I am getting ready to have a MRI scheduled. Here's my question: Can a MRI without contrast accurately show if there is something causing TN? =/ I have seen posts that MRI w/ contrast is preferred, but my doctor didn't order it for some reason...
Thanks =).
Usually first MRI is to rule out MS
I do believe I've seen here contrast is necessary for seeing TN = but somebody else will chime in
It really isn't even necessary to do MRI at all period for TN --
my surgeon - one of the top 5 in the country -
only goes on patient story -- that is his absolute ONLY diagnosis of TN tool!
you have to trust your doc
if you can't - get another!
I am allergic to the contrast, but was told by Dr. Lim at Johns Hopkins it was essential for an accurate diagnosis that the mri is done both with and without contrast. I had to premedicate for a few days with prednisone so I wouldnt have a reaction and I didnt. It took about 1 hour to complete. there is a thread on here somewhere where Red addresses why the fiesta mri with contrast is necessary, you may want to message him
Wendy
A couple of thoughts on MRI. First, the earlier comment that it is not strictly necessary for a diagnosis of TN is spot on correct. Diagnosis is made on the basis of medical symptoms and history. The initial value of MRI is in eliminating some potential causes of pain that may cause wide spread problems: tumor, AVM, cysts, aneurism, other. Beyond that value, MRI may reveal vascular compressions of the trigeminal (or other) nerves, which offer an explanation for Type I TN and/or an indication that MVD surgery may have value when either Type I or Type II pain is refractory to medication. But MRI isn't magic. A substantial number (something over 10%) of compressions are missed, only to be revealed later during the exploratory phase of an MVD surgery.
Concerning contrast, it is my understanding that imaging done entirely without contrast agent may be less easily or accurately interpreted than images reconstructed from the electromagnetic returns of MRI when performed both with and without contrast. Likewise, the FIESTA MRI procedure provides sub-millimeter resolution by applying special magnet weightings in the MRI hardware itself. Not all MRI centers are equipped to use these magnets, and not all insurance companies are willing to reimburse the higher cost.
In all candor, I have long suspected that the cost of MRI procedures is vastly inflated relative to the actual installation cost of the equipment and labor of the specialized technician who administers the procedure. In the US, I've heard numbers between $3-5,000 for a single FIESTA MRI. I'm uncertain whether this is highway robbery or not. Why is 15 minutes of a Radiologist's time worth $400 or more? There don't seem to be any evident answers to that.
Regards all,
Red
The MRI with and without contrast is what discovered my AVM which was the cause of my T.N.Have since had Cyberknife to repair the bulging vein.Hopefully im fixed up!Im claustraphobic so it wasnt easy,but im sure glad i did it.Best of luck!
my Mri was approximately 3k, and the glycerol rhizotomy was around 7k, just as an fyi
Wendy
Richard A. "Red" Lawhern said:
A couple of thoughts on MRI. First, the earlier comment that it is not strictly necessary for a diagnosis of TN is spot on correct. Diagnosis is made on the basis of medical symptoms and history. The initial value of MRI is in eliminating some potential causes of pain that may cause wide spread problems: tumor, AVM, cysts, aneurism, other. Beyond that value, MRI may reveal vascular compressions of the trigeminal (or other) nerves, which offer an explanation for Type I TN and/or an indication that MVD surgery may have value when either Type I or Type II pain is refractory to medication. But MRI isn't magic. A substantial number (something over 10%) of compressions are missed, only to be revealed later during the exploratory phase of an MVD surgery.
Concerning contrast, it is my understanding that imaging done entirely without contrast agent may be less easily or accurately interpreted than images reconstructed from the electromagnetic returns of MRI when performed both with and without contrast. Likewise, the FIESTA MRI procedure provides sub-millimeter resolution by applying special magnet weightings in the MRI hardware itself. Not all MRI centers are equipped to use these magnets, and not all insurance companies are willing to reimburse the higher cost.
