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Indications by Condition
The list below includes a variety of conditions for which MRI/MRA Examination is indicated or may be useful, along with additional notes on protocol where applicable. Click each title for more information. (Please note that this is not an exhaustive list.)
Motor Weakness, Numbness, Speech Difficulty, Vertigo, Imbalance, Visual Changes, or Cranial Nerves Deficit
- Sudden onset (less then 1-2 days history)
- CT examination of the brain (non contrast) is indicated to rule out Intracerebral hemorrhage.
- If the CT is normal, follow-up examination may be either CT or MRI. MRI is preferred if available. MRI will be more useful for brain stem or Posterior fossa stroke.
- Slow onset (weakness or numbness of one of more extremity or cranial nerve deficit developing slowly)
- MRI is preferred. Underlying abnormality may be neoplasm either primary or metastatic, Multiple Sclerosis, Subdural hematoma, or other conditions.
- MRI with contrast is useful in showing infections in the parenchyma, subarachnoid, subdural and epidural spaces of the brain.
- Parenchymal infections may spread directly (along cranial nerves or from sinusitis or osteomyelitis), hematogenously or secondary to prior trauma or surgery.
- MRI with contrast is useful in the evaluation of infections in AIDS to show the toxoplasmosis, HIV encephalitis, CMV ependymitis, and PML.
- MRI can demonstrate the sequelae of infection including encephalomelacia, hydrocephalus, vasculitis, infarction and acute disseminated encephalomyelitis.
- MRI of the brain is first choice to rule out Intra-cranial infection like herpes, CMV, and toxoplasmosis.
- Meningitis is also better evaluated with MRI, as almost all the potential complications can be picked up by MRI.
- In all these conditions MRI examination should be done with and without contrast.
- MRI (with and without contrast) is indicated for the evaluation of abnormalities of pituitary hormones.
- MRI is indicated for the evaluations for the symptoms that suggest a Sellar Lesion mass. ( i.e. bi-temporal hemi-anopsia and cavernous sinus syndrome).
- MRI is useful in evaluating the secondary effects of sellar tumors.
- With dynamic pituitary Imaging; adenomas smaller than 5mm can be picked up with MRI.
- MRI is very useful in evaluating, hypothalamus and to locate the posterior pituitary bright spot, which sometimes can be ectopic.
- CT scan is not being done for pituitary abnormalities, these days.
Supra sellar abnormalities (possible cranio-pharyngioma or suprasellar aneurysm) are also better defined with MRI
- MRI can detect and stage ocular tumors such as melanoma and metastases.
- Retinoblastoma is best diagnosed by CT; however tumor extension is better seen and followed up on MRI.
- Fractures in the orbital walls or adjacent to the orbits are better delineated by CT.
- Extra ocular orbital infection, tumor, myopathy, neuropathy and vascular diseases are best studied by MRI.
- MRI with contrast (with fat saturation) is useful for pathological conditions involving the optic nerve or structures adjacent to it.
- Persistent back pain, with or without radiating to lower extremities.
- Persistent neck pain with associated Neurologic symptoms ( pain radiating to shoulders or arms, numbness in arms or hands)
- Previous back or neck surgery with recurrent symptoms (MRI with and without contrast)
- Neurologic symptoms indicating the possibility of spinal cord tumor or cord compression ( MRI with and without contrast )
- If patient has any contraindication for MRI, CT scan may be done. However MRI examination is superior in terms of sensitivity and reliability.
Acute Headache with Neurologic Deficit
- CT brain scan is the examination of choice (to exclude subarachnoid hemorrhage or intracerebral bleed).
- If negative, MRI examination of the brain and MRA of the Circle of Willis is done to exclude intracerebral aneurysm.
Acute Headache with Fever:
- MRI examination of the brain is done with and without contrast to exclude intracerebral infection.
Chronic Headache with Neurologic Deficit
- MRI examination with and without contrast is the examination of choice.
- Low cost and low risk favor MRA as initial test for intracranial aneurysms.
