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How to instruct the radiologist to look for occult hernia in the MRI?

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  • How to instruct the radiologist to look for occult hernia in the MRI?

    Hello,

    Following up on my introductory thread:
    https://www.herniatalk.com/12969-wha...ical-movements

    This study made by Dr Towfigh:
    https://jamanetwork.com/journals/jam...rticle/1893806

    Mentions the treatment algorithm:
    https://cdn.jamanetwork.com/ama/cont...5G5CRDK6RD3PGA

    I'm currently at the MRI stage:

    High clinical suspicion for inguinal hernia => Nondiagnostic examination (possible hidden hernia?) => Ultrasonography or CT => Negative => MRI

    So I got an MRI scheduled on Saturday:

    *MRI Abdomen with and without contrast
    *MRI Pelvis with and without contrast

    Is MRI of the abdominal and pelvis should be enough to diagnose a hidden hernia? Because the study mentions groin pain, so I wonder if I also need a separate MRI of the groin or it's already included in the MRI of the pelvis?

    Study mentions that a hidden hernia can be missed by a CT scan:
    https://cdn.jamanetwork.com/ama/cont...5G5CRDK6RD3PGA

    "Nondiagnostic Computed Tomography (CT)

    Axial CT through the pelvis is nondiagnostic for an operatively confirmed right inguinal hernia."

    But can be seen by an MRI:
    https://cdn.jamanetwork.com/ama/cont...5G5CRDK6RD3PGA

    "Diagnostic Magnetic Resonance Imaging (MRI)

    Axial (A), sagittal (B), and coronal (C) T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI through the pelvis in the same patient reveals right inguinal hernia (arrowheads)."

    So should I show the radiologist this study, and ask him to try to make a similar angle shot as described here: "Axial (A), sagittal (B), and coronal (C) T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI through the pelvis in the same patient reveals right inguinal hernia (arrowheads)."?

    Also, given that I didn't have pain when I got the ultrasound and CT scan, because I was keeping the pain at bay by avoiding physical activities that trigger it, should I activate the pain like a day before (i.e. by doing some physical activity like playing table tennis), so that way, when I come to do the test, they will able to find the source to the my pain? Perhaps by seeing some indirect sack of fluids generated by the hernia that only the MRI could see?

    I really want to find a diagnosis to my pain that I've been experiencing for the last 4 months, and I think that communication with the radiologist is very important, so any advice would be appreciated.

    Thanks!

  • #2
    In my experience with MRI for hernias, you donít need contrast and you need it with valsalva. Dr. Towfigh has a protocol that I have given to radiology. Important to call ahead because not all imaging centers perform the dynamic imaging. Hope this helps.

    Comment


    • #3
      Originally posted by Momof4 View Post
      In my experience with MRI for hernias, you donít need contrast and you need it with valsalva. Dr. Towfigh has a protocol that I have given to radiology. Important to call ahead because not all imaging centers perform the dynamic imaging. Hope this helps.
      What is the protocol? I'm planning to get it done at Beverly Tower Wilshire Advanced Imaging Center (@ Beverly Hills), do you know if they perform the dynamic imaging including valsalva?

      Thanks!

      Comment


      • #4
        As far as I know, Beverly Tower Wilshire does not have our protocol. You can share it with them. Beverly Hills Imaging does have our protocol, just a few streets away. As does Mink and Cedars-Sinai.

        See our protocol, attached, and you can show it to them to see if they will follow it.

        #MRI #MRIProtocol
        Attached Files
        #ItsNotJustAHernia
        www.BeverlyHillsHerniaCenter.com

        Comment


        • #5
          Thanks for caring and sharing, Dr. Towfigh. I wasn’t sure if the protocol was something I could share or not. I recommended that wth call your office to enquire about the protocol. I should have known you would share. You have the patient’s best interest in mind, even if it isn’t your patient.

          Comment


          • #6
            Originally posted by drtowfigh View Post
            As far as I know, Beverly Tower Wilshire does not have our protocol. You can share it with them. Beverly Hills Imaging does have our protocol, just a few streets away. As does Mink and Cedars-Sinai.

            See our protocol, attached, and you can show it to them to see if they will follow it.

            #MRI #MRIProtocol
            Thank you drtowfigh
            Unfortunately Beverly Tower Wilshire can't follow the protocol, as they have standards to follow they can't deviate from.
            However, I did find a place that my insurance takes that can follow the protocol:

            United Medical Imaging of Century City
            NPI: 1053759811
            2080 Century Park E #104
            LOS ANGELES, CA 90067
            (310) 432-8000,

            But they told me that they don't have 3Tesla MRIs (which is preferred in the protocol), only 1.5T (which is acceptable in the protocol).
            How big of a difference is it for diagnosing the occult inguinal hernia? Just want to know if I should follow through or keep searching through the list of imaging locations to see if there is one with 3Tesla MRIs that also can follow the protocol.

            Thanks!

            Comment


            • #7
              1.5 T is fine for most people.
              #ItsNotJustAHernia
              www.BeverlyHillsHerniaCenter.com

              Comment

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