In all candor, I have long suspected that the cost of MRI procedures is vastly inflated relative to the actual installation cost of the equipment and labor of the specialized technician who administers the procedure. In the US, I've heard numbers between $3-5,000 for a single FIESTA MRI. I'm uncertain whether this is highway robbery or not. Why is 15 minutes of a Radiologist's time worth $400 or more? There don't seem to be any evident answers to that.Regards all,
Red
I don't know if it helps, but I just had a high contrast dye spiral CT scan at an ER and they said they saw nothing that would indicate the physical cause of TN, only could go by my stated history and symptoms. The scan itself took less than 8 minutes.
I can't understand how in this day and age that a physical cause can not be seen with today's imaging equipment.
I had typical tooth ache pain before having 2 root canals done, during the second, the symptoms of TN popped up for the first time. It was the upper that had began to leak into the sinus cavity (but showed a very small infection on the pano). I'm still thinking the TN symptoms are being caused by tooth issues, considering the timing etc. I will pay to find out if I'm just in denial however!
Tegretol is the only thing that helped me.It only took the edge off the pain.But i would set the alarm at night to take it when i was at the worst.I tried a antidepressant,forget which one,but it made me so loopy i went with pain instead.Good luck.
shindig said:
I just spent an hour in the MRI with and without contrast, but haven't had my follow up visit yet to find out my results. I can't imagine what the bill will be, with insurance.
Did around 6 5+ minute intervals and dozens of smaller 1-3 minute ones. But inside the tube for an hour.
I don't know what I'll do if it doesn't find anything, which I've read is common. I'm 28 and have had this since last November. Not taking any medication at the moment and it's all the time. My GP was just trying drugs, and wasn't sympathetic in the slightest, shrugged his shoulders and said "that's weird" to my symptoms, and wasn't going to do anything. I begged him for something and he tried nortriptyline and indomethacin, but he'd only give me 6 weeks supply and it was a revolving door of try this and tell me what it does. I thought a tooth must have moved back and up into my head and was pushing on things, so I went to an ortho who referred me to the neurologist, who just listened to me for 5 min and scheduled the MRI and said he'd talk about meds when he saw the results, but I have to wait 2 weeks for the follow up visit.
RyGuy: I've talked with a number of neurosurgeons who perform MVD. Among their reports are cases in which the "offending" vein or artery is less than half a millimeter thick. In a few cases, the blood vessel has actually grown "through" the nerve core. The lower limit of imaging resolution by MRI is presently about 0.66 mm. So i find it quite credible that medical imaging doesn't pick up a substantial number of vascular compressions. Science is pushing the limits of physics.
Add to that the factor that not all TN is caused by discrete vascular compressions -- particularly Type 2 TN pain, which appears to have a much more distributed and neuropathic character in the trigeminal nerve system. None of this makes the pain easier to bear. But perhaps it can help us to understand the frustration of medical practitioners when they must make diagnoses and select medical treatment solely on the basis of symptoms rather than definitive tests.
Regards, Red
If your not getting answers or the treatment you deserve ask for a second opinion.
I haven't had the mri done yet. They were making the doctor do another referral to get one with and without contrast. I can't get in to see neuro for 1-1.5 years anyway. Realistically speaking, I could be dead by then. ((bit dramatic, I know.. My head is splitting in two.)) I am showing major signs of occipital neuralgia now. . . . The Magnesium w/ calicum and Vinpocetine has helped tn some. Now, it's just finding something for the screwdriver in my ears and whatever else is going on inside my body. I'll be making another dr appointment soon to see if it is ON and I may wait til the doctor appt after that to mention the deep ear pain. :/ Hope she can help, because I can't wait a year and a half.
so understand your state.
