M R I Vs C T (C A T)

[wpcoe]

I had my first MRI a week ago with a herniated disc. I was shocked to know that I have acute claustrophobia and had a panic attack when they attempted to slide me into the MRI machine, even feet first. I'm not sure how much of the panic was intensified by the size: I had to uncomfortably scrunch my shoulders to fit, and my breath bounced back off the inside of the machine onto my face. They ended up sending me, via ambulance (that's possibly worthy of a separate thread!), to another hospital that had an "open MRI" machine that caused me no fear or panic at all.

I was surprised to see the film resulting from the MRI when my doctor showed me, to point out my herniated disc. It was black and white and just looked like an X-ray. I was expecting some high-definition full color printout. What type of machine produces those? Or, am I simply thinking of some CGI photo used on TV and in movies?

I Googled and read "MRI vs CT" articles on the internet. I understand the difference in technology, and read that CT "provides good details about bony structures" whereas MRI provides "less detailed compared to CT scan." Why did my doctor do an MRI and not a CT? Do the discs between the vertebrae show up better on an MRI? It sounds like the bones would show up better on a CT.

Back to my panic attack, I found they are not all that uncommon. Two friends of mine had reactions: one was able to be sedated enough to endure the scan, whereas the other bit the bullet unsedated, was slid into the chamber, and vomited. <g>

I'm confused why I was transported (in agonizing pain) to another hospital rather than being sedated ... perhaps unconscious if necessary ... and slid into the MRI, but for some reason never asked. I think I was just too overwhelmed at the time.

Are CT machines easier for we claustrophobes? Pictures I see on the internet seem like that the hole one slides through is about 10cm deep, whereas the non-open MRI is a loooong tube you enter.

[deadman]

how much was the MRI scan, and at what hospital was it at, if u don't mind me asking? My doctor wants me to get one and i was surprised at the 10K cost. He didn't mention anything about a CT scan, but from what u said i will now ask him if this is a better alternative, and just maybe cheaper

cheers

[lopburi3]

Believe for soft tissue the MRI is more defined but for general check both are excellent and much better than normal X-ray.

I was scheduled for a three part MRI/MRA last week which would have taken 3 hours and radiologist changed it to a CAT which took 30 minutes as felt 3 hours would have been much too uncomfortable in the MRI (enclosed). About 40" waist so not tiny and both tech and doctor were very concerned about trying to put me in the MRI.

The three part MRI was to have cost about 39k and the CAT covering neck to hips was 27,500

CAT is easy as just a move through an six inch or so ring for the area that needs to be scanned and you are not enclosed at all. Mine was two scans and then two more with the IV solution. Quite warm blood using the IV but well warned what to expect and not uncomfortable. The only bad part was keeping arms above head as not a normal position.

From the reading I had done the open MRI is not a very good system for qualify image, especially for cheaper or older units.

Edited September 6, 2010 by lopburi3

[Old Man River]

When I have to have an MRI I have them give me a low dose of Xanax. Otherwise there is no way I am going in that tunnel, although the machine described by the OP seems to be a tighter fit than I have experienced.

On the MRI vs. CT Scan, one doctor told me that multiple usage of an MRI (hopefully never needed)is safer as it doesn't use X-Rays which a CT Scan does.

[DocJD]

MRIs are preferred over CTs for cartilaginous tissue (such as an inter-vertebral disc) and muscle tissues. MRIs are sometimes given with sedation; however, they are scheduled as such. The patient is not supposed to eat for several hours prior to receiving sedation. Most rad techs don't have the training to give sedation or perform first-aid if something goes wrong. Those are probably a couple of reasons as to why you were bounced to a different hospital.

[Sheryl]

CT may be a bit easier to tolerate but many claustophobes have problems with it as well.

It's important to understand that Xrays show bones only. To visualize softer tissues, like inter-vertebral discs, you do need a CT or MRI. Of the 2, MRI better.

However it is also important to know that the fact that a person has pain and has a herniated disc does not necessarily mean the pain is from that; herniated discs are common and can be entirely incidental. The pain may instead be from a bone spur (osetophyte) pressing on the nerve, or it could be from a combination of protruding disc plus spur, etc. Bone spurs may be missed by CT/MRI alone. I have several times seen this (presence of bone spurs pressing on nerve) missed, even by specialists in spinal disorders, and seen that in turn result in improper advice.

It is important to get this clear as the natural history differs. Bulging discs eventually contract, so it is often possible to avoid surgery if this is the sole cause of the pain. Whereas a bone spur isn't going anywhere, and if it is significantly impinging on a nerve, surgery may be unavoidable.

[Old Man River]

MRIs are preferred over CTs for cartilaginous tissue (such as an inter-vertebral disc) and muscle tissues. MRIs are sometimes given with sedation; however, they are scheduled as such. The patient is not supposed to eat for several hours prior to receiving sedation. Most rad techs don't have the training to give sedation or perform first-aid if something goes wrong. Those are probably a couple of reasons as to why you were bounced to a different hospital.

