WHAT IS AN MRI  … AND WHY WOULD I NEED ONE?

Unlike a mammogram, which uses X-rays to create images of the breast or other parts of the body, Magnetic Resonance Imaging (MRI for short) technology uses magnets and radio waves to produce detailed 3-D Imaging of the breast or other organs. MRI of the knee, shoulder, spine, or brain is commonly performed to distinguish the normal tissues from injured or pathologic tissues. 

MRI  is often used to find the reason for a complaint or symptom. For Colorado’s active adults, whether an athlete or a  weekend warrior, knee and shoulder injuries are common. While fractures of bones from trauma are easily evaluated with regular x-rays, the components within the joints and between the bones require MRI to look further. Subtle injuries to components of the knee including the meniscus (cushion between the bones of the knee) or ligaments (fibrous bands that hold the joints together) or tendons (connect the bones to muscles) are all best evaluated by MRI. Different types of coils are used to fit around the area of interest to get the best images. For example, for a chronic shoulder injury, MRI using a shoulder coil may diagnose a rotator cuff tear. For chronic (not sudden but ongoing) knee pain, an MRI may be used to diagnose a meniscus tear. Sometimes an MRI just shows swelling of these soft tissue structures and not a tear.  Injuries such as simple sprains will resolve on their own. However, other conditions may require physical therapy or surgical repair. 

At The Women’s Imaging Center, patients often undergo MRI of the breast for a number of reasons. Breast MRI is often used to evaluate the extent of disease in patients with breast cancer recently diagnosed. MRI is used to look for additional breast cancers within the same breast or in the opposite breast to obtain critical information for the surgeon prior to breast surgery. A single focus of breast cancer not involving critical areas such as the nipple or chest wall may be amenable to breast conservation known as lumpectomy. On the other hand, if MRI shows multiple suspicious areas, then additional evaluation will be needed to include a biopsy of these questionable areas before surgery. If several or many lesions are biopsied and proven to be cancerous, then a lumpectomy may not be the safest treatment plan. 

Breast MRI serves another important role for women with a strong family history of breast or ovarian cancer as high-risk imaging surveillance. Some women have a Breast MRI every year every two years to look for subtle differences that may represent cancer even before a mammogram may show changes. Mammograms are still considered the first radiology imaging exam for women with a strong family history, and MRI is used as an additional imaging service, usually alternating 6 months between mammogram and MRI. Women with a strong family history of breast cancer are most likely to have a genetic mutation such as BRCA 1 or BRCA 2, PALB2 or CHEK2 other mutations that increase the risk of developing breast cancer including  ATM and RAD. Preventative MRI (screening MRI) because of family history or genetic risk factors usually requires authorization from the insurance company. 

We also use MRI to evaluate lesions in the abdomen that were discovered incidentally on a preceding radiology imaging examination such as an Ultrasound or CT scan. If an ultrasound of the liver shows a solid single solitary nodule in the liver, MRI may help distinguish whether this finding represents a common benign vascular liver lesion called a hemangioma or a solid nodule. Note that most findings in the liver are benign. In some cases, MRI imaging may help determine if the lesions seen by ultrasound could represent cancer. 

HOW IS AN MRI PERFORMED:

Contrast dye that is administered by way of intravenous (injection into an arm vein) injection is taken up in benign versus cancerous tissues to different degrees and in different patterns. The MRI imaging examination may take  25 to 40 minutes depending on whether contrast dye needs to be administered or whether special sequences are needed. The complexity and the time needed to perform the imaging may affect the time and the cost. A breast MRI, for example, requires the administration of contrast dye and breast coils fitted around the breasts to pick up signals, which are converted to images for the radiologists to interpret. Both breasts are scanned at the same time. This imaging exam may take 45 minutes but only 30 minutes of this time is actually in the MRI machine (magnet). 

Before the MRI Imaging is performed, it is important to prepare to answer a list of questions that will help The Women’s Imaging Center determine if this exam is the best one for you or if another radiology imaging tool is needed instead. Since we may inject a contrast dye (called Gadolinium) into a vein in your arm, it is important to tell the scheduler AND the MRI technologist if you have ever had an allergic reaction to a contrast agent previously. The dye used in breast MRI or brain MRI is different from that used in a CT exam. We need to know about any previous adverse experiences, especially any severe reactions. For most people, this is not an issue.

Next, you will be asked to complete medical history of any medical conditions related to decreased kidney function such as diabetes, chronic kidney disease, having only one kidney, or kidney transplant because decreased kidney (renal) function may impair clearing the contrast from your system. If there is any question about your kidney function, your ordering physician will order a blood test called “creatinine clearance” to see what your kidney function is, this value typically varies with age. Contrast is used to show blood vessels well and will help identify any vascular process 

For other studies like a knee MRI, the medical diagnostic imaging center time may only take 20-25 minutes. If a whole spine MRI is needed to include the cervical (neck), the thoracic (thorax or mid), and the lumbar (lower spine), the exam may take up to an hour. Some coils are built into the MRI bed but usually, body coils that fit different body parts optimally are used and have to be changed out for different types of exams. 

YOUR COMFORT AND PREPLANNING: 

The magnet makes a loud clunk sound so the technologists will fit you with comfortable headphones and you may choose to listen to music through the headphone that makes the magnet sound indistinct. Many patients actually find the exam soothing because of the music and may fall asleep. It is important not to move quickly or jerk during the exam because this may cause irregularities in the images constituted from signals of the magnets. 

At The Women’s Imaging Center, we have specialist staff dedicated to requesting this authorization from your insurance. If the insurance declines to authorize an exam, you have the option as a member of your insurance company to work with your advocate at your insurance company. Even if the exam is authorized, that doesn’t mean that the insurance will be fully paid by them-this depends on your deductible and your particular plan. Remember, that you also have the option of paying out of pocket for any of your imaging exams. All imaging studies at The Women’s Imaging Center are outpatient, independent of any hospital charges or facility step-up fees, and therefore low cost. We bill globally which means that the price you are quoted is the final cost, no hidden added-on fees. This is unlike any other outpatient imaging center in our Denver area.   

WHO INTERPRETS THE MRI? 

MRI images are read (interpreted) by the fellowship-trained radiologists expert in imaging interpretation of the body or breast.  Usually, Radiologists are grouped by specialty or organ system and certain groups interpret many types of imaging for one particular system. For example, a musculoskeletal radiologist may interpret x-rays, CT, and MRIs all involving the bones in the joints. On the other hand, a Woman’s Imaging Radiologist (such as the radiologists at The Women’s Imaging Center) is specialized in the performance of any or all modalities that are utilized in Woman’s Radiology including breast, gynecologic, abdominal, thyroid, or pelvic. Other types of diagnostic radiologists specialize in the performance of neuroradiology to interpret images of the brain and spine or musculoskeletal specializing in disorders of the skeleton.  

Before the MRI Imaging is performed, it is important to prepare to answer a list of questions that will help The Women’s Imaging Center determine if you can have this exam or if another imaging study such as Ultrasound is needed instead. Since you may need to have a contrast dye (called Gadolinium) injected into a vein in your arm, it is important to tell the scheduler AND the technologist if you have ever had an allergic reaction to a contrast agent previously. The dye used in breast MRI  or brain MRI is different from that used in a CT exam. We need to know about any previous experience, especially any severe reactions. For most people, this question will be “no”.

Next, we will take a complete medical history of any medical conditions related to decreased kidney function such as diabetes, chronic kidney disease, having only one kidney, or kidney transplant because decreased kidney (renal) function may impair clearing the contrast from your system. If there is any question about your kidney function, your ordering physician will order a blood test called “creatinine clearance” to see what your kidney function is, this value varies with age. Contrast is used to show blood vessels well and will help identify any potentially cancerous breast tissue. Cancers need to increase their blood supply in order to grow. On a breast MR or brain MRI, the contrast tends to become more concentrated in areas of cancer growth, showing up as white areas on an otherwise dark background. 

The Women’s Imaging Center uses the highest-rated breast imaging and comprehensive medical diagnostic imaging exams for women and men. We offer breast MRI and other Medical Diagnostic Imaging MRI services at our Denver/Cherry Creek location. The Women’s Imaging Center also provides most other Women’s Imaging and Mammography Services at our other Denver metro area locations including Women’s Imaging- West/Lakewood, Women’s Imaging-South/Highlands Ranch, and Women’s Imaging-North/Westminster locations. 

The Women’s Imaging Center is committed to providing comprehensive individualized, innovative, state-of-the-art affordable healthcare for all women and men.

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Call 303-321-CARE (2273) to schedule an appointment or make an online appointment request.

The Women’s Imaging Center is committed to providing comprehensive individualized, innovative, state-of-the-art affordable healthcare for all women and men.