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MRI explanation required
June 5, 2011 1:29 PM   Subscribe

Help me understand MRI procedures.

A relative of mine has to have an MRI test done. Now I've had a basic MRI taken before, so I tried to explain what is done, what to expect, etc. This test seems to be different. Or maybe not.

The appointment letter calls it "mr Head/Cervical Spine" and says nothing about any contrast, dye, etc.

When my relative phoned to confirm a few details, the receptionist/operator mentioned something about a dye and an injection.

Now I've done some reading on the Internet, and I'm aware that that a FMRI/functional MRI is a slightly different test, but I can't tell if that is the procedure being ordered.

I also don't know if intravenous is going to be required (as some websites suggest).

I'm only trying to figure this out, as the person tends to be a bit on the nervous side and would do better to have a fuller understanding of what is involved before hand.
posted by sardonyx to Health & Fitness (27 answers total)
IV contrast isn't used for fMRI. Your relative may or may not be getting contrast, easiest way to find out if you're not sure is to ask.
posted by sero_venientibus_ossa at 1:40 PM on June 5, 2011 [1 favorite]

I've had an MRI of the head and c-spine and it was not an fMRI. IV contrast (gadolinium) is probably required, though I did not have it.

There are a few things I wish I knew ahead of time:
-It's extremely loud. Like helicopter landing next to you loud. Ask for earplugs.
-They put a plastic cage thing over your face. This didn't bother me, but I could definitely see it bothering someone claustrophobic.
-It takes longer than I would expect. I believe the head part was 15 minutes for me and the c-spine was 20? Something like that. There was a little mirror in the machine so I was able to see a clock behind me. It was nice to be able to see that b/c otherwise you feel almost in sensory deprivation.
posted by dayintoday at 1:41 PM on June 5, 2011

As far as I know, if there's contrast it's administered via an IV.
posted by Dolley at 1:42 PM on June 5, 2011

It's extremely loud. Like helicopter landing next to you loud. Ask for earplugs.

This is what I came in here to say.
posted by LobsterMitten at 1:43 PM on June 5, 2011

While I obviously don't know if the procedure your relative will be having is the same as the one I had, mine involved changing into a gown, sitting down in a little office to have a line put in my arm (they stuck the needle in my arm, connected a tube and a big syringe of dye, and gave me the syringe to take with me). I then walked into the room where they do the MRI, lay down and got slid into the scanner. They did one scan without the dye, slid me out, injected the dye, slid me back in to do the scan with the dye. Neither scan took a particularly long time. Then they disconnected the line, I walked back out and changed back into my clothes.

Bear in mind that 1) this was very likely in a different country than your relative, 2) they might not be having that procedure (mine was head & cervical spine, but possibly looking for something different), and 3) that's the short version, for the long one see another thread somewhere about embarrassing needle-related fainting incidents (which in my case may have been avoided if I'd been able to explain in the local language that fainting was a possibility).
posted by Lebannen at 1:45 PM on June 5, 2011

I'll avoid marking anything a best answer for now, but thanks everybody. All the answers are helpful.

As I said, I've had a basic MRI before, so I'm familiar with the noise level. The rest of it -- the IV, the injection, etc. -- is new to me.

dayintoday, thanks for mentioning the mask. I read about the possibility, but I wasn't sure how common it was. The website didn't really go into specifics. I think having that detail sprung on the person without prior warning might be a bit much, so I'm glad I'll be able to provide advanced warning of the "now they just may..." variety.
posted by sardonyx at 2:12 PM on June 5, 2011

My shoulder MRI went: contrast administration via IV, then get into the machine, which is like a big pipe. Two things not noted above: my GF said -her- MRI was noisy like banging or hammering, but mine went Ting Ting ting ting TING ting ting, not all that loud. Perhaps that was because of point two: they had a set of headphones like very old airline ones where pieces of plastic tubing carry the sound. They had advised me to bring music with me so they played my relaxing CD while the test went on. They could cut in and talk to me through the headset.
posted by jet_silver at 2:30 PM on June 5, 2011

The contrast MRI I had of c/t spine was horrible. But I blame that on the incompetant nurse who refused to believe my hand veins are not suitable. An hour and a half later, I had hives, my hand was swollen and I was ready to tear the IV out myself.

