Serial MRI's Accuracy in Following Aortic Aneurysms

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Duff Man

Duff Man

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I've had two surgeons tell me that they simply won't use MRI's to evaluate the aorta. They both claim that the images derived from an MRA/MRI are not "clear" enough for them. A nurse called it a "dirty picture"... but not that kind :)

I don't think I've ever read that an MRI is less accurate than a CT scan, but rather more time consuming and expensive - which makes it a bad choice for emergencies. I've also read similar statistics for the sensitivity of an MRI in detecting dissections. My cardiologist doesn't seem to have a problem with a yearly MRI, and I think he'd let me know if it were a waste of money/time.

I've seen both CT and MRI films, and from first glance they look really similar... except the CT has a color 3d reconstruction that looks more textured than the MRI black and white 3d reconstruction.

What is the technical difference or challenge that makes an MRI so undesirable for serial scans when it comes to surgeons?

Is an MRA or MRI an acceptable modality to monitor the aorta on a serial kind of basis?
 
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I have been going for anual CT scans after my ascending aorta was repaired two years ago. I asked the nurse practitoner after my last one about a different test due to the amount of radiation used in the CT. She told me that I could go for a MRI, and that my surgeon would have no problem reading it, and it uses less radiation. I guess every doctor is different in what they want or will accept.

Nick
 
I understand that everyone's different, but that doesn't tell us the technical differences in image quality and characteristics. What's so different about them when you're looking at the images? How exactly are they different?
 
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I will be having surgery in a week and a half to replace my aortic valve, root, and ascending aorta. My cardiologists always did MRI's. When I went for a consult with my surgeon he had a CT scan with contrast done on me. When we talked he said that the CT scan is the gold standard for getting the most accurate measurements of the aortic root and/or ascending aorta. He specializes in disease of the aorta so I took his word for it. I can't help you with the the technical reasons just passing on what an expert in aortic disease told me...I didn't ask him why. ;)
 
I've always assumed that a CT gave better images, and that MRIs were used partly to avoid the relatively high radiation doses that CTs give. MRIs don't use ionizing radiation at all, so they give none. OTOH, my own direct experience with MRIs has been very negative, and I've heard similar reports from others, including some experts. (E.g., one of the most trusted experts on back problems hereabouts said once on a radio interview that the best use for MRIs of the spine is for your worst enemy!!)

BTW, a Canadian team recently published an article showing an excess risk of cancer among folks like us who've had lots of X-ray-type scans -- CTs, angiograms =~ heart caths, fluoroscopy, etc. Not anywhere as big a risk as the risks you're avoiding in our cases, but something else to consider -- if you like considering stuff! See, e.g., "Multiple heart scans linked with cancer risk". Most earlier studies just measured the radiation doses and ESTIMATED the cancer risks using a dose-response model, but these authors actually counted the cancers. . .
 
Duff Man, I told that sad and scary story here, at post #8 in that thread. If that link doesn't work, post again, and I'll cut and paste it here. It wasn't about MRI's of my heart, but of my Dad's spine, but the scans and conclusions were Absolutely Totally Wrong!! I don't know how or why, and I doubt that anybody does.

I'm sure that MRI has accurately detected life-threatening conditions and saved lives, but -- at least in my experience -- it also finds too many "facts" that Just Ain't So.
 
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Every time I ask a medical professional what the difference is, they seem to have a hard time explaining it. It almost makes me think they're not sure why they're different. They just seem to dislike MRI. Maybe they've been burned like Norm and his Dad were. I know that once I feel burned, I tend to adhere to the saying "once bitten, twice shy".

I'd love it if a radiologist saw this thread and elucidated the question for us.

The reason why I'm pushing for an answer so hard is because I've had too many ct scans for a guy in his late 20's. I simply can't have any more unless it's a serious, serious emergency. It's a troubling position for me, because that's the only way to image the aorta in a true emergency setting. If I feel some gnarly pain in my chest, I can't just go in out of an abundance of caution to get a quick ct scan. I've used all my scan allowances up on pulmonary embolisms, serial ct scans for following the aorta and false alarms for chest pain.

Hopefully in the future they perfect/speed up/enhance and reduce the cost of the MRI. I'm worried about the bias against it... I hope MRI's don't just go away.
 
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