MRI Dr vs your Dr

[symara]

Ok, so here's my quesiton for everyone. Does what your Dr says match up to your MRI report?

All three of the "second" opinions I had reviewed the MRI slide by slide and read the MRI report twice and said my condition was worse than what was on the report. The last Dr I went to even wondered aloud why he didn't catch the degeneration at L5-S1 and only referred to the L4/L5 "bulge".

Of course this also make me think that my original Dr never even looked at the MRI himself and just read the report.

[Justin]

It depends on the radiologist reading the films and dictating the report. Some reports are short and are not "comprehensive" in that they don't include details your surgeon would prefer to see (sometimes the report only describes the "meat and potatoes" of what is seen on the films).

Most spine surgeons will not read the report and will review the films for themselves. They will ultimately be performing surgery and want to read the films themselves to see what they are "up against."

When I had my CT/myelogram performed, the report that came back was very short. This is often times frustrating not only to the patient but also to the treating physicians requesting the study.

Your second-opinion surgeons that commented that your films are worse than what the report says is not uncommon. Most likely the surgeon reading the films is looking at them with a keen eye, as they are probably running inclusion / exclusion criteria through their heads and are really trying to gauge if there are any contraindications to performing surgery. Almost all spine surgeons will read their own films and you will almost never find one that relies solely on the dictated report--the report can vary greatly from what the surgeon is describing verbally during an appointment. Often times it's easier to explain one's condition verbally and can be difficult conveying similar elements in a written format.

For example, the report could state "Broad-based disc herniation at L4/L5," which doesn't sound that bad while reading it but is definitely a finding that will be put into much better context in person by the surgeon reading the films. In person the surgeon will be able to explain why this finding is an issue and how it relates to the overall condition of your spine. I think the explaining why is what truly changes a rather benign sounding report into something worse--it puts your condition in context to other things seen on your films; thus, often times making your condition far worse than what the report says. I hope this makes sense.

[KBear]

Mine was just the opposite, my MRI report stated "moderate to severe" arthritis in the facets. All 3 spine surgeons read the actual MRI's and all said that it was more like "mild to moderate" and not enough to exclude me from ADR.

My family dr, on the other hand, does not read any films and relies solely on the report.

That is probably also one of the reasons for differences in opinion from a radiologist, they may be viewing the films just 'looking for the big stuff' and not point out smaller things, that don't seem like a big deal to them (like for an inital diagnosis type scenario, such as, "oh, this person is in pain because they have a herniation and some arthritis). Or, in my case, maybe they are reading it with a 'harsh' eye, looking for every little detail, like a surgeon would; but use 'stronger' language, to make sure that the reader of the report appreciates the diagnosis and severity of it.

One of the reasons it was important to me to get 3 opinions, was to go with the general consensus of opinion on the arthritis. I think the surgeons opinion is the most important, as they are the one that is going to be dealing with it "in person, hands on"; but I wanted to make sure that the first surgeon didn't just 'mis-read' it.

[Justin]

That is probably also one of the reasons for differences in opinion from a radiologist, they may be viewing the films just 'looking for the big stuff' and not point out smaller things, that don't seem like a big deal to them (like for an inital diagnosis type scenario, such as, "oh, this person is in pain because they have a herniation and some arthritis). Or, in my case, maybe they are reading it with a 'harsh' eye, looking for every little detail, like a surgeon would; but use 'stronger' language, to make sure that the reader of the report appreciates the diagnosis and severity of it.

Thank Kathy. This is what I was trying to say yesterday and I just could not explain it as easily. I guess it was one of those days.

[KBear]

J- I'm glad that it actually made sense.

[Cindylou]

I have also found that some surgeons just plain don't agree on the MRI findings. And I have had more than one surgeon tell me over the years that as good as MRI's and Cat Scans are, they don't show everything, period! Dr. B certainly had no idea how bad my osteoporosis was till he opened me up. My bone density came back terrific. The nurse actually told me to "keep doing what you are doing." So I just thank God and my lucky stars that it was a surgeon of Dr. B's caliber who dealt with me once I was opened up. I sure as heck know that if my bone density had been more accurate, I would never have been a candidate for 3 lumbar discs.

[Justin]

I have also found that some surgeons just plain don't agree on the MRI findings. And I have had more than one surgeon tell me over the years that as good as MRI's and Cat Scans are, they don't show everything, period! Dr. B certainly had no idea how bad my osteoporosis was till he opened me up. My bone density came back terrific. The nurse actually told me to "keep doing what you are doing." So I just thank God and my lucky stars that it was a surgeon of Dr. B's caliber who dealt with me once I was opened up. I sure as heck know that if my bone density had been more accurate, I would never have been a candidate for 3 lumbar discs.

The bolded text above is a good point. Osteoporosis scans (Dexa scans) are a great tool, but sometimes patients have site specific osteopenia or osteoporosis like CL that might be missed on a Dexa scan.

[Keano16]

In my experience with aprox. 7-8 MRI's, radiologist reports are just not correct enough.

Every time my neurosurgeon almost started laughing.

Example:
Radiologist quote: "No herniation visible"
Neurosurgeon quote: "Herniation visible on operated level".

Funny but true.

[Carmen]

Mine was just the opposite, my MRI report stated "moderate to severe" arthritis in the facets. All 3 spine surgeons read the actual MRI's and all said that it was more like "mild to moderate" and not enough to exclude me from ADR.

My family dr, on the other hand, does not read any films and relies solely on the report.

That is probably also one of the reasons for differences in opinion from a radiologist, they may be viewing the films just 'looking for the big stuff' and not point out smaller things, that don't seem like a big deal to them (like for an inital diagnosis type scenario, such as, "oh, this person is in pain because they have a herniation and some arthritis). Or, in my case, maybe they are reading it with a 'harsh' eye, looking for every little detail, like a surgeon would; but use 'stronger' language, to make sure that the reader of the report appreciates the diagnosis and severity of it.

One of the reasons it was important to me to get 3 opinions, was to go with the general consensus of opinion on the arthritis. I think the surgeons opinion is the most important, as they are the one that is going to be dealing with it "in person, hands on"; but I wanted to make sure that the first surgeon didn't just 'mis-read' it.

I am so glad you received the real thing in your clinical trial. Good for you. My luck I would get the other. Carmen