The contrast fluid hurt going in (and it makes you feel really cold) but that could have been due to the bad IV line too.

posted by guster4lovers at 2:31 PM on June 5, 2011

They had advised me to bring music with me so they played my relaxing CD while the test went on.

I don't think they'll do the headphones thing for a head MRI. I was advised to bring music too, but then when I did, they said, "Oh, sorry, you can't have that for head MRIs." Not sure if that was specific to where I got it done, or a general rule.
posted by dayintoday at 2:56 PM on June 5, 2011

I don't think functional MRIs are commonly used for diagnosis right now, outside of experimental settings. The functional MRI deals with what the brain is doing, so they might (one day) be used for diagnosing autism, Alzheimer's, or other neurological disorders that affect how people think. If your relative has an injury or possible abnormal growth or anything obviously physical like that then they are almost certainly getting a structural MRI done instead.

(The only difference is that in a functional MRI you're asked to do something, such as watch a video or perform a test...something that would cause your brain to react. In a structural MRI, you just have to not move. If you get a functional MRI they usually do a structural scan, too.)

On preview: They need to have special headphones for you to listen to music during a head MRI. Not every office is going to be set up for it, especially if they only do diagnosis MRIs (usually much shorter than experimental MRIs).
posted by anaelith at 3:01 PM on June 5, 2011

When I've had head/cervical spine MRIs, they have used contrast. Whether this happens will depend entirely on whether your friend's doctor ordered images with contrast or not, so a call to the office is in order. If they are using contrast, then yes it will be through an IV. Usually the IV catheter (tubing for access into the vein) is placed into a vein the arm out in the office area, before the person is taken back to the room with the MRI machine. Some MRI images are done before the contrast, and then the liquid is given through the IV in the arm, then more MRI images are taken. When I have received contrast it has felt very cold going up into my arm, which feels weird. It also makes me really nauseated and anxious for about 30 seconds, which is apparently common, but it does pass quickly.

I've also always had a plastic face mask put on, which is awful for me even with only mild claustrophobia. The best advice I can give if your friend is nervous is to not open her eyes once they put the mask on, not even for a peek. I did once and my tenuously-held calm evaporated instantly.

The machine makes all sorts of different noises depending on what kind of scan they're running. I've always been given the option to bring a CD to play over their giant headphones, or to pick a radio station. The first time I picked the local NPR affiliate and was disappointed to discover that I couldn't hear well enough to distinguish what they were saying, though I could tell people were talking. That ruined my audio-book idea for the next session, too. When your friend calls the office, have him/her ask whether they can play a personal CD during the MRI. If so, bring something familiar. If you know the songs, you can hear them well enough to listen and enjoy the music. Unfamiliar stuff just gets lost in the noise.

The best thing I've done in the MRI is to practice relaxation exercises. It helps keep my claustrophobia under control and also makes the time go faster. I picture myself laying on my back on a blanket under a big, branchy, leafy tree that is alone in a giant field of grass. Blue skies overhead, puffy clouds floating by, a soft breeze on my face. (Luckily the places I've gone for MRIs have little fans that provide just such a breeze inside the machine.) I imagine myself somewhere big and open and calm, and try to just relax until I sink into the ground.
posted by vytae at 3:04 PM on June 5, 2011

I've had two head MRIs several years apart at the same hospital and both times the screening/scheduling person on the phone asked me if there was any reason I couldn't have contrast. Both times I did not actually learn whether or not there was going to be contrast until I got to the MRI center. Nthing to ask if your relative needs to know ahead of time. Also, the time I had contrast I believe I was already in the machine when they injected me, so I think the timing depends on whether they want to get some pictures without contrast as well.

The contrast is cold and I felt it going in (I've had contrast with other tests, too, and this is how it usually feels for me.)

The MRI center where I go gives you earplugs but no music for a head MRI. My strategy for dealing with the noise was to count; the MRI techs would tell me over the speaker how long each segment of the test would last and I counted off the seconds in my head. (The noise is the worst part for me and counting is about all I can manage as a distraction.)

They also give you a call button so you can get the techs' attention, which I imagine is standard procedure. It makes the whole thing a bit less isolating. (I had a mirror, too, in order to see outside the head cage, but I mostly kept my eyes closed.)
posted by camyram at 3:06 PM on June 5, 2011

thanks for mentioning the mask. I read about the possibility, but I wasn't sure how common it was. The website didn't really go into specifics. I think having that detail sprung on the person without prior warning might be a bit much,

Yes, it was sprung on me and it was terrifying.

