Indication

The question of whether magnetic resonance imaging is justified is subject to a certain number of criteria and trade-offs that should be carefully assessed. One reason for this is that an MRI is one of the most expensive imaging procedures and consumes an enormous amount of energy. Most importantly, however, the indication for an MRI examination is narrowly defined, since there is only a small number of available devices.

Computer tomographs (CT) and especially X-ray machines are standard in most hospitals today, MRIs are only found in larger buildings or radiological practices. Therefore, it must be ensured that the rare places are available for actually relevant patients and emergencies. Nevertheless, there are a whole range of indications that make an MRI useful, either because it is superior to other examinations in terms of the quality of the image, or because one wants to prevent excessive exposure to X-rays, as occurs with CT. A typical indication for an MRI examination is the precise imaging of soft tissue, such as: The evaluation of tumors is of particular importance, which can be easily assessed by MRI in terms of size, extension and infiltration of neighboring organs (staging).

The primary tumor search can also be made as an indication. Especially the female reproductive organs such as ovaries, uterus and also the breast are often examined by MRI when a tumor is suspected. The kidneys or pancreas are also the focus of attention here.

New formations in the brain can be seen extremely well in the MRI of the brain. Often a contrast medium is used in an oncological indication for better imaging of specific structures. MRI is currently the safest method for excluding or diagnosing a tumor disease.

Musculature and
Tendons
Connective tissue
Cartilage
Brain parts and
Spinal cord and
Intervertebral discs.

In addition to this specialist area, the assessment of the musculoskeletal system, i.e. the musculoskeletal system, is the main part of initiated MRI examinations.

A typical indication here would be the suspicion of a herniated disc or a protrusion of the disc, which has not yet been clinically proven. In this case, an MRI examination can provide a reliable diagnosis, but the patient with his symptoms and not the MRI findings must be treated. In addition to the intervertebral discs, joints are often also examined, with almost every joint being clearly visible with the MRI.

An important indication here would be suspected damage to the articular cartilage in the knee joint, the so-called menisci. One of the most frequent indications in this context is the clarification and precise assessment of the injury in the case of a torn cruciate ligament. But also the distinction between inflammatory, wear-related or metabolic pathological processes can be an indication.

For effusions in the joint, another indication, an MRI can often detect signs of damage earlier than conventional procedures such as ultrasound or clinical examinations. In addition, associated tendons and muscle attachments are also examined by MRI if more precise information is needed in cases of unclear pain or irritation. MRI is often indicated for diseases or injuries of the head.

In addition to the tumor diseases already mentioned, bleeding, which takes place both within the brain and between the brain and the skull, often plays a role. The clarification of ischemia, i.e. an under- or non-supply of brain parts in the sense of a stroke, is also a frequent MRI indication. In addition, an MR angiography may be indicated if there is a suspected occlusion of a blood vessel in the head, i.e. the imaging of arteries and veins with the aid of a contrast medium.

MR angiography can be used throughout the body. Another indication is, for example, the assessment of the aorta, pulmonary vessels in cases of suspected pulmonary embolism, or the examination of vessels in the abdomen, pelvis and legs. Another important indication is the search for typical signs of multiple sclerosis (MS) at the front of the body, which are particularly well visible on MRI.

For this purpose, special MRIs ́s for MS are prepared with contrast medium. A rather rare, but all the more important indication for an MRI as a supplement to cardiac ultrasound is the detection of certain diseases of the heart. These are mainly congenital malformations and the status of the coronary vessels, as well as structural defects or malignant neoplasms.

Theoretically, it is possible to examine the entire body with MRI, from the head and neck area to the chest, stomach and feet. In many cases, such as those mentioned above, it offers better detection and presentation of the disease than other methods. However, there are also a number of indications where CT is superior to MRI.

Moreover, many of the diseases or injuries can be detected and treated in advance. Only if more precise clarification is required, an MRI examination is considered as a supplementary means. Head MRI (synonym: magnetic resonance imaging of the skull) is a radiological examination procedure in which the brain can be visualized with the help of a magnetic field.