"I can't understand how in this day and age that a physical cause can not be seen with today's imaging equipment.".- agree with you completely.
and i think the thought it IS something dental ....is or was in all our minds. i was at no less than 50 dental doctors.
so much in pain right now,
RyGuyUSA said:
I don't know if it helps, but I just had a high contrast dye spiral CT scan at an ER and they said they saw nothing that would indicate the physical cause of TN, only could go by my stated history and symptoms. The scan itself took less than 8 minutes.
I can't understand how in this day and age that a physical cause can not be seen with today's imaging equipment.
I had typical tooth ache pain before having 2 root canals done, during the second, the symptoms of TN popped up for the first time. It was the upper that had began to leak into the sinus cavity (but showed a very small infection on the pano). I'm still thinking the TN symptoms are being caused by tooth issues, considering the timing etc. I will pay to find out if I'm just in denial however!
i know that if you ARE doing an MRI. i think there is a special protocal called Fiesta as red mentioned ...that what i was done here - which is considered the best to check TN.
so if you have come to the stage you are doing an MRI - try to ask and do on the best one.
Mine didn't either. Without contrast can rule out MS or tumor, but may not be able to see if it's an artery or vein pressing on the nerve.
Sometimes dental work sets it off and makes it worse. That's what happened to me.
Nir Morita said:
so understand your state.
"I can't understand how in this day and age that a physical cause can not be seen with today's imaging equipment.".- agree with you completely.
and i think the thought it IS something dental ....is or was in all our minds. i was at no less than 50 dental doctors.
so much in pain right now,
RyGuyUSA said:
I don't know if it helps, but I just had a high contrast dye spiral CT scan at an ER and they said they saw nothing that would indicate the physical cause of TN, only could go by my stated history and symptoms. The scan itself took less than 8 minutes.
I can't understand how in this day and age that a physical cause can not be seen with today's imaging equipment.
I had typical tooth ache pain before having 2 root canals done, during the second, the symptoms of TN popped up for the first time. It was the upper that had began to leak into the sinus cavity (but showed a very small infection on the pano). I'm still thinking the TN symptoms are being caused by tooth issues, considering the timing etc. I will pay to find out if I'm just in denial however!
Well I had my MRI with contrast and Neurologist appt after. Here's a bit of a run down:
MRI started with no contrast, the after the first run they added contrast while I was still in the machine. Don't remember how long it took, I sort of fell half asleep but I'd say around an hour.
Then saw Neuro, he showed me the scan on a rather small old laptop and while pointing to the RIGHT side of the scan described how the vein\artery whatever was not close to the nerve etc.... I pointed out my pain was on the LEFT and he said "OH, Left?!, your pain was on the left" then points to the other side and says the same thing while describing the scan. Yet seemed a bit confused at first if he was telling me about the R or L side of my head verses what he was pointing at. After the correction, he clicked through several images and pointed and talked as though I were an imaging tech who knew what he was looking at. I saw nothing really on the scans, they showed up on the screen just under the size of a cantaloupe, in black and white. He didn't see where the nerve could be compressed anywhere and said the cause could be local (to the pain). Come back in 3 months....
I am a bit disappointed to say the least. After my 1st appt with him and him only giving me 200ms Teg ER twice a day, I ordered Tegretol 200 regular from online in India. Seemed to work the same as what I had. No shock really, it was made by the parent company to Norvartis. Yes I told the neuro about that and he said "but Mumbia India is a third world country, we don't know what their standards are" etc...... (I almost mentioned "but didn't you come from there?!?" but I didn't, he's a nice guy). I told him I didn't care, I can't get by without that extra Teg, I did reduce what I use of it down to only when desperate, like maybe 1 or 2 pills a day at most. But I'm not going without.
I have to say though, ordering online for any med doesn't seem much cheaper than getting it here. Of course I didn't need a scrip for this order. As long as it's not a controlled substance (like Oxy or Hydro) I guess it doesn't really matter that much (same as if you're in Mexico). I was VERY hesitant to order that way, so put it on my smallest limit credit card just in case. So far, no probs, knock on wood.
So, now I'm thinking, "now what?"