Posts tagged ‘trauma’

August 22, 2014

Head Aches and Head Issues #4: Head MRI – What To Expect

MRI of headIf you are experiencing headaches and your evaluation by your doctor suggests the need for imaging, you may be sent for either an MRI or CT scan. CTs are quick and valuable in the evaluation of patients presenting with headaches after trauma. MRI is an alternative means of imaging the brain and adjacent tissues.

CT vs. MRI

The main differences in the two technologies are as follows. The decision as to which test is needed is based on your history and findings, as well as the following:

 

CT:

  • uses ionizing radiation (avoided in pregnancy unless there are significant findings or significant trauma) in conjunction with computers to generate images
  • takes 10 minutes or less
  • may or may not use IV iodinated contrast material
  • great in looking for blood in and around the brain, which can be traumatic or non-traumatic in origin
  • uses a short bored tube

 

MRI:

  • uses magnets and radiofrequency waves in conjunction with computers to generate images – no radiation
  • can be used in pregnancy after the first trimester and without IV contrast material
  • may or may not use IV gadolinium contrast material
  • takes 30 minutes or more
  • uses a long bore tube (can seem confining although there are ways of treating this sensation!)
  • shows anatomy in greater detail than CT
  • some pathologies such as multiple sclerosis are best visualized on MRI
  • must hold still for longer time periods – may be difficult for younger children

 

 

What To Expect

Before an MRI of the head, no special preparation is necessary. However, metal is a big issue (seriously, the machine is one giant magnet and any metal on your body can become a hazardous missile with potential for harm to you, the technologist or the machine). So – extreme care is used to ensure that you have no metal on your body. Also, metals in things like artificial joints and pacemakers can create problems so full disclosure is needed.

The procedure takes approximately 30 minutes with only the head moving through the machine.

Holding still during the imaging is key to getting good pictures. Images are taken without contrast to begin with and then if needed (and patient is not pregnant) additional series may be run after an IV injection of a contrast material containing the heavy metal gadolinium. This should be used in caution in certain patients with kidney problems, so we always obtain a full history prior to giving this, and may check your kidney function before giving it. The injection may cause a cooling sensation.

What Happens Next

After your exam is completed, the images are studied by your radiologist for interpretation and reporting. The results are then shared with your referring doctor to integrate the new information gained from your head MRI with clinical symptoms for a specific diagnosis. After the test, we recommend drinking extra fluids to help flush the contrast from your system if it was used.

On Your Way!

Headaches can be a vexing issue, and getting you on the road to being headache-free is the goal of the medical team, including the radiologist carefully analyzing those images. As ever, we hope to help to get you on the road to your best possible health.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

August 21, 2014

Head Aches, Head Issues #3: CT Scan of the Head

CT scan by NithinRao via Wikimedia Commons Copyright Public DomainSo if you’ve had a good wallop to the head (or it just feels like you have) your doctor may direct you to a head CT.

 

Like all CTs, a modifiable dose of radiation is used to image the body in “slices” which are then reconstructed into images. Use of radiation in pregnancy should be reserved for special cases, so let the technologists know if you are or could be pregnant.

 

What To Expect

 

Before a CT of the head, no special preparation is necessary. However, metal interferes with the images, so jewelry, hairpins and the like will need to be removed from the region of the head.

 

The procedure takes approximately ten minutes with only the head moving through the machine. Persons with claustrophobia typically do well with CT because the exam is fast and the machine itself is not too confining. Holding still is important – as with all images, motion causes blurring.

 

CT of the head is often performed without contrast. For cases following trauma or in an evaluation for headache a non-contrast examination may be sufficient.  There are times when IV contrast injection is necessary. This additional part of the study can be very helpful to evaluate the blood vessels in the head and for assessment of the brain tissues and its enhancement. The iodinated contrast material will be given thru an IV which may cause a feeling of warmth. Images are then taken in the same manner as the initial non-contrast series.

 

What Happens Next

 

After your exam is completed, the images are studied by your radiologist for interpretation and reporting. The results are then shared with your referring doctor to integrate the new information gained from your head CT with clinical symptoms for a specific diagnosis.

 

On Your Way!

 

That’s it! A CT head is a quick, simple procedure which can be invaluable in looking at your brain and surrounding tissues. It can help get you on your way to being headache- and anxiety – free!

