If I have kidney disease, can I get an MRI without the extra contrast?

Here is My Question:
BECAUSE I HAVE KIDNEY DISEASE, CAN I GET AN MRI WITHOUT THE EXTRA CONTRAST ADDED BECAUSE IT MAKES THE KIDNEY DISEASE WORSE?

Answer:
MRIs without contrast provide valuable information in people with known or suspected MS ; in fact, contrast is usually avoided in people with impaired kidney function.  
It is important to understand why we use contrast in clinical practice. Here are the most common reasons:

1. We define MS disease activity as new or significantly enlarged MRI "lesions" without contrastand/or a documented relapse. It is both the presence of this disease activity and its subsequent elimination that formed the basis for the approval of almost all disease modifying therapies (DMTs). We can confidently determine the presence of new or enlarging MS T2 hyperintensities (the so-called white spots observed without any contrast) without contrast, as long as the background amount of T2 hyperintensities, called the lesion burden, is not too large and images from different time points are collected in a similar manner. When the lesion burden is large, visually observing relatively small new lesions can be akin to finding a needle in a haystack.  Contrast helps us understand if the new or enlarging MS lesions are relatively new or arising within a previous region of T2 hyperintensity, a piece of information that is harder to determine without contrast.
2. Contrast tells us if there is breakdown of the blood brain barrier (BBB). In the case of MS breakdown of the BBB is usually caused by acute inflammation. This contrast enhancement is far more common in people under the age of 45 than people over 45 even off of treatment.
3. The hallmark of most modern DMTs is the elimination of contrast enhancing lesions. Once we determine that a therapy is working as desired by MRI and clinical criteria, it is often possible to forgo using contrast on further monitoring MRIs

When is contrast useful? Diagnostically, it is very hard to observe certain disease features suggesting another diagnosis such as a vascular malformation, leptomeningeal enhancement, diffuse subependymal enhancement or a brain tumor. For this reason, contrast scans are often obtained if the initial non-contrast scan does not answer the clinical question being asked

Revere P (Rip) Kinkel, MDProfessor of Neurosciences
Director of the Multiple Sclerosis Program
University of California San Diego
#MRI #MS #multiplesclerosis #DMTs