Case Study : Utilization Of MRI

According to the American College of Radiology Criteria for cervical MRI, MRI may be beneficial in a patient with ongoing neck pain with no history of trauma or neurologic findings if the neck pain persists and there are degenerative changes demonstrated on plain

As per medical report dated 4/19/16, a lumbar MRI with and without contrast was requested to evaluate for a discogenic and/or facetogenic etiology for pain. MRI would also allow evaluation of conditions such as spinal stenosis.

MRI of the cervical spine dated 08/17/16 showed at C3-4 and C4-5, there is mild posterior disc bulging.

The MRI modality can be used in either a T1 or T2 scan which can help differentiate the different tissues to see the abnormalities. T1 scans show the current disease by highlighting the active inflammation that is either new or a larger form from over time. Dark images can be used to see permanent nerve damage as well. On the other hand, T2 scans show the amount of space that the lesion takes up. The myelin layer that protects the nerve cells are made up of fatty tissue which repels water. However, once that layer is destroyed from the immune system attacking itself, “the area holds more water, and shows up on an MRI scan as either a bright white spot or a darkened area depending on the type of scan that is used” (NationalMSSociety). T2 scans are the most preferred MRI images to diagnose the Multiple Sclerosis. FLAIR is a newer image technique from MRI that is being used to identify brain lesions for Multiple Sclerosis. Spinal cord imaging is also used through MRI that is useful for diagnosing MS. The stronger the magnet, the better the quality of the image will turn out. By using magnets with higher Tesla’s, the stronger image can show the lesions better for a more accurate diagnosis.

When a patient is suffering with knee problems and/or pain, a Magnetic Resonance Imaging (MRI) scan may be ordered. An MRI is a diagnostic test that physicians frequently order to evaluate the knee. Following the procedure, MRI Specialists use the images obtained to investigate the source of potential knee problems and conditions.

That is a great example. I actually have assisted with several MRI visits, and have often heard how dangerous it could be inside. But, there are no liability measures if a person come across a dangerous situation. Like you, I used to be someone very quiet and not ask questions. However, after coming across these scenarios, I would definitely ask questions if in future I have to get into a MRI scan, or even any kind of radiological or neurological testing. I think that people in the community are not aware about this as a person might be needing to do a MRI in order to diagnose the illness that they have. And, in that process they do not really care about the adverse effects of the

MRI has largely replaced CT. This is a chronic injury patient with a 1992 date of injury. He is s/p back surgery. The latest progress report noted that the patient has chronic lower back pain, which radiates to the left leg. He has been approved for an intrathecal pump and would like to proceed with a trial. It was noted that he had an MRI of the lumbar spine, however, the findings of the MRI scan have not been documented. There is no clear rationale for the indication of a CT scan after an MRI scan. The guidelines state that MRI has largely replaced CT scans. In addition, there is no documentation of any recent trauma, fracture or infectious myelopathy that would warrant the need of CT scan. Medical necessity has not been established. Recommend

Myelogram is a fluoroscopic study done with contrast injected into subarachnoid space.CT is another modality that can be used to diagnose herniated nucleus pulposus, it might be used in conjunction with the myelogram, or by itself. MRI is considered the preferred modality for diagnosing HNP. MRI is non-invasive procedure that does not require ionizing radiation and provides more clear images. When diagnosis of herniated nucleus pulposus is established, a variety of treatments are available, ranging from non-invasive to surgical. The severity of the condition usually dictates the treatment. In most cases restricted physical activity, over-the-counter pain medication, and physical therapy are recommended. In some cases epidural injections of corticosteroids are prescribed. In severe cases surgical treatment such as microscopic discectomy or laminectomy are indicated. Surgical treatments are generally recommended if symptoms do not subside within 6 weeks and neurological damage is

Also, had been reported that the incidence of immediate hypersensitivity reactions to MR contrast media was 0.079%, and the recurrence rate of hypersensitivity reactions was 30% in patients with previous reactions. It is a very low percentage if we compare it to iodinate contrast media but however it should be considered.

Regarding MRI cervical spine, CA MTUS supports imaging studies with red flag conditions; physiologic evidence of tissue insult or neurologic dysfunction; failure to progress in a strengthening program intended to avoid surgery; clarification of the anatomy prior to an invasive procedure and definitive neurologic findings on physical examination, electrodiagnostic studies, laboratory tests, or bone scans.

fluid-filled cavity or syrinx within the spinal cord. The sagittal T2 MRI reveals a syrinx centered at C7, extending between C6–T1. Given the location of the syrinx, areflexic weakness in the upper extremities and dissociated anesthesia (loss of pain/temp with preserved position and vibration) in a "cape" distribution in the lower extremity is often present. Given the patient’s right lower extremity and bilateral upper extremity physical exam findings, the focus of the syrinx (comparable to a fluid-filled balloon) most likely is on the right side of the spinal cord below C7 and extends to compress the spinal cord bilaterally above. Given the lesion’s location, right lower extremity weakness along with increased knee and ankle reflexes with ankle clonus and a

There are many types of MRI scans that can be performed. In this case, a better alternative technique that can be used to observed CSF influx is a specialized MRI called Cine MRI scan. Not only is MRI scanning cost affective, it also very easy to process. In addition to this, MRI scanning is also very safe and painless. It uses a magnetic field to produce a detailed image of the bran by detecting changes with blood flow. Since with each heartbeat, CSF is forced out of the ventricle of the bran, into the cisterna magna and down the spinal cord with a CSF tracer we can use MRI scan to track the movement of CSF in the

Low flow venous malformation appear on MRI examination as lobulated, serpentine, poorly demarcated lesion with septa, hypo- or isointense on T1-weighted sequences and hyperintense on T2-weighted sequences. Signal void rarely occurring, but characteristic, due to phleboliths or caused by the presence of clots in veins. The lesion exhibits diffuse contrast enhancement on delayed dynamic study [21, 44, 45]. The two lesions included in our study showed fairly demarcated margins with typical signal intensities on T1 & T2 sequences with small signal void area of phleboliths within one lesion. Mild homogenous delayed enhancement seen in both lesions on MRI+C, no arterial feeder was appreciable on TRICKS-MRA. Both patients underwent successful sclerotherapy & No residual or recurrence of either lesion on follow up

Magnetic resonance imaging has the potential of totally replacing computed tomography. If history was rewritten, and CT invented after MRI, nobody would bother to pursue CT. --Philip Drew (Mattson and Simon, 1996)

Imaging reveals tumors or MS with great precision, but the neurovas-cular compression with a fair degree of precision. As progress in diag-nostic imaging continues, the accuracy of diagnostic imaging will likely advance. However magnetic resonance image (MRI) does not differentiate a symptomatic nerve with vascular compression from an asymptomatic nerve. (Patel NK et al., 2003). Furthermore, MRI cannot differentiate TN patients with microvascular compression whose symptoms will be improved after microvascular decompression (MVD) from those who will remain symptomatic after