In the course of head MRI, bony parts of the skull, the head blood vessels, the cerebral ventricles (cerebral cavities) including the cerebrospinal fluid (cerebrospinal fluid) and the remaining soft tissues of the skull can also be depicted. Today, head MRI is routinely performed for a variety of conditions. The reason for this is the fact that this diagnostic procedure provides particularly meaningful images.

In addition, unlike conventional x-rays, an MRI of the head does not expose the sensitive brain structures to radiation. The performance of a magnetic resonance imaging of the head can be useful for many different indications. Especially after an accident, head MRI can help to visualize possible cerebral hemorrhages, brain injuries and craniocerebral trauma (SHT).

But also in cases of inflammatory changes (e.g. MS) or bleeding into the brain, an MRI of the head can be helpful.Further indications for head MRI are: Furthermore, head MRI can be used to visualize the orbit, the inner ear including the ossicles and internal auditory canals, malformations of the bony skull and changes in the temporomandibular joints. Since it is essential that the patient remains in a certain position when performing an MRI of the head, a so-called head coil is placed on the patient before the examination. The head must also be fixed on the examination couch.

For this reason, head MRI is particularly difficult to perform in anxiety patients. In order to avoid anxiety or panic attacks during the preparation of the head MRI, it may be advisable to take a mild sedative. There are basically two different methods of head MRI: The image without contrast medium and the so-called contrast medium image (MRI with contrast medium).

In most cases, head images are first taken during the session without contrast medium. However, if special structures or the course of the vessels have to be depicted, a contrast medium must be administered additionally during the examination. In this case, an indwelling cannula (peripheral venous access; PVK) is usually inserted before the patient is fixed in the device.

The usual contraindications for head MRI apply as for any other MRI examination. Particularly in the case of persons who are fitted with a pacemaker, it must be carefully considered whether the preparation of an MRI is justifiable. With a few exceptions, head MRIs may not be performed on patients with artificial heart valves either.

Further contraindications for a head MRI are

Brain Tumors
Cerebral infarctions
Meningitis (inflammation of the meninges)
Encephalitis (inflammation of the brain)
Changes in the blood vessels
Unclear headache
Chronic headaches
Implanted defibrillator (ICD)
Metallic foreign bodies in dangerous localization (for example, near the eyeball)
Medical implants (especially cochlear implants)

The high-resolution images that can be obtained using magnetic resonance imaging make this method the ideal diagnostic method for joint complaints. Above all, diseases that arise in the course of a traumatic event (for example, during sports) or as a result of years of wear and tear can be optimally depicted with the help of knee MRI. An MRI of the knee is usually performed on an outpatient basis by a radiologist in private practice.

However, the preparation of a knee MRI is also possible in most clinics. Before the actual examination, patients should remember to empty their bladder completely. It is not possible to interrupt this process during the images.

In addition, all metal objects must be deposited in a changing room in front of the examination room. This applies to jewelry and hair clips as well as piercings and removable braces. Afterwards the knee to be examined must be placed in the MRI machine.

For people who suffer from claustrophobia, the knee MRI is comparatively comfortable. The reason for this is the fact that the upper body is completely outside the tube even during the examination. In addition, with an MRI on the knee it is in most cases even possible to take an accompanying person into the examination room.

This can be of great advantage, especially for small children and anxious patients. In contrast to conventional X-rays, the magnetic resonance tomograph does not use X-rays. For this reason, this examination method does not involve any radiation exposure for the patient.

During the preparation of the MRI images, it should be remembered that any movement will cause the images to become blurred and thus unusable. The examination of the knee joint using MRI for the knee usually takes no longer than 30 minutes. The MRI examination for the knee makes the tissue, ligaments and cartilage of the joint visible.

For this reason, magnetic resonance imaging of the knee joint can be useful in a variety of diseases. Particularly in the case of cartilage damage, torn cruciate ligaments or meniscus damage, there is no comparable diagnosis to MRI of the knee. The typical indications for knee MRI include Arthroscopy is considered an alternative to knee MRI.