 

 

(Image credit: CT scan by NithinRao via Wikimedia Commons Copyright Public Domain)

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

August 19, 2014

Headaches and Head Issues #2: Looking Inside Your Head

800px-Brain_MRISo… there will be times when a headache prompts further evaluation. Imaging can be used to study the brain and its surrounding tissues. CT and MRI are both common imaging techniques for evaluating the brain and adjacent tissues when imaging for headaches is indicated.

 

For sudden onset headache, thunderclap headache, and headache following trauma in the past 48 hours, we often start with CT of the head.

 

CT Scans

The initial CT imaging is done without contrast; images are obtained through the skull while the patient lies still. This takes only a few minutes.

 

From this we can see hemorrhages in and around the brain – one of the serious causes for headaches that can be seen from both traumatic and non-traumatic causes.

 

Occasionally, the noncontrast study will be followed by postcontrast imaging after an IV injection of iodine-containing contrast – this highlights the vessels and demonstrates abnormal enhancement in the brain, such as masses.

 

CT uses radiation to make its images – therefore, use in pregnant patients will generally be reserved for special indications and circumstances.

 

MRI Scans

If there are any neurologic changes associated with your headaches (things like numbness, loss of strength or confusion) imaging with MRI may be requested. An MRI shows the internal structure of the brain in great detail. Masses and areas of abnormality from things such as strokes and multiple sclerosis are well shown with this modality. Because the procedure takes about 30 minutes to fully image the head, it does require the ability to lay on your back for a length of time. Images can be obtained both without and with IV contrast containing gadolinium, often times with both. Gadolinium contrast helps us look at vascular structure and for abnormal enhancement.

 

MRI can be used in some instances during pregnancy, but only after the first trimester is complete. No IV contrast is used for MRI in pregnancy.

 

Patients with pacemakers and other implanted surgical devices may not be able to undergo MR imaging. Let your doctor know of all surgeries and procedures prior to scheduling your MRI.

 

These exams can shed amazing light on the brain and its functions (or malfunctions). While we always work to image wisely, we can also image exquisitely. From the finest of endings to the largest of masses, we are able to have a noninvasive peak inside the inner workings of the brain. Through this we are able to get our patients on the road to their best possible health!

 

 

(Image credit: Brain fMRI via Wikimedia Commons, Copyright Public Domain)

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

August 13, 2014

Headaches and Head Issues #1: When NOT To Image

headache by Pierre Willemin via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)Headaches are a common complaint and come in different forms. Most headaches, though they may not feel like “nothing” at the time, are often simple and solvable problems.

 

As radiologists we have a special role when it comes to headaches. Ready for this? Most times patients with headaches need not visit their friendly radiologists. The brain (and even the musculature around it) is a complex and honestly beautiful thing. We are advocates of imaging carefully – and there are times when that means no imaging at all.

 

The crux is this: it can be hard to know when a headache should prompt medical evaluation. Rules have been developed helping medical professionals determine when imaging will be most beneficial. if a headache has other symptoms associated with it (such as nausea or vomiting) or is new, significantly worse or comes on suddenly, medical evaluation is warranted and imaging may be needed.

 

According to a recent article published in the Journal of the American College of Radiology:

 

“Most patients presenting with uncomplicated, nontraumatic, primary headache do not require imaging. When history, physical, or neurologic examination elicits “red flags” or critical features of the headache, then further investigation with imaging may be warranted to exclude a secondary cause.”

 

What are the “red flags” that mean imaging may be necessary?

 

 

  • history of head trauma;
  • new, worse, or abrupt onset headache;
  • thunderclap headache;
  • headache with pain radiating to the neck;
  • one sided headache with facial pain;
  • persistent and positional headaches;
  • headache centered at side of head (temple) in older individuals.

 

 

It’s important to not ignore intuition. If something about your headache is unusual, or the circumstances predicating it are new, it is definitely worth seeing your doctor. However, if s/he doesn’t opt for imaging in the initial stages, that may be perfectly okay too. We love seeing our patients on the road to their best possible health!

 

 

(Image credit: headache by Pierre Willemin via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0))

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

May 14, 2014

What’s Up with Your Neck? (and just below…)

Image

Have pain in your neck or upper back? You are not alone! While less common than low back pain, pain in the neck is a common complaint leading to doctor’s office visits. Pain in the upper back is somewhat less common, but we will include it in our discussion for completeness.

