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Word of Caution -- MRI Radiology Reports

gwennie17gwennie17 Posts: 2,957
edited 06/11/2012 - 8:37 AM in Back Surgery and Neck Surgery
I recently traveled to another state to have a "postional" MRI, in my case it was standing and sitting. While the actual facility and personnel were competent, I was very disappointed when I received the written report that was sent to my surgeon.

At first I was just disappointed, but now that I have thought about it for a longer time, I realize that it could also have been very detrimental to my diagnosis and further treatment. I wanted to mention this experience to those of you reading this forum as a cautionary tale.

If I had little experience looking at MRI films and reading radiology reports, I would have concluded that my trip and the positional MRI were a big waste of time. The report that was sent out was almost like a standard, stock form. It was so basic as to be almost meaningless. However, it also contained gross errors. Example: The report stated:

"At L4-5 there is mild disc bulging. No canal stenosis. Mild bilateral neural foraminal narrowing isi present.

At L5-S1, there is no disc bulge, disc herniation or canal stenosis."

I have NO disc at L4-5. It was removed at the time I had a fusion, and I have a Peek cage holding the space open.

At L5-S1 there is a significant bulge that would have been noticable to anyone, and retrolisthesis as well.

Had I not asked for my own copy of the MRI images on disc, I would have assumed that my spine was fine. Had my surgeon been the kind of doctor that relies on the radiology report and merely glancing at the MRI for a couple minutes, he would not have noticed the much more significant findings that DID show up on the standing MRI that were not visible on the standard, lying down MRI. He might not have realized that the source of my pain is coming from the S1 nerve due to the problem at the L5-S1 dis bulge and retrolisthesis.

Luckily, I knew enough to carefully review the written report and the MRI imaging and I suspected what was wrong. I was able to point this out when I met with my surgeon...and we are going to do a little more testing but are confidant we are on the right track to figuring out my lingering source of pain.

I would like to caution everyone to take the time to get copies of their reports and to review them. There are a lot of new, private imaging facilities opening around the country that are somewhat untested. Perhaps they are hiring radiologists to review films that are not as experienced or qualified as those that are employed by hospitals and more established clinics. I am just speculating here --.

MRIs are just one piece of the diagnostic puzzle, but it is nice when they are at least accurately read and reported.

This is just another long example of how we really need to be on top of our own care. Do not assume accuracy. To the extent you can, get and keep your own records, and review them to see if things make sense as best you can. I know we are not doctors, but it behooves us to learn as much as we can about our individual problems. Don't be afraid to ask your doctor questions -- have them show you on the MRI where the problem is located -- if there's something on your MRI report that doesn't make sense, ask the doctor to explain. We are consumers and we have to be smart about it. I think this is only going to become more important as we move into a new age of healthcare.

Cheers -



  • So far I have been lucky that my surgeons read the report but look at all the images. The current neuro doesn't even worry about the report and doesn't want a CD. He wants the full images. He just went over the pertinent ones with me showing me what was wrong and what/where he was going to fix it.

    I'm curious. Is the standing up one show that much difference than laying down? Many of us can't understand why they don't use sit and stand since that is when the problems show up. I've wondered just how much the compression shows up when comparing the same image view of laying and standing.

  • I'm lucky, too. Mine want the films, but I have had a couple who relied more on the written reports than the films.

    There are only about 100 of the Fonar MRI machines in the US at this point. For this reason, many doctors are not that familiar with them, and tend to discard them as being not that different, or they'll say the images aren't as clear. I heard a number of excuses from several surgeons why it wasn't important that I seek out a standing MRI.

    But in my case, it did make a difference. It was not as dramatic as I was hoping it would be. It did not reveal anything "new" that was not apparent on the normal MRI. But it did show that a small bulging disc that everyone had been ignoring since it "couldn't be causing my pain", turned out to be much worse when I was standing, and less so when I was sitting.

    I have to tell you though, it was very painful to do. If you have pain when standing, imagine what it is like to stand for 15-20 minutes without moving at all. My back went into spasms, my thigh felt like it was in a vice....The technician said he'd had two people faint on him that week and he kept asking me if I was doing OK. It was very difficult and took every ounce of concentration I had to keep still. I just kept reminding myself I needed to the images to be as clear as possible so they would finally find what was the source of my pain.

    There are comparison photos on this site:


    xx Gwennie
  • If that report is in fact, yours (and not somebody else's) it is very worrying. How could a radiologist get it so wrong?

    None of my xrays came with a report. Dr. sends us up to x-ray, who fit his patients in immediately and we're back in his office with the x-rays minus a written report, within half an hour. He does his own readings.
  • Thanks, Gwennie--you're a wealth of information and wonderful advice. I hope you and your doctor, working together, do find the source of your lingering pain and can do something about it. :)

    And thanks for the heads-up on the MRI. It's a good thing you understood the report. I have long believed that a person has to be their own health advocate and learn as much as possible because nobody can look out for your wellbeing better than you yourself can. And the medical establishment, as good as it is, can and does make errors. We must be informed and watch out for ourselves.