However, with this examination method, a small camera must be inserted into the knee joint through a skin incision. This method can also be used to reliably visualize changes in cartilage and damage to the menisci.The advantage of this examination method is the possibility to correct some changes during the mirroring. Thus, slightly pronounced changes in cartilage can often be treated in the same session.

The disadvantage of arthroscopy is the fact that it is a surgical procedure and therefore the typical complications can occur. Especially wound healing disorders and infections are among the most feared complications of arthroscopy. In addition, unlike MRI of the knee, arthroscopy of the knee must be performed as an inpatient procedure in most cases.

Furthermore, the surgical incisions lead to a temporary restriction of the knee joint’s mobility. The significance of such an arthroscopy of the knee also depends to a large extent on the skills of the surgeon. The images of the knee MRI, on the other hand, can be stored digitally and thus, if the findings are unclear, can be interpreted by various specialists.

Unclear knee pain
Meniscus damage
Cruciate ligament rupture
Cartilage damage

Magnetic resonance imaging (synonym: magnetic resonance tomographyMRI) is considered the ideal method for sectional imaging of the spine. For most spinal column diseases, MRI is even considered the examination method of choice. Since MRI also provides high-resolution images in the area of the cervical spine (cervical spine), pathological changes can usually be depicted in the smallest detail.

Above all, the fact that the roots of the individual spinal nerves can be depicted without superimposition during cervical spine MRI offers ideal diagnostic possibilities. For this reason, diseases such as nerve compression and irritation, which occur in the course of a herniated disc, can be optimally assessed. Further indications for the performance of an MRI of the cervical spine are

Herniated discs of the cervical spine

Since magnetic resonance imaging is best suited to depict the spinal column in its smallest parts, parts of the lumbar spine (lumbar spine) can also be imaged.

Depending on the type and location of the complaints, sectional images of the lumbar spine can be generated from any direction and in any plane. On the basis of these images, the specialist can quickly and specifically make a diagnosis. In addition, additional images of the entire spine can be taken even in the case of complaints that only affect the lumbar spine.

This is particularly important because pain in the spinal column likes to radiate into other segments. Complaints perceived by the patient in the lumbar spine may, under certain circumstances, originate from the thoracic vertebrae or the hip joint and have no connection with the actual lumbar spine. Above all, the non-overlapping imaging of the roots of the spinal nerves allows an optimal assessment of the extent of various diseases.

This is of enormous advantage especially for patients with nerve root contusions or nerve root irritation. In addition, less frequently occurring causes of pain in the lumbar spine, such as inflammation or tumors, can be reliably ruled out with the help of lumbar MRI. In addition to the preparation of a lumbar spine MRI without contrast medium, images taken with a special gadolinium-containing contrast medium are now standard procedures.

Typical indications for the preparation of an MRI of the lumbar spine include

Herniated disc of the lumbar spine

For most shoulder diseases, magnetic resonance imaging is considered the diagnostic tool of choice. With the help of shoulder MRI, the bony structures as well as the ligaments and muscles of the shoulder joint can be visualized. In addition, changes in the cartilage of the shoulder can be depicted in detail.

In most cases, an MRI of the shoulder takes 20 to 30 minutes. During this time, the patient to be examined must remain in a certain position. If he does not do so, the MRI images become blurred and unusable for further diagnostics.

For this reason, it is particularly important that the patient is fixed on a movable couch before the actual examination begins. Especially in the area of the head and shoulder, there must be no room for movement. Even swallowing too forcefully or sneezing unintentionally can render the images useless.

The fixation can be very uncomfortable, especially for people who suffer from claustrophobia. For this reason, it is advisable to take a light sedative before the examination, especially when performing an MRI of the spine, head and shoulder.In addition, it can help if the patient is accompanied to the treatment room by a trusted person. It should also be noted that driving a motor vehicle after taking a sedative is not permitted for the time being. For this reason it is also worthwhile for the patient not to come alone to the shoulder MRI appointment. The most common diseases that can be diagnosed by means of shoulder MRI are

Chronic shoulder pain
Chronic overloading of the shoulder
Chronic instability of the shoulder
Tear of the long biceps tendon
Arthrosis
Impingement Syndrome
Tendinitis