this out and take it to my appointment in February in the hopes that she will read the opinion of a fellow colleague, and perhaps understand my concern.

    "To live is the rarest thing in the world. Most people exist, that is all." - Oscar Wilde

  10. #10
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    Hello Dr.W.YOUNG,
    Correct me if I am wrong.Can a CT scan be done
    with metal of any kind along the injured area ?
    Years ago I had a Myelogram (?) done because of
    the metal but this is a very painfull procedure.
    friendly regards,
    Wilfried.

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