    2009 Foraminotomy C6-72010 PLIF L4-S1Multi RFA's, cervical inj, lumbar injLaminectomy L3-4 and fusion w/internal fixation T10-L4 July 17Fusion C2-C5 yet to be scheduled
  • Although I didn't have such a dramatic misread as yours, I did get a report from my MRI last week that I find almost laughable. Looks like the radiologist already had his/her mind made up before looking at anything. I have two other MRIs that contridict this one. I have a CD to take to the NS next week. I wish I had films. I am assuming films are much more clear. My NS didn't even look at the written report last time.
  • RangerRRanger on da rangePosts: 805
    Hi Gwennie,
    Great post, I would hope most everyone here with spine issues reads that and absorbs your warning. I am very fortunate that my neuro and rheumy are very thorough not leaving any doubt to what is causing my symptoms. They review the MRI's, CT scans, and X-rays with me and educate me so I totally understand and am confident in the prognosis. Your point is very valid and we must be responsible for our health and well being.
    Take care,
  • This may or may not be the case and maybe someone here can clear it up. I read somewhere that some imaging places were outsourcing the radiologist reports and having their in house people review and sign off on it. One of my reports says something like "Reviewed by so-and-so MD"
  • I'm not sure either, but I think these places that are run just like any other businesses, that are free-standing and just do imaging, contract with a radiologist to read the films and write the reports that are forwarded to the physicians who ordered the tests. Mine was so brief and looked very generic. Even if it had been accurate, I would have been disappointed in the lack of detail.
  • That's wonderful, and that's how it should be. When I had my first appointment with a spinal specialist when my problems were just beginning, we sat down with a package of oreo cookies and a huge lightbox where he could put up at least a dozen pieces of film at one time, and he showed me how to read a MRI. Of course he used an oreo to describe disc problems. It is a great luxury to find a doc who will take the time to do this.
  • Hey Gwennie,

    I just did some research on where I can find one locally. Turns our the first place I went too for an ESI has one. They aren't a hospital, but they are a very large group of doctors. They bought one of these a couple of years ago. I will be sure to bring this up to my surgeon before doing another MRI. I didn't like the PM doc at that practice or the neuro they assigned to me. So I never went back. However they do have lots of $$$ and the best equipment.

    My first surgeon was big on getting the reports but did look at images. He was fine with a CD. This neurosurgeon insists on having the images. I get a CD as a matter of course and unload it on my computer. I have every MRI and CT Scan saved away.

    Did you know the amount of accuracy and change in view of L5/S1 vs any other lumbar level? It appears that if the issue is at L5/S1 there doesn't seem to be as much difference. As soon as you get to L4/L5 and above it really shows up. I'm assuming that is because of the size of the disc and there is much more movement at those levels.

  • Lumpy said:
    Although I didn't have such a dramatic misread as yours, I did get a report from my MRI last week that I find almost laughable. Looks like the radiologist already had his/her mind made up before looking at anything. I have two other MRIs that contridict this one. I have a CD to take to the NS next week. I wish I had films. I am assuming films are much more clear. My NS didn't even look at the written report last time.

    If you got an MRI at a hospital. You do have images. They keep them unless you or your surgeon specifically requests them. Once you remove the images from the hospital it is now your responsibility to keep them. I have a couple of large packets of images. The recent ones are with my surgeon as he will use them for surgery.


  • If I understand correctly what you are asking about L5-S1, the standing MRI revealed exactly what I was looking for at that level. It is true that L5-S1 has far less normal movement than the other lumbar levels, but mine tips at such an angle that it is pinching off the S1 nerve root...and this is clearing demonstrated on the standing MRI.

    Don't be surprised if your current doc who is not associated with the clinic that has the Fonar tells you it is not worth doing, will not show anything that different, etc. I inquired several times of both my surgeons, at different times, if I could have a standing MRI and they each said it wouldn't show anything that different, etc. Finally, I just told my current surgeon that I was traveling to see my daughter where they had a facility and I wanted to have it done. Would he write me the order? And he agreed.

    You will find there is a great deal of jealousy and competition among spine specialists!! Neuros and orthos don't play nicely together!! And they tend to recommend the imaging they are familiar with or that their clinic is associated with.

    Good luck. If it hurts you to stand, the MRI will be awful for you...but hopefully worth it!!