Reason (herniated disc) aside, I can assure you that the sedation (Xanax 5 mg) with my first visit into an MRI was not scheduled as such and I fully empathize with the OP's experience. I was put into the MRI and yelled I wanted out. I tried again and said get me out of here. Then, they gave me the Xanaz and after 20 minutes or so, I was able to stay in it until the test was over. If you have any feelings of claustrophobia, a mild sedative is the only way to go if you have to have the MRI.

[wpcoe]

how much was the MRI scan, and at what hospital was it at, if u don't mind me asking? My doctor wants me to get one and i was surprised at the 10K cost. He didn't mention anything about a CT scan, but from what u said i will now ask him if this is a better alternative, and just maybe cheaper

For the life of me, I can't recall the name of the hospital with the "open MRI" machine, I just know it was quite a distance away and the name, when they told me, was unfamiliar to me. From the "decor" that I viewed, looking mostly at the ceiling, I would say it was possibly a government hospital.

My hospital bill lists "Standard Diagnostic Imaging" (which I assume is X-ray) of B1,050, and "Special Diagnostics" (which I assume is the MRI) of B13,600. I recall signing a document authorizing my transport to the other hospital, and for their MRI, and B13,600 amount sounds about right. I had calculated roughly in my mind that it would be less than US$500. Not that it mattered. I would have paid triple if I thought it would help get me out of that pain.

And, "Ambulance Services," although listed separately shows amount "0.00."

[wpcoe]

Wow, Sheryl, you gave me something to think about regarding things other than the herniated disc being the only problem.

I had an almost identical episode about 1.5 yrs ago, but no MRI was ever done, so I asked my spine doctor today if, looking at the MRI, he could see any *other* disc that had herniated in the past, but it's only the one between lumbar vertebrae 4 & 5. I asked him the likelihood that I had ruptured that disk 1.5 years ago, and now just ruptured it some more, and he had no definite answer.

Now, with Sheryl's input, I wonder if it's either (a) something *else* or (b ) the disc *plus* something else. When I left the hospital today, they tried to give me copies of the MRI films, but I asked them to keep them until my next appointment next week, as I was going shopping, and those films are rather large to be carrying around. Right now, I wish I had them at hand, to see if I could find anything else. (Highly unlikely, but one never knows!)

I was also surprised that they gave me films, rather than a CD (DVD?) with a digital version.

[Sheryl]

It is the film you need.

And IMO you couldn't do better than to bring them to Dr. Wicharn at the spine center in BNH to see what he thinks. He will most likely insist on a regular xray as well.

There are nerve tests that they can sometimes do to help determine if a particular problem is the cause of pain being experienced. They are a bit costly so only worth doing if surgery is being contemplated.

If you do not have any radiculopathy (pain radiating to the legs or weakness/numbness in the legs), conservative management is usually advised first.

[wpcoe]

Thanks for the specific recommendation, Sheryl. I wonder how Dr. Eakpatipan at the Spine Center will feel about me seeing Dr. Wicham. LOL!

They already took x-rays (before the MRI) so, he'll have them available already.

I've had another fly in the ointment. As Thai doctors tend to do, I was amply medicated upon discharge:

After initial discharge on 01/09/2010 (Sept 1):

1. Biocalm Tablet (50mg) 3x daily

2. LyriCA (150mg) 2x daily

3. Arcoxia (90Mg) 1x daily

4. Paramed-CO (300/10) 4x daily

After 7-day follow-up exam on 08/09/2010 (Sept 8):

1. Biocalm Tablet (50mg) 3x daily

2. LyriCA (150mg) 2x daily

3. Arcoxia (90Mg) 1x daily

4. Tramal (50Mg) 4x daily

The only difference was changing the codeine for Tramal. I took the first Tramal in the evening and the second one after breakfast (at around 0830) the next morning. By 1000 my feet had swollen, not painful but visibly larger and very tight feeling, so I called BNH and talked to the nurse. (After the call, I remembered that the tops of my feet had felt like they were bruised when I went to bed, but I looked at them and pressed on them, and decided nothing was amiss. Now, in retrospect, I realize it may have been minor swelling.)

She said it was odd that Tramal would cause edema, but it *was* a possible side effect of Arcoxia. But, I pointed out it was also odd that I'd been taking the Arcoxia for seven days with no edema. We agreed on the phone that I would stop Tramal for a day, to see if swelling went down.

