Are MRIs Worthwhile?

[RJG]

Hi,

I had a total gastrectomy this time last year to remove cancer from the junction between my oesophagus and stomach. At that time, the cancer had not spread to lymph nodes or any other tissues or organs.

A recent CT scan showed a single mass in my liver which is about 14 mm in diameter. The surgeon recommends that I have a MRI scan with liver-specific contrast in an attempt to identify the mass. There is no rebate from Medicare for this MRI and it is not claimable against private health insurance. At a price of $780, which I realise is trivial as compared with the treatment for some cancers, I wonder whether it is worth spending the money. I have sent the following questions to the surgeon, but doubt that he will respond. Maybe someone here has been through this and might know...

1. What is the relative sensitivity of a MRI with liver-specific contrast as compared to CT scans that have already been performed? That is, can it really detect a cancerous mass?
2. What is the diagnostic accuracy of the MRI scan? That is, what are the chances of a false positive, a false negative and an inconclusive diagnosis of cancer? This is a lot of money to spend if the result can not be trusted.
3. Is there another diagnostic tool that can provide similar surety of diagnosis as the MRI, but at a lower cost?
4. What happens if the MRI is inconclusive?
5. What happens if the mass is assessed as highly likely to be cancerous?

Thanks in anticipation,

Rick

[Jane1]

Hi, I have recently been diagnosed with breast cancer. At first I had ultrasound, mamogram and core biopsy. I was booked in for a lumpectomy,and lymph node removal to be followed with radiation treatment. The surgeon suggested having a MRI at a cost of $610. I thought this really expensive, but I said yes, even it meant that some bills might not be paid on time. The MRI picked up more cancer in the breast that the other tests had not found. This led to a mastectomy. Some of my lymph nodes ended up having cancer in them so now I will be having chemo and radiation treatment. The thing here is if, I had not had the MRI, which picked up more cancer, I would be in a worse situation later on.

I also had been told that the MRI could be done cheaper at a hospital in Sydney, but there was a waiting list.

[RJG]

Hi Jane1,

Thanks for your reply. It is good to know that the MRI is worth the effort and cost.

My oncologist also recommended that I proceed with the MRI.

I did actually get a reply from the referring specialist this morning, but he didn't actually answer any of my questions. I realise that there are rarely any guarantees in medicine, but I am getting a bit fed up with the ubiquitous response of "everyone is different, so I can't really answer that". Generally, I am just after an indication or likelihood of various options/outcomes. I guess this lack of preparedness to make a call on things comes from our increasingly litigeous society.

Thanks for leetting me get that of my chest.

MRI booked in for Tuesday morning at a different digital imaging service where the cost is only $580 (ie, $200 cheaper).

Rick

[Jane1]

Hi,

I think you have made a good choice. I have only been diagonosed for about five weeks and a lot has happened. I think it is best to take whatever advice is offered and "better to have tried than to have not tried at all". Since my MRI I have thought of all those who do not have a choice in doing it because of the cost. Anyway, my treatment has progressed now to mayby surgery, chemo and then radiation. But, I have told everyone involved that whatever they think is best I will be happy with, because I do not know what to do.

All the best.