MRI for tailbone pain/rule out bone mets...w/o contrast or with?

beckstar18

Anyone who has had an MRI for bone pain, was it ordered without contrast, or with and without? Or does anyone know the benefit of using either or both to assess sacral/tailbone pain?

Back story: I've been having tailbone pain for about 6 months, no injury or event to precipitate it. It's gotten significantly worse, to the point where it hurts to sit, stand, lay down and using a donut at work is useless. Going from sitting to standing position is excruciating at times. There is even pain there with BMs and during sex. I saw my PCP who did a physical exam which nearly made me jump off the table when she pushed right on the spot at the bottom of my tailbone (darn near a rectal exam!). She ordered x-rays first, which were negative. Then she ordered a pelvic MRI without contrast for further evaluation. When the hospital called me to schedule the MRI they went through the standard list of questions (implants, surgeries, cancer history), and said because of my cancer history my doctor needs to order the exam as an "MRI sacrum with and without contrast". There was literally 2 weeks of back and forth between the hospital, me, and my doctor's office, with me playing the middle man, on getting the "right" test ordered under the correct code per the hospital's request, MRI pelvis w/ and w/o contrast was the final order and was approved by insurance as both. BUT, I ended up having to do an 11th hour location change because by the time the order was finally in it was too late to get scheduled at the hospital because their MRI machines were down for service until July 11! Somehow when the order was transferred to the 2nd imaging center, it got scheduled as "MRI without contrast", which I had done on Tuesday. I was unaware we weren't doing contrast until the exam was finished and the MRI tech said we were done. SERIOUSLY?? Ugh...now again I'm stuck in the middle between my doctors office and this 2nd imaging center. Someone screwed up, but no one will take ownership. Instead the PCP's scheduler is telling me "well if you want an MRI with contrast Dr. XYZ said she'll put in another order and see if insurance will approve it." I told her that it's not what I want, but what is the right exam for me to have? I told her my doctor should be the one to determine that, and I wanted to know if I should be having it with conrast to adequately assess my pain given my history of breast cancer (and melanoma, and benign brain tumor)? I was going off what the hospital radiology department told me, who said that it should be with and without contrast based on my cancer history.

So here I am, Tuesday's MRI without contrast was normal. The MRI WITH contrast is now scheduled (and re-approved by insurance) for July 6. But now I'm wondering if it's a waste of time since the without contrast MRI showed nothing. Also not wanting to unnecessarily have contrast injected in me if it's not indicated. Does the contrast show anything in the sacral/tailbone area that the regular MRI wouldn't pick up? I've had a broken tailbone from a snowboarding accident about 20 years ago, and this is honestly worse. And it's been ongoing and worsening since the beginning of the year. I just want to have the right test done to get a definitive answer as to what is causing so much pain!

bevin

Have the test done. MRIs don't have radation like a CT scan and better to get fully checked. Good luck

beckstar18

Bevin, thank you for the info and support. Hoping others can chime in as well on the pros/cons of using MRI contrast for bones. I agree about the CTs, although I've had them when necessary the radiation exposure is definitely a strong con.

SummerAngel

Are you still taking Tamoxifen? Just curious, as tailbone pain can be a side-effect of it (it was one of many I experienced, and was getting progressively worse until I quit.)

ShetlandPony

Where is your medical oncologist in all this? I would think he/she would order a bone scan. (That is not high radiation,) Be sure to mention your previous injury as it could show up and make the bone scan ambiguous, If so a PET scan could help distinguish.

beckstar18

SummerAngel, I stopped tamoxifen a long time ago. I was only on it 18 months and had to discontinue due to liver damage. I've been on Femara 2.5 years and have tolerated it very well. The joint pain is extremely minimal compared to when I was on tamoxifen.

Shetland Pony, I actually have my next routine follow up with my oncologist in July. I saw my PCP on June 3 after sustaining a concussion, and I mentioned my tailbone pain during that visit. So she did an exam and ordered scans. I do plan to discuss all of this with my oncologist as well though at my next visit with her. I've had a couple bone scans in the past (negative) but it has been awhile. Do bone scans typically pick up things that MRI doesn't? I thought MRI was more sensitive. Although, I don't know if that means MRI with or without contrast. (?)

ShetlandPony

Hmmm, it would be good to ask djmammo those questions. It seems like PCPs sometimes use MRI to look for injuries, while MOs use bone scan, PET, CT, and MRI in various ways.

KBeee

It needs with and without the contrast to best assess for cancer. They will be able to compare the new one with contrast to the old one without

beckstar18

Thank you all for the responses. I'm planning to keep my appointment for the MRI with contrast this coming Thursday. I just wanted to be sure before I moved forward whether or not it was warranted, and could provide any extra details for analyzing sacral/tailbone pain beyond the MRI without contrast which was done last week.