  • Gwennie,

    Good information to have. I will say anyone who doesn't have a quality surgeon or concerned and having problems with the films getting read correctly, may want to have a independent radiologist read the films. When they are getting paid just to read the films tend to get more accurate on the readings. I have to say my first surgeon didn't use the reports either, kudos to him. The reports are so vague and actually missed a few things as well. However, I think the radiologist he used knew he wasn't using his report either.
  • The MRI report for my ACL injury was incorrect. I did have a total rupture and the report stated it was intact. The MRI report for my lumbar region stated herniations on left side of L3/4 and L4/5. Finally, stand up and flexion x-rays revealed the spondylolisthesis which the neuro I went to for the first opinion completely missed. I would have initially had surgery that only addressed the herniations based on the MRI report. Thankfully the ortho I saw ordered those x-rays and got to the real root of the problem. Granted I wound up with more extensive surgery but I hope that in the long run, it will be the only surgery I'll have to have.
  • Gwennie,

    I think you got good results from stand up vs laydown at L5/S1 that is not common. I was noting that based on the % they show on Fonar website. It appears that typically a conventional MRI for L5/S1 is just fine. For picking out difficult situations, like yours, the stand up helped.

    I understand on the curvature part. After the discogram and CT Scan to prove my pain was generated from L5/S1. My surgeon had me in for a Sacral MRI. That actually took almost an hour!!! That was bad. My surgeon wanted that to verify the curvature of my spine was not too steep. If the end of the sacrum has too much curve. He won't do an Axialif. Can't get the tool in the sacrum at the right angle to drill into S1 -> L5.

  • My sacrum veers off at a fierce angle. The docs never really comment on it, but the other day I was showing my new MRI to my guy thatI call my rearranger because I don't really know how to describe what he does....he works with a couple PTs and they were all in the office oohhhing and aahhing over the extreme angle where L5-S1 meet up and the sacrum goes off.

    I think my surgeon will just do a minimally invasive PLIF at L5-S1 since I have already had fusion at L4-5. We haven't figured out if L3-4 is a problem yet. I'm having another nerve block in about a week.
  • Duplicate post removed by moderator paulgla. Please refer to the forum rules regarding duplicate posting.
  • I'm an ex- X-ray tech (long story there-ask me???)

    Now we find out via internet & lawyers that 33% of all Xrays (this includes, Xrays,Mammo's, PET scans, MRI's, CT's, Ultrasounds....) are mis-diagnosed...
    this means: Omissions or lack of findings PLUS
    Wrong Reads or Partial reads (got some parts right but missed some too)

    In my husbands case complete Misreads or Omissions
    are under the auspices of Negligence per the Law
    NOT Malpractice...He went Mis-diagnosed or as we like to re-iterate UN-diagnosed for 4 solid months.
    (I had told him I'm only an ex-Xray tech but the
    c-spines looked herniated to me and your labrum looks torn...I missed the biceps tendon...)

    He just kept complaining about the pain, lack or movement and lack of sleep due to pain,numbness and tingleling sensations thru out his body,,,so now...
    3 surgeries later....he will no longer be a
    'truck driver' that livelihood is gone.. his work says they want him back, but what will he do and what position to be 'retrained' in he stills healing from the 3rd surgery so we will not know for many months....

    So we went to an outside Dr. for a third opinion and he says no his clavicle is Not broken. (He was too fast to say and did not even want to look at the Xray, at all)
    These Doctors, 1) Do not want to testify against their colleagues, 2)they do not want to go to court,
    3)As long as your being 'repaired' and it's getting -paid for- why stir up unnecessary problems,
    4) these surgeons are credited experts in their field, you can't accuse them of 'wrong doing'

    Our WC lawyer uses the Dr.s who performed the surgeries
    for depositions in their cases,,,,
    So if anyone knows any great 'Negligence' lawyers PLEASE
    pass their names/URL's on to me. We are not going after the surgery Doctors but the Radiologist's and medical centers they work for who initially said, "oh, he's fine...!"

  • The only way to know for sure what's wrong with your back for instance is going under the knife. I had x-rays, MRI's, and ct/myelograms and they all missed all the facet arthritis I had going on. It was a surprise to my surgeon as he opened me up for my fusion, and he had to clean up a lot of debris. Technology can only do so much and so many things are missed or just not caught at all.
  • That is one of my fears with this or any other surgery I have had. I hate the idea of the surgeon going in without the necessary information and not being able to correct the issue the first time.
  • Meydey--You bring up something I have thought about a great deal. We all know how spine surgery can be a life-changing event, and not always for the best. When you think how long your surgeon looked at your films and listened to your description of symptoms and medical history before he said "Here's what we're going to do" or before he gave you a diagnosis, do you ever wonder if there might be something else (less obvious) wrong, too?

    It seems like it takes all of five minutes for a surgeon to decide what surgery a patient needs, and how he's going to do it. Once that decision is made, do they ever think about any other possibilities or options? I think it is downright scary how little time goes into these decisions that are so incredibly life-altering to the patient. Once the diagnosis is made, the surgeon rarely rethinks what else might be going on.

    Now that so many surgeries are being performed "Minimally invasively" there is not the opportunity to look around the see what else might be going on either. Even when they perform Open surgery, they use as small an incision as possible, so they really cannot see much of anything other than specifically what they are operating on.
  • I talked to the people at Fonar about where to find these stand/sit/dynamic MRI machines.

    Anyone can call 1 888 NEED MRI to find a location nearest to them any place in the world, or send an E Mail to needmri@fonar.com

    This isn't intended to be an advertisement and more just research into who to contact. There are other groups and I am looking into that.

    You can Google "dynamic MRI" or "positional MRI" or "upright MRI" or "stand up MRI" etc.. You'll find lots of links to facilities and information on how it can be used.
  • dilaurodilauro ConnecticutPosts: 9,846
    should never try to read MRI images/reports for other members. I have heard about enough situations as you describe to make you wonder what is going on.
    MRI reading is not an easy task.. Even take the same MRI image and report , you may have two different readings from trained doctors.

    The stand up/sit down/Open MRI's are still relatively new. Their magnets are not as strong as the conventional MRIs, thus some of the images do not have the resolution that is needed at time.

    Many times, and Gwennie you are a prime example of patients that take a strong position on their condition. You research and you do your homework. So when you have a question regarding something your doctor said, you have a basis on which to question the statements.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Sounds to me like Gwennie has EXCELLENT people out there in the medical field. If we could only ALL be that lucky. I envy her & really appreciate ALL her input!!!
    I'm 6 mos post op also from a posterior cervical foraminotomy. Surgeon cut a 4" incision because he said he wanted to look all around while he's in there because the MRI's aren't exact - (3) of them. Makes sense to me. That explains when some people only get 1 area done, the initial problem is still there.
  • hi jeng could you please tell me where i could find where and what state did yo get your mri done? as i need a sitting mri and live in w.a and we have not got one.thanks dave

  • This week I traveled to another city to meet with a neurosurgeon that has an impressive reputation. The interesting thing was he would not even LOOK at my positional MRI. I had brought the DVD of it and my most recent prone MRI. He used the prone one and would not even look at the other one, even though his assistant had it up on the computer right next to the first computer displaying the prone MRI. When I asked if he had looked at it, he laughed like he'd be caught...and then confessed that he had not looked at it...that he thought positional MRIs were a "gimmick" and basically it wasn't worth the effort.

    I was a tad annoyed....
  • annoyed, especially as you spend time looking into things to be as informed as possible.
    You'd think that he would look at it just out of interest to see if there was much difference between it and the prone MRI.
    I wonder if surgeons with impressive reputations think that they already know everything that they need to know.
    Did he have any ideas of how he could help you?
    Hope that you had a good Christmas and New Year.
  • I suppose it is a time issue. He probably didn't want to take the time to check out two separate MRIs, especially when he puts no credence in one of them.

    He basically suggested doing what my surgeon is already planning. And I now know that I have examined all current options and that there is nothing that I would qualify for other than an open fusion surgery...so, I suppose that is something! He basically confirmed what I thought was going to be the case...but, now I know it to be true from several specialists from different specialties.

    I noticed earlier a post from someone in Australia looking for a location for a positional MRI. Apparently they are not available there so it was suggested she go to Asia to have it done. I felt like posting "be sure your doctor will LOOK at it before you fly far away to have it done." Who would have thought a specialist would refuse to even look at it?

    Happy New Year (a tad late)!
  • That really is sad Gwennie. I know we all get set in our ways. There is what we learned in school then what we learned as we go. To have a surgeon just shrug it off as a joke is annoying. I'm sure they get inundated with new ideas and some are really just BS.

    I asked the neuro who just did my AxiaLIF about it. He said it might show something but was concerned how weak the images are. He was not interested in a dynamic MRI. The images he had from my MRI, along with proof from discogram, and images from CT scan. He was confident on what we needed to do.

    Not to defend doctors but.... in their defense. Look at all the new technology being created. You convince your surgeon to use dynamic MRI and AxiaLIF. Both don't have a long history. He screws up your surgery. You blame him and want to sue him. That is a big fear and problem for them. It's one thing when you chance buying a BlueRay player instead of a DVD. Then find out BlueRay is a fad. Oh, you lost a few bucks, not your spine...

  • I recently had l4/5 fusion, open inicision, it is all of 8 inches long. My Dr's explanation: he wanted to see what else was going on in there. I cannot express how much I apprectiate that. Even though I was expecting 3-3.5 inch incision. I am ok with the bigger one Even with infection. I know he did more checking than an MRI or x-ray could tell him.

    I am curious though, if you have contacted that independent imaging center of their gross error in your reports and diagnosis and if there has been any response.

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