- Catheter angiography is indicated for evaluation of aneurysms in the setting of acute subarachnoid hemorrhage.
- Conventional MRI and MRA are useful to evaluate arteriovenous malformations; however, catheter angiography is necessary for complete evaluation.
- Venous angiomas, cavernous angiomas and capillary telangiectasias are well seen by conventional MRI (don’t need MRA or catheter angiography)
- MRA for Circle of Willis and MRI brain with and without contrast are indicated to screen for intracranial aneurysm
- CT is more helpful for Pelvic Fractures (including acetabular fractures).
- MRI is ideal for suspected femoral neck fractures not visible on plain x-ray
- MRI is the procedure of choice for suspected avascular necrosis of the femoral head and transient bone marrow edema. (Trauma, Corticosteroid Medication, Sickle cell disease, Gaucher’s disease, Alcoholism, Pancreatitis, Radiation).
Other Conditions where MRI is Helpful
- Bursitis adjacent to hip joint.
- Muscle and soft tissue injury.
- Osteomyelitis (MRI with contrast)
- Developmental abnormalities
- Bone tumors
- Osteonecrosis (MRI is very sensitive for early AVN )
- Soft tissue mass lesions
- Osteomyelitis (MRI with and without contrast is the initial test )
- Bone marrow abnormalities
- Primary or metastatic neoplasm
- MRI is being used to evaluate patients with prostate carcinoma and possible metastasis in the pelvic bones and spine.
- MRI is also very helpful to evaluate the possibility of spinal cord compression in patients with metastasis in the thoracic or lumbar spine.
- MRI is the most sensitive imaging technique for the evaluation of Multiple Sclerosis.
- T2 and FLAIR sequences are particularly useful. T1 is the most useful sequence especially if periphery of the lesion shows T1 hyper intensity.
- Multiple Sclerosis plaques are often ovoid in appearance and point towards the ventricle reflecting peri-ventricular inflammation.
- MRI with contrast is useful for demonstrating disease activity in Multiple Sclerosis.
- CT brain is not as sensitive as MRI and is not being done.
- CT is the examination of choice to evaluate acute head trauma. MRI is preferred for old trauma.
- MRI is indicated when CT findings are discrepant or do not fully explain the clinical situation.
- MRI is indicated when diffuse exonal injury or non-accidental trauma (domestic/child abuse) is suspected.
- MRI is useful to evaluate the posterior fossa extra-axial location, when CT may be limited due streaking artifacts.
Notes on Protocol
- If the head injury occurred within previous 2 -3 days
- Do CT brain scan without contrast
- If the head injury occurred more then 3 days ago and patient is symptomatic
- Do either CT brain scan with and without contrast or MRI without contrast.
- If the patient has neurologic deficit and the head injury occurred more then 2 weeks ago, MRI will be more helpful.
MRI is useful for the evaluation of:
- Carotid arteries
- Intra cranial circulation
- Femoral arteries
- Pulmonary arteries
- Intra cranial venous structures
- Portal vein
- Mesenteric circulation
Other Indications in the Cardiovascular System Include:
- Cardiac tumors
- Thoracic aortic aneurysm
- Aortic dissection
- Superior venacava syndrome
- Congenital heart disease
- Left ventricular function analysis
- Myocardial perfusion
- Myocardial infarct evaluation
Currently Available Indicated Procedures
- Renal MRA
- Mesenteric MRA
- MRA for thoracic and abdominal aorta.
- MRA for carotid arteries in the neck
- MRA for circle of Willis is also routinely done.
Cardiac MRI is not available at this time
Indications by MRI Examination Region
The list below provides suggested conditions that may indicate MRI examination of that region, along with additional notes on protocol where applicable. Click each title for more information. (Please note that this is not an exhaustive list.)