I was a little annoyed that the nurse from my PCPs office made it sound like it was up to me whether or not I wanted it. I have no idea! I told her I'm not a radiologist, so I wouldn't know which one (or both) is the best and to please find out from my PCP. She called back and said my PCP ordered it, and it sounds after reading these replies that it might be helpful to have the contrast.

Weird thing though...the radiology staff at the hospital said it should be with and without contrast based on my cancer history, but the tech at the 2nd radiology office where I ended up having the scan said the one without contrast would show everything they need to see. She was so bewildered when I asked about the contrast and then I felt totally dumb. I was just going off what the first radiology group told me. (?)

At my brain surgery follow-up a couple weeks ago, my neuro-oncologist asked to review the MRI scans as well, and he said he's going to consult with his neuro-radiologist on them. So I'm happy to have some extra eyes looking at the results. I see my general oncologist next week for my 6-month check-up so I'll be going over everything with her too then.

ShetlandPony

What I do not know, but would ask, is this: Should the with and without contrast be done in the same session? Do they need to compare the two, with you in the exact same position? If that's the case, the order needs to be "with and without contrast". I still think the PCP may be confused about an MRI to look for an injury vs. an MRI to look for cancer. I really don't know for sure, but I would want to talk to the oncology radiologist before going for that MRI. Or have your onc talk to them.

Libber

steiner18.

I had a neck/cervical MRI done last week. It was with and without contrast. The tech first sent me into the machine for scans without contrast. Then injected and did two last scans. It really wasn't a big deal. The contrast is not a concern for me. In the end the MRI shows arthritis and edema in C3 and C4. I had some scan anxiety due to the pain so now am glad that is behind me. My doc reminded me today that we have PTSD from the negative tests/scans endured. Tough to get past that. He also reminded me to speak up with any concerns.

I hope all turns out well for you. Try not to worry so much. I know easier said than done.

ShetlandPony

Steiner, please forgive me if my reply sounded insensitive; I was focused on the technical question. I should have said, "to rule out cancer" since there are so many other possible causes for pain. I'm sorry you have the added stress of getting stuck in the middle trying to figure out what should be ordered.

theresa45

I had an MRI with contrast for tailbone pain. It may have also included the MRI without contrast. I have Stage IV cancer confirmed by biopsy of mets to lymph nodes in my neck and a hilar lymph node biopsy. I was taking letrozole alone at the time. From April 2016 to November December 2016, I had increasing tailbone pain. I had 2 PET/CT scans during that time that did not show bone mets to my tailbone. My excellent Stanford oncologist ordered the MRI with contrast to determine if I had mets to my tailbone. They compared the MRI with contrast to my previous PET/CT and determined that I had inflammation, but no mets in the area. Over time, my tailbone pain has subsided. I sit on cushions and try not to sit leaning back on my tailbone. I also take tumeric which may have helped with the inflamation. I had a bone scan when I was originally diagnosed Stage 1 years ago, but have not had a bone scan since. Maybe that is because I am been followed by PET/CT.

I just wanted to let you know that my oncologist believes that MRI wth contrast is a good tool for assessing bone mets to the tailbone. Also, that even when you are Stage IV, tailbone pain may not be bone mets. The pain could be caused by letrozole or something else. I would have the MRI with contrast (easy peasy for me, with low radiation) and remain hopeful.

Hope that helps! Theresa

beckstar18

ShetlandPony, they are able to compare today's MRI with contrast to the one done last week without. I'm at the same imaging center. My PCP already told me they'd be doing that. And no offense taken, I didn't think anything of your posts. I'm the direct and give me facts/get to the point type myself, so maybe that's why it didn't faze me. 😉 I appreciate your insight and help!

Libber, I'm glad your scans didn't show cancer. I hear ya on the scanxiety piece. I've had so many scans over the last 5 years, it has gotten immensely better with time but it'll never be zero worry. I really have gotten better about giving my worries to the Lord and not consuming myself with them.

Theresa45, thank you for sharing your story. It gives me confidence that coming back for this 2nd scan is the right thing to do in order to thoroughly assess my pain. I'll be honest, I cried when I got the news last week that the MRI without contrast was normal. Obviously not because they found nothing to worry about, but because I felt completely invalidated with the amount of pain I'm having. I hope today's scan shows no cancer but also shows what the problem is (i.e. nerve compression or whatever) just so I can have an answer and move toward a solution to the pain

KBeee

Hoping you get a non-cancer answer