They asked if I was claustrophobic and since I never had been, I said no. Then they clamped that mask on my head and I just freaked out. I started yelling for them to get me out, etc. I was embarrassed about how I reacted, but I had a total panic attack. They finally called to get me a xanax and after that took effect I was able to do it.

My mother and friends have had several MRIs and the doctor always prescribes a xanax or a valium and tells them to take it ahead of time. I would suggest that your relative ask the doctor to prescribe one and have the person take it about an hour before they have the MRI. You just don't know whether you're claustrophobic or not until that mask is on...
posted by la petite marie at 3:09 PM on June 5, 2011

thanks for mentioning the mask. I read about the possibility, but I wasn't sure how common it was.
The "mask" is called a head coil - it's not a possibility but a certainty. Most people are fine.. with the tube, the contrast, the noise, etc. I really wouldn't worry much unless your relative has some sort of specific need that should be considered.
posted by sero_venientibus_ossa at 3:32 PM on June 5, 2011

Once again, thanks everybody for the fabulous answers.

Today, when I was making arrangements about what time this person wanted me to pick her up -- I'm driving as the test is being administered about 100km away -- was the first I head about the possibility of contrast.

We tried calling the hospital for more details, but of course, with it being a Sunday, nobody was answering.

As the test is scheduled for tomorrow, I don't know if we'll have a chance to call in and ask questions before we leave.

I'm sorry to hear about the bad experiences guster4lovers, vytae and la petite marie suffered. I am hoping to help this person avoid similar experiences, hence my question to the MetaFilter community.

I'll report back tomorrow with the after-test report.
posted by sardonyx at 3:54 PM on June 5, 2011

I was going to come in and say that the MRI I had was the first time I'd ever a) been claustrophobic and b) had anything ice-cold stuck in my veins. If I had to do it again, I'd more or less demand a Xanax. And I'd bring earplugs myself.
posted by SMPA at 4:02 PM on June 5, 2011

A bit late to the party, but I'd like to add a positive note: yes, the anticipation is awful, the contrast and preceding saline is unpleasant, yes holding still for 30-45 minutes is damned hard, yes it can get claustrophobic and boy howdy, it is loud. But somehow, I was able to associate the bangs and pings and vibrations with some kind of weird cross between a Laurie Anderson concert and sleeping on a Greek fisherboat. It was okay. I get my results tomorrow.
posted by likeso at 4:03 PM on June 5, 2011

I hope the results are good, likeso.
posted by sardonyx at 4:05 PM on June 5, 2011

Thanks, sardonyx! And you're a good friend. :)
posted by likeso at 4:18 PM on June 5, 2011

Er, relative. friendly relative? Hope things are good for you both.
posted by likeso at 4:19 PM on June 5, 2011

Relative. And friendly (well most days, you know how it is with relatives).
Thanks for your well wishes.
posted by sardonyx at 4:37 PM on June 5, 2011

My C/Spine MRI was without injection and I failed the first one, because the pain I was having even without being in an MRI caused me to move ever so slightly. The second MRI was done at a different place with a device placed around my neck (some sort of plastic collar) that kept me from moving. I was given a vallium to take when I got to the MRI place. I do like the Open MRI concept, instead of a doughnut with a sliding bed, this was two large pancakes of magnets that allowed one to see daylight, etc... while being scanned.

It is extremely most everyone above has noted.

Good luck!
posted by bach at 4:58 PM on June 5, 2011

Just to counter the unpleasant stories: I have had a head/cervical MRI both with contrast and without. When I had the contrast it was injected while I lay in the machine. It didn't particularly hurt. The technicians had music available that I was able to listen to through headphones - I chose Queen and had an MRI to such inspirational songs as "We Will Rock You" and "We Are the Champions". I must say, the music selection definitely helped make the experience a positive one, and all three times I've had head MRI's I've been able to listen to music, so there's no medical issue there (ie head MRI/listening to music).
posted by smartypantz at 6:06 PM on June 5, 2011

I have had MRIs of both neck and head, one with contrast, one without. I had no problems with the contrast. I think the main counterindication for contrast is if you have liver or kidney disease, because a rare complication can occur. The nurse warned me that it might feel hot going in, but I didn't notice anything.

Bring earplugs, although they will probably give you some. They'll give you a panic button if you get claustrophobic. I found it helps to go in with your eyes closed, and keep them closed.

It is loud and boring, like being at the world's dullest rave. I found I could tune it out after a while.

Good luck!
posted by thinkingwoman at 7:33 PM on June 5, 2011

Just thought I'd chime in my my MRI experiences. Due to a messed up set of arteries in my brain, I have a standing date with the MRI every two years, and I've already had 2 (never mind so many CT scans I've lost count...)

Both MRIs were with contrast. For me, there was an IV in my arm (at the elbow), and about halfway though they released the contrast as they were looking for scans both with and without. It's a lot less noticeable the the contrast they use for CT scans; I didn't even notice it (on the other hand, it's impossible to ignore the CT stuff)

For me, the worst part is simply not being able to move. Because of course as soon as someone tells you to stay perfectly still, you will of course need to scratch, cough, sneeze. It's just inevitable. My techs were pretty good about letting me know when they were between scans, so I could take those few seconds to readjust as necessary.

Other than that, I didn't find them to be that big a deal. I'd personally rather have an MRI than a CT, because of the differences in contrast. Another thing to note is that they will ask you a whole bunch of questions about whether or not you could possibly have any metal in your body. Aneurysm clips and metal shavings in the eyes (??!??!!) were the things they seemed most concerned about. But that being said, we also discovered that my belly-button piercing did not need to come out, after much discussion and them threatening to cut it off (i've never taken it out and have no idea how to...)

Next time I'm bringing earplugs and am going to try and sleep though the whole procedure. I actually think I might be able to pull it off.
posted by cgg at 9:44 PM on June 5, 2011

Some anecdotes from my experiences, fwiw:

I have had over a dozen total spinal column MRIs, all of which involved a contrast agent. The contrast agent always feels sort of weird, but not much different from any other non body-temp fluid being pushed into a vein (But I also have very easy veins).

MRI scans make me feel very warm, which seems unusual from what others tell me.

Also, MRI scans for me correlate with nasty headaches about an hour later. I suspect it might be from the contrast agent, but y/tmmv.

The one time the scan was of my brain, they placed my head in a snug cage (maybe this is the same as the mask?). This is not so much to keep you head still as it is actually a coil to receive the generated signals (for other scans, it's actually under the mattress you're on).

If they give headphones to wear, make sure the volume is set high enough. MRI scans are louder than you think.

Drink enough fluids afterwards, especially if the scan used contrast.

Good Luck!
posted by HFSH at 12:20 AM on June 6, 2011

I've marked a lot of answers as best answer. Actually I feel as if I should mark them all with best answer. Thank you so much everybody who posted. It certainly helped me reading about all your experiences. It gave me enough background to explain the procedure, which sadly was absolutely necessary.

The set-up was like this: the receptionist handed out the typical forms to sign (any metal in the body, etc.), told my relative to sit and wait for somebody to come and get her and that was pretty much it. There was no explanation of what to expect, or anything. We had to ask the very basic questions: how long will it take, is she getting contrast, and so on. The receptionist didn't seem very happy answering the questions. Mostly we got one word answers.

The test itself was about 40 minutes in length, although the overall wait time was a bit longer than that.

Before and during the test, it seems as if little was explained. When she came out she said she was really starting to wonder if the technician made a mistake and forgot to insert the dye. She said she was dreading having to go through the whole thing again as her back was extremely sore.

It was only in the last few moments that they injected the contrast. She said she didn't seem to have any negative effects from it.

Oh and she definitely had the thing around her head and face, but because she knew to expect it, she coped with it just fine.

I really don't think it should have to be my job to look up test or surgery procedures on the Internet and explain them to my relatives. I really feel that the doctors and/or the hospitals should do a better job of preparing people for what to expect. I know I've been blind-sided a couple of times by the completely unexpected when going for testing, and I never appreciated it.

All that said, I'm very, very happy that I've got such a wonderful resource as MetaFilter at my fingertips and so many wonderful people who are willing to share their experiences. As I said it, today it made a great deal of difference. Thanks for that and thanks for your well-wishes for her. Now we just have to wait for the results.
posted by sardonyx at 8:12 PM on June 6, 2011

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