MRI brain - with or without contrast?

Just had the MRI of the brain today to help rule out neurosarcoidosis. Prof. Ayliffe had requested with and without contrast as long as I wasn't allergic to the dye.

I had to argue with the hospital because they said it was radilogical protocol NOT to use contrast. When I showed up for the MRI they said, "we will be doing the MRI with contrast because you have sarcoidosis"

Anyway I wanted to know what the difference was so I looked it up. See below. I suspect "radiological protocol" is actually to wait and see if MRI without contrast is normal or not.

MRI with contrast is a more sensitive test than MRI without contrast, when looking for
certain types of abnormalities, for instance brain tumors while obvious on regular MRI are very
easy to see as the contrast (gadolinium ) is taken up by the tumor causing it to "glow'
on the final scan.

Some lesions like active MS plaques are very obvious on a contrast enhanced scan, the may be seen
on a routine scan but the uptake of contrtast indicates that the lesion is active and recent
as opposed to older and inactive.

In most cases abnormalities are seen on a non-contrast scan , but the
visualisation is much better and more information is obtained using contrast.

If the non-enhanced scan is totally normal the need for a contrast image is not so

Edited April 13, 2012 at 9:16 am

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They did a non-contrast and then injected the dye to do a contrast on all 3 of my MRI's.

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Hi PlainTRUUS - I'm glad to hear that you got the contrast scan you needed.

My understanding of the purpose of contrast is similar to your own. The contrast will show up active inflammation. In my experience, It is simply a matter of timing as to whether the lesions are seen as "enhancing". If you have lesions which do not enhance, it may be difficult for the doctors to tell whether these are due to normal ageing. What it will do however is stand as a bench mark for comparison with subsequent MRIs.

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I had a cardiac MRI done and they did both with mine as well. The dye made me a little dizzy and sick feeling for a few minutes.

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During my career as a x-ray tech, I was paid by the hospital, but I worked for the Radiologists. Radiologic protocol (for me) is what the Radiologist requires to read the exam. Good luck to anyone who decides differently. Early in my career an Urgent Care MD ordered a one-view chest x-ray (2 views is the usual) on a young patient. It was a Sunday and I was working by myself. Figuring that the MD was going for a reduction in radiation exposure I complied. On Monday, the Radiologist read me the riot act --- who was I to decide what he needs to read a x-ray ?!?

Working under these conditions is stressful to say the least. As I gained experience, I learned how to please both sides most of the time, even if it did involve some deception upon occasion.

Frequently, it takes a conversation between your MD and the Radiologist to change "protocol" --- and even that doesn't always work. Zelda.

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Thanks, Zelda. That explains alot.

I'm just happy I got what the doc needed. They did not use contract on my cardiac MRI. Would there be any reason to suspect that my normal MRI was not normal after all?

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Hi TRUUS --- I never worked with MRI (that's Nuclear Medicine, not Radiology), but I can tell you that any imaging study with contrast is more sensitive than one without.

Try not to read anything into your exam results --- especially anything negative. Get a copy of your report for the facts. Z.

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Hi Plain...

They did a brain MRI on me without contrast and then one with contrast.

Either way, they couldn't find my brain.

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I always wondered if some of theses lumps are bits and pieces of my brain slipping away to play hide and seek mostly when I am trying to remember what I am suppose to do next or how to spell a simple word, you gotta love the sarcoid.

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Thanks for posting info about contrast.

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wearwolf......OOPS there it is
Somedays I feel like I have a's missing in thought.
Who would have thunk?

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My spelling ability (scale 1-10) would be a 1.3
as for remembering what I'm suppose to do, I put post it notes all over my dresser, night stand,bedroom door
sometimes they help,sometimes I forget to read them>I need to try brightly colored postits.

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