MRI vs. Contrast CT Scan

[Herniahelper]

I suspect that you are being sent for a CT scan because your providers are diagnostically destitute.

You’ve had physical exams, other modalities of diagnostic imaging, and none of them have explained your symptoms… More or less everyone on Earth that complains of pain near the abdomen for long enough is going to get a CT scan.

I think part of your reaction is that another doctor is saying “I can’t believe so and so didn’t get this test, or operated on you before getting this test…”

I don’t know what your circumstances are but I highly doubt that it would have showed anything regarding your groin injury or changed your course at that present time.

The vast majority of people with true hernias don’t get any imaging at all. It’s purely a clinical diagnosis based on exam.

There are rare instances where subtle hernias or groin injuries are found on imaging. There are instances where technical problems with a repair like a meshoma can be visualized and it can help diagnosing the source of a patient’s pain.

Most surgeons are more comfortable reading CT scans more than anything else. That’s where they start. Because the majority of their practice is built around fixing the things that CT scans show best.

But people that do a lot of work with groin injuries and hernias may choose to start with an MRI because in their hands that can provide them with much more information about those problems than a CT scan.

Was your problem a presumed sports hernia?

If you were complaining of musculoskeletal groin pain and had ultrasound and MRI I think it’s unlikely a CT scan is going to add anything unless there’s something about your complaint that makes people suspicious that bone or bowel is involved. So I don’t think it’s wrong at all not to get one.

The secondary question of if all of your initial studies were mostly negative… Should you have continued to get more and more studies until you definitively found a problem? That’s a personal choice. I think it’s always risky offering someone surgery when you’re not really sure what you’re trying to accomplish.

And there’s a lot of people out there that have meshes and want them removed that look completely normal on imaging.

I think surgeons are much more excited about revising or ex-planting a mesh when there’s clearly a recurrence or other technical problem that’s visible on exam or imaging which can be corrected. Groin explorations or sports hernia treatments should have more sobering expectations.

Of course we don’t know how any of this was presented to you or what your specific problem was.

I do know that Dr. Brown has said to patients in no uncertain terms that ‘revising a groin hernia should be viewed as a palliative procedure. Full recovery should not be the expectation.’

Sometimes it can be hard to read between the lines based on all the information that’s being given to you. Patients want to hear ‘I can offer you this procedure that might make you better.’

I don’t know how confident you’re diagnosis was or what the objective of your surgery was.

For patients that are looking for a doctor to help them with their problem it’s really important to ask difficult questions and try and nail down how confident they are and their ability to identify and correct your problem.

Most of them are not chasing money, they legitimately want to help you. Finding the right person for your problem can be really difficult if nobody even knows what your problem is.

So the short answer to your question is no it is not wrong to get surgery without a CT scan. Even if you had a CT scan that showed nothing different than your MRI I’m not sure it would have changed anything regarding your decision making. Getting a CT scan now is also appropriate. And if it shows something does that mean it should have been obtained a long time ago? Hindsight is always 20/20.

Personally if I could pick any imaging modality for groin pain and I had to only pick one it would be MRI. It shows you all of the anatomy. The new ones with huge magnets can go fast enough to catch moving bowel now. And it doesn’t involve any radiation for the patient. How many general surgeons or even radiologists are use to reading abdominal and groin MRIs? Probably not many, because it’s just not a big part of most people’s practice.

It sounds like you’re going to get your CT scan and so you will know whether it was relevant or not soon enough.

At this point I would caution you not to embark on any additional surgeries very carefully. If you have the benefit of seeking the opinions of world experts you absolutely should.

As I’m sure you have noticed there are many different ways to repair hernias and every surgeon has a different idea about what’s best. Some will tell you that if you believe the sports hernia data all inexplicable groin pain in an athlete with normal imaging can be fixed by stuffing a mesh in it. And they may seem very confident about it.

It sounds like you have a very tricky problem. I’m not sure that Dr. Towfigh can offer you a fix. But if you haven’t yet I think that it would be well worth the expense to go visit her. She has the luxury being able to take the time to be very thorough and she seems to enjoy problem solving difficult cases.

[MarkT]

It really depends upon the underlying problem as to which method is best.

AFAIK, the usual order of imaging tests for groin pain is ultrasound, then CT, then MRI (and at least some of the reason for that is cost, time, and the expertise/equipment needed).

Dr. Towfigh uploaded a HerniaTalk on imaging a couple of months ago, which includes discussion on a couple of papers she and colleagues have published on the topic (including how the expertise of the person reading the scans is critical):

https://www.youtube.com/watch?v=jJcu8kHPkgA

In my case, a physical exam, ultrasound, and contrast CT have revealed nothing…next step seems to be MRI.