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June 9, 2013
The Brain MRI
The findings from the MRI of my cervical spine prompted further tests. The neurologist ordered an MRI of my brain for the following day, January 5, 2013. The order itself said "demyelinating disease," which caused me no small amount of panic. The most common demyelinating disease is Multiple Sclerosis, and one of its common symptoms is loss of sensation in the extremities. I did some research and started to think this could potentially be my condition. Some things didn't really align, but the neurologist's order said "demyelinating disease," and in my state of alarm, it seemed like many of the MS indicators described me.
When I went into the radiology center for the brain MRI, the tech looked at the order and asked me, "How long have you had MS?" I bit my tongue, gave her a shitty look, and said as evenly as I could, "I don't know." Meanwhile, my head was spinning. I thought that the neurologist had diagnosed me with MS, and that the radiology tech was only discussing common knowledge.
The MRI itself seemed to last hours. If you've had one before, you understand that it can be stressful and difficult. If you haven't had one, I'll describe it briefly. During the procedure, you are positioned on a narrow padded plank and then drawn into a narrow opening tubular opening in a large machine. Your face is about 3-6 inches away from the roof, and the rest of the tube is not much wider than the average individual. If you are claustrophobic, it can cause some level of distress. You are given earplugs and instructed to stay still and calm for the duration of the procedure. The technician talks to you through a speaker inside the machine to give you instructions, update you on status, and keep you calm. Then "the magnet" spins up. They perform multiple imaging sequences. Each sequence runs for a different duration, with a different magnetic field strength, is modified by different radiofrequency pulses, and targets a different location in the patient. The MRI may also be ordered with or without contrast. Without contrast is the default, and means you just get imaged once. With contrast means that you get imaged once, then injected with a contrast agent and imaged a second time. The contrast agent is a gadolinium-based solution that enhances the visibility of internal structures. It is generally only ordered under certain circumstances.
You experience a series of loud, cacophonous, and dissonant but generally rhythmic atonal beeps, bloops, clangs, and bangs. It's similar to an orchestra warming up in the way that different discordant sounds mix for brief periods, anywhere from 45 seconds to 6 minutes or so. You feel as well as hear the magnetic fields throughout your entire body. The whole experience can be very disconcerting if you don't relax and stay calm. But you can also be lulled to sleep by the process if you can convince your mind to shut off.
My circumstances called for contrast. After the first sequence of images, they withdrew me from the machine, gave me the contrast agent intravenously, and reinserted me into the machine to experience it all again. In fact they only redo certain sequences with contrast, so the second run only took about half as long as the first.
This whole procedure is controlled by a computer operated by the radiology technician. The end result is a series of black and white images of your bones and internal soft tissue structures, which are then analyzed and interpreted by a radiologist. The radiology center provides you with a CD-ROM containing the images and a summary report of their findings, which you then provide to your referring physician for further analysis and explanation.
In the time between having the MRI and discussing the results with my neurologist, I was in a fairly anxious state. Multiple Sclerosis is a serious disorder, and though there are treatments and therapies, I was extremely nervous that the MRI would confirm that diagnosis. I did a lot of research to convince myself that I was ready for just about anything.
Posted by jon at June 9, 2013 2:19 PM