MRI with Contrast Patient and Family Education

I have undergone MRI for my lower back pain and let me share you below educational information from Makati Medical Center.

The patient has the right to be informed about his/her condition and the recommended procedure(s) to properly decide on the treatment recommendation after knowing the risks involved and other treatment options.

Potential Benefits and Drawbacks

The Attending Physician believes it is beneficial for the patient to undergo a diagnostic imaging procedure known as Magnetic Resonance Imaging (MRI) to obtain additional information that may aid in the diagnosis and treatment of the patient medical condition. MRI does not use X-rays or radiation. Instead, magnetic field and radio waves are used to create image(s) of the internal body structures.

Because of the magnetic field and radio frequencies, people with heart pacemakers, brain aneurysm clip(s), and any implanted metallic or electrical device(s) must not undergo MRI. It is important that the patient inform the Technologist-on-Duty of any of these metallic devices/implants.

Contrast media will be administered according to the request of the Physician. When the examination is finished, the body will naturally get rid of the contrast material through the kidneys. There will be no change in the color of the urine. The patient is encouraged to drink lots of fluids after the examination to assist the kidneys in removing the contrast from the body. If the patient is on fluid restriction, this would not apply. Please consult with the Attending Physician.

For Female Patients Only: Although the redundant majority of data suggests that it is perfectly safe for embryos or fetuses to be scanned, there is still much that remains unknown. However, if the doctor believes that undergoing the procedure will outweigh the risks involved – Medical Clearance is required. Please inform the Radiologist or the Technologist-on-Duty if pregnant or if there is any possibility of pregnancy.

Possible Alternatives

The MRI study may be conducted without the injection of contrast, but the images may not be as helpful to the Radiologist and the Physician. The patient must inform the Technologist if he/she wish to decline the contrast injection, or if the patient refuses to undergo an MRI scan, or choose another test instead. Alternative imaging procedures may include Ultrasound, and Computerized Tomography (CT scan). However, these alternative tests may not be as accurate as MRI and these alternative procedures require the approval of the Attending Physician. Consultation with the Physician is highly advised.

Likelihood of Success

The procedure is painless the patient will not feel the magnetic field or radio waves, and MRI only requires that the patient lie steadily on a padded table that gently glides him/her into the magnetic dome. While undergoing the procedure, the patient will hear humming and thumping sounds. These are normal and must not worry the patient. Earplugs and/or headphones will be provided to minimize the loud sound during the MRI procedure. The patient must notify the Technologist-on-Duty if he/she feels uncomfortable, or if the patient worried about feeling claustrophobic inside the MRI machine The patient must talk to the doctor beforehand as he/she may be advised to take a sedative before the procedure. The patient will also be given a call button to call the attention of the doctor/technologist if the patient wishes to stop the procedure, at any time.

Possible side effects:

Contrast is given by injection into a vein and aids in distinguishing normal from abnormal tissues. People who have severe kidney disease, advanced liver disease, or on dialysis and given a gadolinium-based MRI contrast agent. This may have a small risk of developing a disease called, Nephrogenic Systemic Fibrosis (NSF). Symptoms of NSF are often associated with the following: - thickening and tightening of the skin (usually the arms or trunk) – scarring, including the diaphragm, heart, lungs, and muscles.

About 1 in 50 (2%) of patients will experience very minor and temporary side effects, including pain at the injection site, nausea, headache, dizziness, itching, rash, or hives. In about 1 in 5000 patients (0.05%), a true allergic reaction may occur (including facial swelling, difficulty breathing, or low blood pressure) requiring treatment. The odds of an extremely severe reaction, including death, are very rare – approximately 1: 400,000 (0.00025%).

When the contrast medium is injected, it is normal to feel coolness at the site of injection, usually on the arm for a minute or two. Occasionally, less than 2% Of patients experience some nausea after the injection. This tends to pass rather quickly. In less than 1% of patients, additional side effects may be noted including facial swelling, – flushing, headaches, chest pain, itching, and watering eyes.

The needle may also cause some discomfort when it is inserted. Once it is removed, the patient may experience some bruising.

The patient must notify the MRI technologist if he/she:

• Had a previous allergic reaction to any contrast media;
• Is allergic to Other medicine, drugs or food;
• Has kidney problems;
• Is pregnant or any possibility of pregnancy; and
• Has implants (e.g. heart pacemaker, brain aneurysm clip, etc.).

The use and injection of contrast is optional. However, the physician believes the potential diagnostic benefits for the patient to exceed these small risks.

Less common risks and complications include:

• The contrast that was injected may leak outside of the blood vessel, under the skin and into the tissues which may require treatment. In very rare cases, further surgery could be required f the skin breaks down.

Rare risks and complications include:

• Allergic reactions which may occur within the first hour after injection, most cases happen in the first five (5) minutes after the injection.

The reactions vary from:

• Mild – headache, nausea, dizziness, hives, rashes, and itching;
• Moderate – widespread hives, headache, facial swelling, vomiting, and shortness of breath;
• Severe – severe reactions are rare but may include: life-threatening heart palpitations, very low blood pressure, throat swelling, fits and/or cardiac arrest;
• Nephrogenic Systemic Fibrosis (NSF) for severe renal impaired patients; and
• Death as a result of MRI Contrast is very rare.

Possible Problem Related to Recovery

After the contrast injection, the patient will be required to stay at the Center for 30 minutes for monitoring. A nurse will remove the IV line from the arm before leaving. The patient will be able to return to normal activities. MRI with Contrast procedure is minimally invasive, the patient may experience minor discomfort but is relatively a safe procedure that does not require any recovery time.

For Female Patients Only: Manufacturers of intravenous contrast indicate breastfeeding mothers must not breastfeed their babies for 24 to 48 hours after the contrast medium is injected. However, both the American College of Radiology (ACR) and the European Society of Urogenital Radiology notes that available data suggest that it is safe to continue breastfeeding after receiving intravenous contrast. The Manual on Contrast Media from the ACR States:

"Review of the literature shows no evidence to suggest that oral ingestion by an infant of the tiny amount of gadolinium contrast medium excreted into breast milk would cause toxic effects. It is believed, therefore, that the available data suggest that it is safe for the mother and infant to continue breast-feeding after receiving such an agent.

If the mother remains concerned about any potential ill effects to the child, she must be given the opportunity to make an informed decision as to whether to continue or temporarily abstain from breastfeeding after receiving a gadolinium contrast medium. If the mother so desires, she may abstain from breast-feeding for 24 hours with active expression and discarding of breast milk from both breasts during that period. In anticipation of this, she may wish to use a breast pump to obtain milk before the contrast study to feed the infant in the next 24-hour following the procedure."

Possible Results of Non-Treatment

MRI includes more effective medical management in a timely manner. patients can be scanned for the doctors to assess the condition. A procedure might be necessary based on the MRI images that will show the exact location of the health problem. Without this information, the success of the treatment is greatly compromised and there's a potential result of inappropriate medical treatment.

Reference:

Makati Medical Center. (2017, September). Radiology services – magnetic resonance imaging: MRI with contrast patient & family education [Pamphlet].