Well, this morning, 48 hours later, my feet -- and now my lower legs, apparently -- are swollen. Two nights ago a slipped getting down from standing on a chair to change the air con filters and I banged my shin. I have a small surface scratch, but apparently also an invisible bruise. While normally I think the bruise would be limited to the immediate area -- say, an inch or two around the scratch -- the entire lower leg on that side feels sore. My instinct says it's because the leg is swollen enough to put pressure on the bruise, even though my leg doesn't *look* larger, like my feet do.

So, this morning, with swollen feet and sore leg still in effect, I stopped taking *all* of the meds. I already feel a bit achy all over, but I'm determined to get rid of the edema. It's entirely possible the edema is from some totally unrelated cause. Things like allergic reaction to something in my environment (food?) or some sort of bite, or who knows what. I want to eliminate the meds as the culprit first.

Am I playing a dangerous game by not immediately seeing a doctor, most probably at Bangkok Hospital-Pattaya who has a sketchy reputation with treating farang? Going all the way to BKK more than once a week is really a hassle, but if I'm endangering my health, it'd have a sense of more urgency.

[Sheryl]

I did not realize your were already a patient at BNH spine center. Dr. Eakpatipan also has an excellent reputation and I have seen very positive feedback on him on this board.

In terms of the swelling:

1. If you have any of the following, should see a doctor at once:

- shortness of breath on exertion (for example, climbing stairs)

- a history of heart problems

-a history of liver of kidney problems

- any loss of sensation in your legs/feet (for example trouble feeling a pinprick) or unusual weakness in the legs

2. In terms of meds, you are wise to stop them. The biocalm, tramadol, arcoxia and lyrica are all possible culprits. Most probable IMO is the tramadol since it is the newest and it does, indeed, cause peripheral (arm/leg) edema in a small minority of people. The paracetemol + codeine is less likely. I would say, stay off all of them if you can, if the pain becomes too much take either plain paracetemol or the para plus codeine but not the others.

[wpcoe]

Thanks for the reassurance, Sheryl. My mind can spin into some illogical eventualities some times!

I think the swelling must fall into the "more benign" category since I don't satisfy any of the criteria you mentioned.

I think the swelling is increasing a bit, as both my lower legs feel "tight" now.

Since I'm already getting free medical advice (THANK YOU!), I will ask two more questions: How long should I wait before I'm clear of residual effects of the meds I've been taking for over a week? Can I consider myself "all clear" from effects from the two Tamadol doses I took over 48 hours ago?

Overall body achiness is setting in now, and specifically the area where my back injury (allegedly) occurred is more tender, so my movements must be made more gingerly now. As long is things don't get any worse, I can live this way without the meds.

Also, it's nice to come down from a 24/7 "high" that I was on since I started taking the meds. My mind is more focused now.

[wpcoe]

As I said, my mind likes to work overtime with paranoia , and to fuel speculation:

(1) I realized this afternoon that my right leg (the one with the scratch) is visibly (slightly) bigger than my left leg, and

(2) I just now noticed that my right leg is warm to the touch on the front.

If it's same-same (or worse) in the morning I guess I'd better go to the hospital. <sigh...>

The Good News is that my body is tolerant of my medication withdrawal. The pain in my back, and my upper body in general, is tolerable.

[Farlooker]

The biggest difference between MRI & CT is the amount of Radiation you get from the CT. Computed Tomography, (CT), is basically a very powerful X-Ray machine that takes pictures in a 360 degree circle around the body part being examined. Because of the powerful Radiation many Physicians are reluctant to use CT, especially if you have had them in the recent past. MRI on the other hand has NO radiation at all. The computed imaging is based on the power of Hydrogen Atoms. The more Hydrogen, (water) in the tissue the brighter and whiter the images. Tissues with less water, (bone) tend to turn up dark or black. Discs should appear bright white due to the large amount of water. When you have a "dark" disc this means there is significant degeneration and wearing out of the disc. Open-Air MRI used to be looked down on because the quality of imaging was very poor compared to the "tube". But the scientific advances have changed that and it is just as likely to get a very clear image with Open-Air.

In any event before you consider any kind of invasive procedure please consider seeing a Chiropractor first. Dr. Don in Bangkok is perhaps the best Chiropractor in Thailand, has been in practice there well over 15 years and has an excellent reputation. Something to consider. I am in Malaysia so I have no benefit from making this recommendation, I just believe he is the best.

[Sheryl]

As I said, my mind likes to work overtime with paranoia , and to fuel speculation:

(1) I realized this afternoon that my right leg (the one with the scratch) is visibly (slightly) bigger than my left leg, and

(2) I just now noticed that my right leg is warm to the touch on the front.

If it's same-same (or worse) in the morning I guess I'd better go to the hospital. <sigh...>

The Good News is that my body is tolerant of my medication withdrawal. The pain in my back, and my upper body in general, is tolerable.

One leg more swollen than the other and warm to the touch, history of a cut, scratch or bite = quite possibly cellulitis. See a doctor. Don't let it go too long or you may end up needing IV antibiotics which means a hospital admission. Caught early enough, oral may suffice.

[wpcoe]

Went to doctor (Bangkok Hospital Pattaya, with trepidation), and he did a quick exam, and said it was simply edema from the Arcoxia. When I asked why I was able to take Arcoxia 7+ days with no swelling, he said it may have been an interaction with the Tramal. Made sense, and put my mind at ease.

He also put my mind at ease about infection. I quietly had visions (did I mention I get paranoid? ) of some MRSA bug muching away at my leg tissue.

He gave me two diuretics to take once daily after breakfast. Now on day #2, the swelling is unchanged, but my anxiety level is massively reduced. The doctor and the pharmacist led me to believe I'd be urinating practically nonstop. Well, only 4x yesterday, and only 3x today so far.

I do get a headache which lasts a couple hours after taking the pills, but I tough it out, as tempting as it is to take some Tramal or leftover codeine...

One other bonus: Between the time I took a shower in the morning and the time he examined me (about two hours) blood vessels began bursting in my right foot. Not a pretty sight.

(The diuretics are 100Mg Hyles and 40Mg Lasix.)

[wpcoe]

One leg more swollen than the other and warm to the touch, history of a cut, scratch or bite = quite possibly cellulitis. See a doctor. Don't let it go too long or you may end up needing IV antibiotics which means a hospital admission. Caught early enough, oral may suffice.

After the edema swelling eased a bit the shin and foot pain surfaced. At that point I was, in fact, diagnosed with cellulitis, and was prescribed IV antibiotics, although they were administered on an outpatient basis on three consecutive days. I also took oral antibiotics for a week. My foot and leg are still swollen, I still have a big old "knot" on my shin, and today the Internal Medicine doctor at Bangkok Hospital Pattaya threw up his hands. I'm not entirely convinced now that I even had cellulitis.

I have an appointment tomorrow at BNH with my back doctor and the BHP doctor said to ask him about my foot swelling and the pain in my ankle and foot. (I cannot put full, flat pressure on my right foot without pain, and it is tender to the touch.) He said it may be nerve damage related to my ruptured disk, some sort of sciatica?

For the swelling (knot) on my shin he said that it might be an abscess and sent me to a surgeon, who reached the conclusion that it was more likely a hematoma that should dissipate on its own in another week or so. Each pain itself is not major (even the ruptured disk is manageable), but put together all this aggravation for the past several weeks has worn me down. I am just so tired of it! And, tired of all the meds! I don't subscribe to the Thai tendency to overmedicate, but I've been so desperate for relief, that for the most part, I've complied with the pill taking.

[wpcoe]

In case there are other readers who cannot tolerate entering a standard "cylindrical MRI" machine, the hospital where I was sent for the "open MRI" machine was Urupong Medical Center.

On my last visit to the BNH Spine Center, they gave me the MRI images which were in a sheath with the hospital info. Surprisingly, they don't have a web site, but their phone number is 02-668-3040,

Edited October 9, 2010 by lopburi3
email removed per forum rules

[shepsel]

I recently had an MRI and it showed a herniated disc. The most uncomfortable thing about the MRI is having to lie there still while it is being done (sometimes up to an hour) and listening to the horrendous noise even though they put ear plugs in my ears. Prior to that I saw another specialist who did an xray on my spine, and it did not pick up the herniated disc at all.

So, I believe it is worth a little bit of time to feel uncomfortable to get accurate and detailed results.

[lopburi3]

Would add a caution that open MRI have not produced the quality image of closed systems (although improving for newer/expensive models) from my reading.

For comfort the CAT scan is easy and only requires a breath hold of being still - but you have a high dose of radiation and that is a known hazard.

For MRI most systems here seem to be of about one hour and may not have good supervision (there are dangers with injections/reactions and you are alone for a long period - we have had serious issues with lax monitoring at a major hospital). But the upside no x-ray radiation (you have to be aware of any metal in body however) and no good long term knowledge of any possible magnetic radiation effects.

[wpcoe]

At Urupong, I was relieved to see a technician sitting in the room across from me.

In my case, it's not just a case of holding my breath and being still, I had an anxiety attack and would have totally freaked out if they continued to slide me into the closed MRI machine. I've found that it's not that uncommon, but usually they offer tranquilizers which usually do the trick, but some times, a full anaesthesia knock-out is required. For whatever reason, I was sent to the other hospital with the open MRI. I suspect for some reason it was important that I remain unsedated until the diagnosis of my problem was complete.

The open MRI scan resulted in a very clear snapshot of my herniated disk. It looked almost exactly like the ones shown on some medical web sites.

And, my doctor told me after the X-ray and before the MRI, that an X-ray does not display the disks, only the surrounding bones. Different body parts are best displayed with different methods: X-Ray, MRI, CAT scan, ultrasound, etc.