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When to Order an MRI with Contrast

MRI with contrast should be ordered when a more detailed view of organ structure and function is needed; a detailed view of inflammation, analysis or diagnosis of a reported tumor, or to analyze blood flow and supply. Contrast allows for more detailed and clearer image capturing and is useful in the assessment and diagnosis of a variety of disease processes.

When to order contrast:

The information below was taken directly from a chart by Mayfair diagnostics. It may be helpful to review the chart in its entirety if you are curious if contrast may be useful in your imaging. The chart also includes ordering suggestions for without contrast, for MRA diagnostics and how to write a physician’s order.

Clinical indications for ordering MRI with contrast may include but are not limited to the following:

Extremities

  • Osteomyelitis for ANY extremity; spine or general infection
  • Soft tissue mass of ANY extremity or joint
  • Palpable mass, neuroma, tumor of the LOWER extremities (femur, tibia, fibula, calf)

Brain

  • Report of tumor, history of cancer, Bell’s palsy, seizures
  • Known acoustic neuroma, prior surgery for acoustic neuroma
  • Report of pituitary adenoma, tumor, abnormal prolactin, galactorrhea, amenorrhea
  • History of visual disturbances, proptosis, optic nerve
  • Soft tissue neck mass

Spine

  • Cervical spine: Multiple Sclerosis, spinal tumor, infection, syrinx
  • Thoracic spine: Multiple Sclerosis, spinal tumor, infection, syrinx, previous surgery within last five years
  • Lumbar spine: spinal tumor, infection, syrinx, post-operative spinal surgery

Body

  • Chest: Evaluate mass or pain, rib cartilage, diaphragm
  • Abdomen: Tumor, liver or pancreas evaluation
    • Liver, pancreas, kidney (renals)
  • Pelvis: Pelvic pain, mass, surgical planning
    • Pelvic pain, mass, surgical planning, gynecological abnormalities
  • Renal: Report of renal tumor, kidney tumor or mass
  • Breast: History of breast cancer, abnormal diagnostic mammogram, abnormal diagnostics ultrasound (requires recent mammography study)

*Typically when the previously mentioned items are ordered they are ordered “with and without contrast.” Likely two images will be taken (one with contrast and one without) in order to compare the two images.

What is an MRI?

MRI stands for Magnetic Resonance Imaging.

MRI is a technique using magnetics, radio frequency pulses and computer technology to take detailed pictures of the body. It allows medical professionals to see anatomical structure and function, or in simpler terms: it let’s a doctor take picture of a specific area of the body (an organ, bone, or tumor for example) and analyze what it looks like and how it is working.

Why use an MRI?

Often MRI is used to help provide a diagnosis, determine the progression of diseases, and determine organ function.

What is contrast?

The contrast is a substance introduced into the bloodstream that provides additional visual detail under an MRI.  The substance that is usually used in MRIs is called gadolinium, a heavy metal. It works with the electromagnetic technology of the MRI to provide a sharper image of the organ of interest.

Sometimes contrast is ordered by a physician to be administered during the MRI. Contrast helps to make the images taken during an MRI clearer. Simply, a contrast agent (chemical substance or “dye”) is injected into a blood vein that helps to make the organs and blood flow show up better in the pictures.

Why use contrast?

Contrast helps provide a more detailed and easier to read image.

So, why not use it all the time? Not every MRI will require the use of contrast–only cases where a more detailed analysis is required. There also can be some risks using contrast, therefore it is not used all the time.

On the other hand, sometimes a physician may want images both with and without contrast.

What do I need to know?

Contraindications:

As a patient, you will want to be sure to tell your doctor, radiologist (the person who interprets your images), or other medical professionals if you have or have had kidney issues. Contrast is eliminated from the body through the kidneys. If your kidneys have less than normal function or are more susceptible to damage you should not receive contrast. (It should be noted however that in some cases medical professionals may still recommend the use of contrast if the risk of other disease outweighs the risk of damage to the kidneys.)

What to expect if I receive contrast:

Common symptoms felt by patients who receive contrast agents are:

  1. Metallic taste
  2. Urge to pee
  3. Warm sensation

Other symptoms may include dizziness, nausea or vomiting, and headache.

Uncommon symptoms are severe allergic reaction, and nephrogenic systemic fibrosis (NSF). “Nephr”– refers to kidney. This symptomatic disease is much more likely to occur if you have a pre-existing kidney disease. Main indicators of NSF are internal organ damage and skin thickening and/or tightening.

How does the contrast enter my body?

A medical staff person will administer the contrast into a blood vein. Sometimes this is done manually and sometimes with an electronic pump. It is a quick injection, approximately 10-30 seconds.

How does the contrast leave my body?

As mentioned previously, contrast agents (specifically gadolinium contrast) is eliminated through the kidneys. Kidneys are your body’s blood filters–they run blood through an intricate system of filtration and take out what doesn’t belong. The collection of filtered toxins, etcetera, (in this case filtered gadolinium contrast) is run by small tubes into your bladder and then released from the body in the form of urine. 

There is some recent research that has shown small amounts of gadolinium being retained in bones and some tissues of the brain. The amounts are very minuscule and thus far there has been no evidence of adverse or negative effects on the body from retained contrast. However, because of this recent finding, doctors are much more cautious in their recommendations to use contrast.

Pregnancy and breastfeeding:

If you are pregnant or think you might be it is important to communicate this information with your doctor. Likely you will not receive contrast but in some cases where it is essential to your health and safety it may be recommended. You doctor will review the risks and benefits of MRI scanning and contrast injection with you prior to the imaging.

It is considered safe to breastfeed after receiving gadolinium contrast. However, please review with your primary care doctor or pediatrician prior to doing so! Similarly to gadolinium retention in bones and brain tissue, as mentioned previously, there have been minuscule amounts that have shown up in breastmilk after gadolinium injection. However, there has been no indications of needing to dispose of breast milk before feeding your baby. One article notes that 1/1000th of the amount of the contrast you receive may be found in breast milk and of that, what your baby may ingest is so small that it is not thought to present any danger to the infant.

 

Resources:

Mayfair Diagnostics, Radiography. (2016). https://www.radiology.ca/sites/default/files/ckfinder/files/Mayfair_MRI_Reference_Charts_Regina_2016_v3.pdf

Ferris, Nick, Doctor. and Professor Stacy Goergen, Inside Radiology. (2017). https://www.insideradiology.com.au/gadolinium-contrast-medium/

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