Indications For MRI Examination of Shoulder Joint
- Painful movement, no history of trauma
- Trauma with limitation of abduction and internal rotation
- Night-time pain and limitation of movement
- Shoulder instability and recurrent dislocation
The most common abnormality detected on shoulder MRI examination is a tear in the rotator cuff tendon. There may or may not be any history of recent trauma. Most commonly the tear is in the supraspinatous part of the tendon. The symptoms in these patients may be:
- Persistent pain
- Inability to put the shirt on
- Difficulty in abduction
- Shoulder pain while sleeping
- Disturbed sleep
Sometimes the tear may be more anterior in the subscapularis part of the tendon. These patients have difficulty in internal rotation of the shoulder.
Other abnormalities detected on MRI include:
- Injuries to the glenoid labrum
- Injuries to the joint capsule
- Degenerative arthritis in the acromioclavicular joint (causing impingement of the rotator cuff tendon)
- Degenerative spur from the acromion process (causing impingement of the rotator cuff tendon)
Indications for MRI Examination of the Elbow
- Chronic pain, either within the joint or adjacent to it.
- Cubital tunnel syndrome (ulnar nerve entrapment)
- Injury to the ulnar collateral ligament
- Biceps tendon injuries
Indications of MRI Examinations of the Wrist
- Ulnar-sided wrist pain
- Palpable or audible click during rotation of the forearm
- Carpal instability
- Carpal Tunnel Syndrome
- Osteonecrosis (navicular bone or lunate bone)
MRI examination can also be used to exclude fracture of the navicular bone, not visible on X-ray.
Indications For MRI Examination Of The Knee Joint
- Persistent pain with plain x-ray being normal
- Trauma, plain x-ray showing no fracture but knee pain not resolving
- Painful knee with joint effusion
- Tibial plateau fracture
- Suspected stress fracture
- Mass lesion adjacent to the knee
- Villonodular synovitis
Knee is the most often examined joint with MRI. The most common abnormalities are:
- Meniscal tear
- Anterior cruciate ligament tear
- Medial collateral ligament tear
- Bone bruising
Patients generally have painful, swollen knee or instability.
The information available on MRI is much more then plain x-ray and quite often will determine the course of management.
Indications for MRI Examination of the Ankle and Foot
- Suspected injuries to tendons and ligaments adjacent to the ankle
- Assessment of infection in the foot, particularly in diabetic patients (MRI with and without contrast)
Other conditions where MRI may be useful include:
- Plantar fasciatis (patients have persistent foot pain)
- Morton’s neuromas
- Stress fractures in the tarsal or metatarsal bones not visible on plain x-ray.
Indications for use of Contrast Media in MRI Examinations of the Brain
- To exclude underlying mass or other abnormality in the patients with the history of Seizures
- Workup of a patient with possible intracranial neoplasm, either primary or metastatic
- When clinical symptoms indicate possibility of a mass in the cerebello-pontine angle (acoustic neuromas, meningioma or epidermoid)
- Pituitary related abnormalities, either micro adenoma or macro adenoma
- When there is suspicion of intracranial infection (encephalitis, cerebritis or brain abscess).
- Workup of a patient with severe headache, when it is needed to exclude any intracranial mass.
- When there is a clinical suspicion of a mass in the orbits.
- In a patient with multiple sclerosis, contrast enhanced examination helps to monitor the prognosis and also response to the treatment.
- When there has been previous surgery on the brain for neoplasm or an abscess.
- When there is a suspicion of granulomatous. meningitis.
Indications for use of Contrast Media in MRI Examinations of the Spine
- In patients with previous spine surgery, contrast enhanced examination helps to differentiate between post surgical scar tissue and recurrent disc herniation.
- When a syrinx is present, to exclude the possibility of any underlying mass.
- When there is possibility of mass
- Patients with history of recent surgery, when there is clinical suspicion of Osteomyelitis, disckitis or an abscess
Indications for use of Contrast Media in MRI Examinations of the Musculoskeletal System
- When Osteomyelitis is suspected
- When there is suspicion of a mass
- In case of foot examination, contrast enhanced examination is needed when planter fasciatis is suspected.
- For diagnosis of early Rheumatoid arthritis (shows changes of synovitis)
The list of conditions that are contraindicated for MRI/MRA examination includes, but is not limited to, the following: