Discussion in 'Dr. Stephen Nagler (MD)' started by Lisa88, Nov 14, 2014.

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    1. Lisa88

      Lisa88 Member

      Tinnitus Since:
      Hi Dr. Nagler,
      A few months ago, I had two MRI's. First I had a brain/ear MRI without contrast only. Then two weeks later, a brain/ear MRI with contrast. The first without contrast showed hyperintensities in the white matter of the left frontal lobe. The second with contrast two weeks later showed all clear.
      I know there could have been a fault with the machinery here.
      But as a surgeon who has dealt with MR before, I ask you this:
      First question: What shows up on non contrast MRI that does not show up on with contrast MRI?
      I had thought the with contrast was the master of all MRIs.
      Second question: Should those with non pulsatile t get an MRA?
      Thanks, Dr. Nagler.
    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Atlanta, Georgia USA
      Tinnitus Since:
      I am not a neuroradiologist, but here's how I have come to understand it specifically in regards to the work-up for tinnitus. When an MRI of the brain and internal auditory canals is indicated (for example to rule out acoustic neuroma in a patient with unexplained asymmetrical tinnitus), large tumors will generally be readily seen on a non-contrast study, but smaller tumors might only be seen on a contrast study because the contrast enhances the tumor. However, unless you have a non-contrast study to use in comparison, it is possible even a contrast-enhanced small tumor might be missed.

      Generally not except possibly in the case of an unexplained constant non-pulsatile somatosound originating in the head or neck, but even that's a stretch.

      Hope this helps more than confuses.

      Dr. Stephen Nagler

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