 

In a recent post we talked about imaging of the lumbar spine, the lower portion of the spine which sits behind your belly.  Much of the imaging for the rest of the spine is similar to what is done for the lumbar region.

 

The cervical spine (coming from the Latin word for neck) is sometimes referred to as the C spine. It consists of the first seven vertebrae (from the skull) and the cartilage discs between them, in addition to adjacent ligaments and muscles. A lot of motion (up,down, around!) occurs in this part of the spine during the day, so this is a common spot for symptoms of overuse or muscle strain to occur.

 

Patients with cervical spine problems may have pain in the neck with or without symptoms in the upper arms/shoulders – this can be pain or can be nerve type symptoms like numbness or tingling. How far the symptoms go down your arm can help indicate the level of involvement in the cervical spine.

 

The T Spine is the thoracic spine consisting of the 12 vertebral bodies, discs, adjacent muscles and ligaments at chest level. There is less movement of the spine at this level, so symptoms here are less common. Symptoms of thoracic spine problems may include pain in the upper back, shoulders, arms, or to the sides of the chest. Nerve symptoms like numbness, tingling or weakness may also be present.

 

As in the lumbar spine, there are a lot of age-related changes involving the discs and/or the adjacent bones; these may or may not be related to the patient’s symptoms. Imaging of the cervical and thoracic spine is generally performed after careful history and physical examination, and may be delayed to see if a trial of conservative treatment improves symptoms. Imaging immediately may be warranted if there are serious symptoms such as major trauma, weight loss, or nerve symptoms, particularly weakness of the arms or legs.

The spectrum of problems in the cervical and thoracic spine is similar to that in the lumbar spine and can include disc displacement, fractures, and muscle strain. Less common causes of neck and upper back symptoms include disease in the spinal cord itself, spinal cord tumors and things like multiple sclerosis. Note that the spinal cord ends at approximately the upper lumbar level; therefore, these problems do not directly affect the lumbar spine.

 

Imaging of the cervical and thoracic spine is similar to that for the lumbar spine. X-ray, CT and MRI can all be used to diagnose problems.Plain films or x-rays may be the best starting point as they can show alignment and fractures. X-rays can also show any narrowing in the spaces between the vertebra indicating disc disease. A CT shows bones and adjacent tissues and is the test of choice if we are concerned about fractures. CT can see the cord and nerve roots if we do it after a myelogram (more commonly done with C spine than with the T spine). Last, an MRI can show the spinal cord, nerve roots and discs and how they relate.

 

Ultimately, imaging of the neck and upper spine may be helpful to determine the proper course of action to get you on the road to your best possible health!

(Image credit: Illu vertebral column via Wikimedia Commons Copyright Public Domain)


Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

May 8, 2014

Imaging of the Lumbar Spine

Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative Commons  Creative Commons Attribution-Share Alike 2.1 JapanTo continue our conversation about back pain, today we’re going to focus on the different imaging tests that may be requested to evaluate someone with back pain, specifically lower back pain. Imaging for lower back pain will likely focus on the lumbar spine. It’s the lower back region, usually the lower 5 vertebral levels – the series of vertebrae highlighted in the picture here.

 

There are several modalities we use to examine the lumbar spine, including (but not limited to) x-ray, MRI  and CT.

 

Conventional films or X-rays are often the starting point when evaluating someone with back pain. This allows an overall assessment of alignment and can look for signs of a more serious issue requiring additional imaging, like a fracture or an area of abnormal appearing bone. If the back pain follows recent trauma, is seen in someone with known osteoporosis or is in someone over the age of 70, conventional films may be the imaging study of choice and may be the only imaging needed.

 

MRI (magnetic resonance imaging) of the lumbar spine is the most common imaging test for back pain because of its ability to see details of the soft tissues, including the nerves as well as the bones.  As an added benefit, no radiation is involved. Remember with MRI the images are made with a large magnet and radiofrequency pulses (those are the loud sounds you hear). With MRI we can examine all of the following:  the structure of the discs (the cartilage cushions between the vertebrae) and look for how the disc relates to adjacent nerve roots; the bones that make up the spine including the vertebral bodies;  the conus (the lower end of the spinal cord); and the soft tissues surrounding the area. Imaging takes about 30 minutes, and remember – you can’t have an MRI if you have a pacemaker (most types anyway!) or some implanted devices like stimulators. Lastly for the safety of all you cannot bring metal of any kind into the room!

