Tuesday, 25 November 2014

Understanding MRI..the need for education

Brand J, Köpke S, Kasper J, Rahn A, Backhus I, Poettgen J, Stellmann JP, Siemonsen S, Heesen C.Magnetic Resonance Imaging in Multiple Sclerosis - Patients' Experiences, Information Interests and Responses to an Education Programme. PLoS One. 2014 Nov 21;9(11):e113252

Background. Magnetic resonance imaging (MRI) is a key diagnostic and monitoring tool in multiple sclerosis (MS) management. However, many scientific uncertainties, especially concerning correlates to impairment and prognosis remain. Little is known about MS patients' experiences, knowledge, attitudes, and unmet information needs concerning MRI. 

Methods.We performed qualitative interviews (n = 5) and a survey (n = 104) with MS patients regarding MRI patient information, and basic MRI knowledge. Based on these findings an interactive training program of 2 hours was developed and piloted in n = 26 patients. 
Results Interview analyses showed that patients often feel lost in the MRI scanner and left alone with MRI results and images while 90% of patients in the survey expressed a high interest in MRI education. Knowledge on MRI issues was fair with some important knowledge gaps. Major information interests were relevance of lesions as well as the prognostic and diagnostic value of MRI results. The education program was highly appreciated and resulted in a substantial knowledge increase. Patients reported that, based on the program, they felt more competent to engage in encounters with their physicians. 
Conclusion. This work strongly supports the further development of an evidence-based MRI education program for MS patients to enhance participation in health-care.
I have never had an MRI, so I can't speak from any position of knowledge, but it appears that MRI baffles you just like it baffles me.  But education can help you understand these images.

Ask an MRIer to explain what MRI really is and what each of the imaging modalities actually shows, eg. T1, T2, gadolinium, MTR, FLAIR, DTI, etc, etc and half an hour later you are often still no wiser. You get the gist by little appears to be concrete fact. 

One MRI physicist once said of the scientist that "you lot will never understand this" cos the mathematics was too complex. MRI has revolutionised the diagnosis and monitoring of MS, but many of the outcomes, still have no definitive pathological outcomes so we hear associating this and prediction that. 

Maybe some MRIers would like to do some guest posts to explain....Doctor Klaus? or are there some websites that you find particularly useful.

11 comments:

  1. For a start "MRI made easy" is 25 years old, but still as simple as it gets. You'll find a pdf here: http://www.stat.columbia.edu/~martin/Tools/MRI_Made_Easy.pdf

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  2. the physics of NMR is not so hard (unless you have to build your own scanner, of course).
    but how this correlates with physiology? I think only some clues exists nowadays for most of the findings available with current technology

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  3. Hah. just found that on wikipedia… American mathematician John Turkey, who developed Fast Fourier transform algorithm which is crucial for signal processing, CT, MRI and all other imaging techniques, as well as for the whole ours digital world, was an doctoral advisor for Paul Meier, known for … Kaplan-Meier analysis. What a connection :-)

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    1. Bless you vasy!
      Wish I knew/remembered something/anything about Kaplan-Meier analyses and Fourier transforms

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    2. Well… the most important thing you probably want to know about Kaplan-Meier is that every time Prof G. posts on efficacy of some DMT, you probably will see a Kaplan-Meier plot there. This is the way survival (and treatment) efficacy is analysed in medicine. Probably Profs would correct me..
      And on FFTs .. it is a very powerful tool to analyse signals and used extensively in almost any application involving signal processing such as image reconstruction in CT/MRI scanner or your digital camera, audio compression in your cellular phone or MP3 player and in may many other fields. I personally was pleasantly surprised to find such a connection between this two important but unrelated things. :-)

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  4. I have found this website useful:

    http://www.radiologyassistant.nl/en/p4556dea65db62/multiple-sclerosis.html

    It shows how MS is differentiated from other diseases on the MRI. If you have MRI lesions it does not automatically mean you have MS.

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  5. Thank you to those who posted web addresses offering info about MRI, but unfortunately they were still very technical – my interest is not in the science and engineering of how an MRI works but what it all means to me as a patient. The same as I don’t want to know the details of the programming language that makes my computer work or how to write a program – but I do want to understand what its error messages mean, so that I can decide what to do about them.

    As noted in the abstract above, “Major information interests were relevance of lesions as well as the prognostic and diagnostic value of MRI results” – this is me – and clearly others as well.

    I want to be able to understand things like what underpins decisions to not use Gadolinium e.g. is this only used in relapses or ??? (then I might understand why my MRIs have been done without Gadolinium), what the relevance of lesions in various parts of my brain and spinal cord may mean and what systems they can affect, why MRI reports state “no change”, but my symptoms have actually worsened, and so on. I don’t want to become an MRI expert, as a patient I just want a reasonable level of understanding of what it all means, expressed in language I can comprehend.

    Maybe the experience of spending five or ten minutes in an MRI machine could be a valuable learning experience for doctors. My first MRI was a bit scary, but the worst part was that I am very tall for a female, and it took way longer than I was told it would be – they had to do three passes to cover my brain and spinal cord, when it was assumed that because I was female (thus not tall!) it would be done in two passes. However, the staff were great and managed to give me a break in between passes. For my second MRI they knew what they were dealing with and booked extra time.

    Yes – it can be claustrophobic and it sure is incredibly noisy, but I’m lucky in that I manage to “zone” out, which helps with the need to remain absolutely still for what is really quite a long time when you are “stuck in the tunnel”. However, one of the most awkward things for worrying about is if you are an MSer with bladder problems – and suddenly need to go in the middle of it all. And you can guarantee that your nose will get itchy when you are not allowed to move. What you don’t’ get told as a matter of course is that after nearly two hours of being bombarded by all that magnetism your brain can be a bit scrambled and you can feel a bit strange for the next 24 hours. After finding this did happen to me after my first MRI, I had the good sense to forward book leave for the day after my second MRI.

    Maybe Team G could approach the authors of the article above, and see if they have suitable materials from the course that was run for patients, and look at posting it on this blog.

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    1. This link to the MS Society website many be of help may be..

      http://professionals.mssociety.org.uk/forum/new-diagnosis-and-diagnosis/brief-beginners-guide-brain-and-mri

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    2. Thank you so much - this was an excellent resource which was written in the right sort of language, and I will have to spend some time digesting it. It does mention that Gadolinium is not used as often as it used to be if the scanner can do DWI (diffusion weighted imaging) so I will follow up with the radiology department to see if our local MRI machine does this or not and this may answer my questions about why no contrast was used during my scans. My MRI reports make no mention of at all re whether there were active lesions as well as the "numerous white matter hyperintensities" (which I now understand are old inactive lesions) but if the local machine does use DWI it could also explain for me why the "more subtle lesions" in my thoracic spine which were noted in the first MRI report did not get a mention in the second comparison report - in other words, they may have resolved (even if my symptoms are no less)

      Living with MS which has already caused significant and permanent disability before you even get a diagnosis is not much fun, but some of us find it easier to deal with if we have a higher level of understanding as the days of "Trust me, I'm a doctor" are over (as they should be). And as the abstract above notes - patients having a better understanding does contribute to "to enhance(d) participation in health-care" - and for me "Knowledge is empowerment" which is vastly different to "Knowledge is power"!

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    3. I've just found this as a good simple explanation in "ordinary" language
      http://forums.prohealth.com/forums/index.php?threads/this-the-best-explanation-on-ms-lesions-that-ive-read.260099/

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