MRI's as Part of Your Cancer Follow-up
Maybe part of your diagnostic process was a breast MRI, but why would your doctor be ordering another MRI now after your diagnosis or even years after your treatment?
Magnetic resonance imaging (MRI) is a tool your doctor can use to see if your cancer has spread to other parts of your body. It uses radio waves and a strong magnetic field rather than x-rays to show internal organs and tissues. MRI allows evaluation of some body structures that may not be as visible with other imaging methods. It is especially effective with soft tissues, which is why you hear about it so much for diagnosing sports injuries in ligaments and tendons, and why it will be one of your oncologist’s first choices if he wants to get a look at your brain.
Depending on the organ your doctor wants to see, there may be an option of either a CT scan or an MRI. The CT is faster and less expensive, and most people find it less traumatic, so if your doctor thinks he or she can get good images from a CT, that is usually the way to go. However, the MRI does not use radiation, so if you are concerned about radiation exposure, you could discuss with your doctor the pros and cons of the two tests in your situation.
As with any imaging tests, it is important to ask questions when the test is ordered. Why is the doctor ordering the test? How will he or she use the results to determine your treatment? What special precautions should you take before you arrive? Can you eat and drink normally?
The first time I had an MRI I had been warned that it would be noisy, but I wasn’t prepared for the loud random bangs and clangs. In fact, I panicked and had to be pulled out of the machine and get myself calmed down before the test could proceed. So I would like to tell you more details about what to expect in an MRI.
Here is what happened during my most recent MRI to check for a possible metastasis of my breast cancer to my brain. The MRI machine at my local imaging center is so busy that I was able to schedule a convenient appointment after work. My husband and I arrived and checked in. I knew from previous experience that it is easiest to take the test if you are not wearing anything metallic, so I didn’t have any zippers or jewelry to dispose of, and didn’t have to put on a hospital gown. The techs asked me about any metal implants I might have like dentures, pacemakers, or joint replacements.
Because the MRI uses strong magnets, metal in your body could potentially be displaced by the machine, so be sure to let the technician know about any metal implants. In fact, discuss these with your doctor when the test is ordered. Depending on where they are, your doctor may need to come up with a different plan for getting the images he or she wants.
Next came the IV for the contrast solution. Often the doctor wants to see two pictures—one without contrast and one with. The contrast solution for MRI’s is usually gadolinium, which is less likely to provoke allergic reactions than the contrast medium usually used with CT scans, but I was asked about previous allergic reactions to contrasts. Fortunately, I have never had any, so we were ready to proceed to the actual test.
I lay down on a narrow metal table, and the technicians arranged cushions under my knees to keep me as comfortable as possible and put a wide strap with Velcro around me to keep my arms at my sides. I find the strap more comfortable than trying to keep my arms still, but I must admit that images of a silent film heroine tied to the railroad track came to mind as I lay on the table.
The MRI machine is a long tube. I am a bit claustrophobic, so I have learned to keep my eyes closed so that I don’t see how close the top of the tube is to me. If I have someone to drive me to the test, I take a mild sedative prescribed by the doctor to help me stay calm during the procedure. It helps me to know that the technicians can hear and see me even though they are not in the room, so I can call for help if I need it.
There are open MRI machines, so if you are claustrophobic, you can ask if an open MRI is available in your area. Depending on the reason for the test, the doctor might want you to give the regular machine a try because sometimes the open machines are not as accurate. Don’t hesitate to ask your doctor about some tranquilizing medicine if you are claustrophobic; many people who face down all sorts of terrors daily ask for some help with the MRI.
Next they gave me earphones and asked what kind of music I would like to listen to. With the easy listening station humming in my ears, I closed my eyes, as the table whirred its way into the long tube. During the test, I used visualization techniques to transform the random noises into a story. The bright light in the machine was the sun warm on my face at the beach. I drowsed in the “sun” listening to the cacophony of gulls, trains, and fog horns.
This part of the test can take 15 to 45 minutes depending on how much of your body is being scanned and whether pictures with and without contrast are needed, so just staying still is one of the challenges you will face if your test takes a long time. Ask ahead of time, so that you are not surprised.
Once the images were taken I was free to go. I double checked about which doctors would receive the report and when I could expect to hear the results. A few days later I got the good news: There was nothing in my head! At least, nothing unexpected!