 

CT (computed tomography) is an additional means of looking at the spine. Images with CT are made with x-rays that are created in a ring around the body allowing the body to be imaged in thin slices. CT allows an excellent look at the bones making up the spine. It may be the study of choice for evaluation of acute trauma or fracture. Changes in the discs can be seen, but the nerve roots are not visualized in a routine CT. There are times when a CT of the spine is performed after a myelogram – this is a procedure where contrast material is put in the fluid- containing space surrounding the spinal cord and nerve roots. This then allows CT to better evaluate the nerve roots and soft tissues of the spinal canal. A CT scan may be used to help with planning before back surgery. A CT lumbar spine takes around 10 minutes. It should not be used in those who are pregnant unless it is an emergency (as with severe trauma).

 

All of these are straightforward procedures that can give an excellent anatomic evaluation. Remember imaging of the spine will often reveal age-related changes in the discs and bones, not all of which will be associated with symptoms. Imaging is not always needed for back pain – see your doctor to determine if imaging can help get you on the path to your best possible health!

(Image credit: Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative CommonsAttribution-Share Alike 2.1 Japan)

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

March 13, 2014

Self-Exams for Men (and Women)

Operation Truck Nuts - Successful by The359 via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0) Cropped

Operation Truck Nuts – Successful by The359 via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0) Cropped

Okay, we’re slightly nerdy.

Aside from being fans of thought-gems on TED.com you may have noticed on our other blog, MammographyKC.com that we’re also fans of Lifehacker. We can’t help it – there are thought-gems there too. Recently, they did a report on Three Self Exams Everyone Should Perform. Because early detection saves lives, and we as radiologists have the capacity to assist in early detection, we are great fans of self-exams.

But there’s so much to learn!

Self-exams put the power in your hands. You are the first line of defense when it comes to taking care of yourself, from eating right to exercise to noticing unusual changes in your body. But you have to pay attention! This is why we loved the article so much – it encourages you to pay attention.

We’ve written about breast self-exams on our MammographyKC blog (here) so today we’d like to use the Lifehacker article as a jumping-off point to talk about men’s health and the scrotal self-exam.

Men’s health is something we care about too.

The Lifehacker article gives good tips on how a man can perform his own scrotal self-exam. Knowing how to do it and what to look for are step one!

Testicular cancer is a leading cancer type in young men – and if found early, most testicular cancers respond well to treatment. Scrotal self-exam after puberty is one of the ways of finding scrotal changes that may be a sign of this cancer. Testicular cancer will often present as a firm or hard persistent lump in the testes.

If you find a scrotal lump on self-exam, step one is to get in to see you doctor. He will perform a careful physical exam and may also evaluate blood work. Depending on the results of those tests, you may be referred to a radiologist for a scrotal ultrasound.

Earlier on this blog, Dr. Sid Crawley talked about scrotal ultrasound and what to expect. It’s a non-invasive and relatively quick procedure. Besides masses or lumps what other symptoms may prompt a request for a  scrotal ultrasound? Pain, feeling of heaviness/fullness, infertility and scrotal trauma are also reasons men may be referred for scrotal ultrasound. Remember any persistent scrotal changes should not be ignored!

What can we see on scrotal ultrasound?

Scrotal ultrasound examines the scrotum and contents including the two testicles, spermatic cords, and each epididymis. The exam evaluates for the presence or absence of masses within or outside the testes, infection, trauma, fluid accumulation (hydroceles) and testicular torsion (an abnormal twisting of the testes which causes blood circulation to be impeded and can lead to permanent damage or loss of the testes). The sonographic evaluation will help guide your clinician to the appropriate course of treatment.

Just as we talk about in the breast, all lumps are not cancers. Many benign cysts and other benign masses may feel like a lump or knot. The beauty of scrotal ultrasound is being able to examine right where you are having symptoms, and answering the question of what is this lump!

A quick word about scrotal trauma – many times, trauma to the scrotum prompts a first scrotal self-exam. If you feel a lump do not assume the lump must be from the trauma – one of the most common scenarios for finding testicular cancer is the patient who first feels a lump after an episode of trauma.

Take a breath.

Most often, the scrotal ultrasound will reveal benign, treatable conditions. A monthly scrotal self-exam is an excellent means of keeping aware of your body and finding changes early. So breathe easy and take care of yourself with a simple monthly self-exam.