MRI v Ultrasound

[Cornishrex]

Hi, This is a little tangential to our main topic but hoping some-one can help. My rheumy finally agreed to send me off for an MRI of my foot to see what is going on down there after 1 year of constant weight bearing foot pain, zero impact from increasing doses of MTX, and my ongoing insistence that I don't feel like I have RA. I've suggested that my left foot, at the very least, feels like I have a Mortons Neuroma.

The letter came through yesterday for the scan appt. However, I am booked in for an ultrasound, not an MRI. The rheumy definitely said MRI to me and that is what he wrote in his letter to the GP.

Whoever does / looks at the scan results, I want them to not only look for signs of Mortons Neuroma but also look to see whether there is any evidence, either for or against, for my ongoing foot pain more generally being caused by RA.

I don't know whether I should be bothered by the change from MRI to ultrasound and whether I should put up a fuss. Does anyone know whether ultrasound would be less helpful in looking for these problems than with an MRI? Given that it has taken me a year's worth of foot pain to actually get some-one to agree to look at one of them, I probably won't get another bite at the cherry for a long time to come .....

Many thanks

[allanah]

I think ultrasonography rd are very good at spotting things and if they felt that the scan showed something they would suggest further things to investigate. MRI are more expensive to prescribe and often the waiting list is longer when I've had them. So it's a step forward ( pardon the pun) I think to give a bit more information which they can act on xxx

[oldtimer]

An ultrasound is safer for you and should give you enough information about the structures of the foot to give an indication of what is there that shouldn't be. It is very sensitive at picking up the signs of inflammation too.

[bpeal1]

MRI scans are much more detailed than ultrasound scans. I have had both on my feet. If you were expecting an MRI scan I would phone your Rheumatology helpline nurse or your consultants secretary and check to see what they were expecting. There might be a good reason for changing it or it might be an error by admin in the scanning department. It would be better to check then waste your time and their time going for the wrong sort of scan. If they do change it to an MRI I have discovered you can usually beat the waiting lists by phoning the scanning department once they have received the request as they often have cancellations which they are only too happy to fill.

Good luck.

Becky

[stbernhard]

Hello Cornish King, I've got toe trouble in my left foot. Like a sharp stone in my shoe when bad and like an electric charge when quiet. Musculoskeletal specialist thinks it maybe Mortons and he thinks a ultra sound scan is better than a MRI for this. I'm booked for 14/12. Hope this help a little. All the very best.

[Cornishrex in reply to stbernhard]

Yes, sharp stone I relate to. And sometime I can audibly hear it making a clicking noise as the ball of my foot rolls over the floor. And sometimes, if I put my foot into a tighter fitting shoe, I can feel the lump "move upwards" as my bones crush together on it. I don't have an "electric charge" though I think. Already had an x ray and it showed nothing at all wrong, which is strange given the clear clicking noise sometimes when bare foot. Got my appt on 26/11 so I'm hoping it will show Mortons with a clear remedy. Good luck with yours. I guess I'll stick with the ultrasound then.

[alioli58]

Hi

Just read up you can have cryosurgery done on your Morton's. The sooner done the better. Look into this when properly diagnosed.

[penelopejane]

I have had steroid injections into my feet, between my toes, under ultrasound guidance for this condition. Unfortunately several times.

But they work - pain free feet for ages.

Hoping there will not be a next time.

[Cornishrex]

Thanks everyone - there's some really good thoughts there for me to follow up on. I thought you might be able to help .....

[earthwitch]

The problem with MRIs of smallish areas like feet is that when they do the imaging, they do it in kind of "slices" about a quarter inch apart, so can very easily miss stuff that is in the gap between the pictures they take. They also have to choose the right sequences (types of images) that will show up the type of tissue that they are looking for - so one type of sequence might show up inflammation, another sequence might show up solid masses, another fluid filled cysts, etc. The difficulty would be that they wouldn't know exactly what they were looking for, so ,may not do the right sequences and it might end up not showing anything at all.

On the other hand, Ultrasound is very very good at looking at the muscles and tendons and other tissues and identifying anything unusual, so I would expect it would be a much better type of imaging to pick up a range of things from inflammation to a solid mass (neuroma) to tendon tears, etc.

If you find when the ultrasound results come back that it hasn't shown up anything definite, maybe then you could ask again for an MRI.

[flow4 in reply to earthwitch]

That's an interesting and useful explanation of how MRIs work, earthwitch. Thanks.

[Cornishrex]

Thanks for everyone's feedback on this. I stuck with the ultrasound and they found THREE neuromas across the two feet and possibly TWO bunions about to start developing. I never thought I'd be so happy saying that !!! A definite problem a with potential definite fix !!!

[nomoreheels in reply to Cornishrex]

It's highly possible Cornishrex. On diagnosis I had visible signs of bunions which reduced in time after treatment commenced. I do have very slightly noticeable (probably only to me) beginnings of bunions again but determined I won't let them progress like my nan's & my dad's. I've ugly enough feet now without adding to them when all it took was meds after two years of asking my Rheumy to examine them!

It is a shame it took so long for your Rheumy to relent & examine your feet. I'm afraid it happens all too often, leaving them far too long then the it becomes a case of damage limitation to a greater or lesser degree. Did your Rheumy discuss possible treatment or have you not discussed the findings of the scan yet?

[Cornishrex]

Haven't got that far yet nomoreheels. The radiologist said he would be recommending a follow up x Ray to look at the possible bunions, and as for the Mortons neuromas, he said his opinion was that I needed to try to fix them naturally with orthotics before considering surgery. But I've got to wait now until either a GP or the rheumy give their own view. Hopefully before my next scheduled spot with the rheumatologist in Feb .....

What kind of treatment did you have for bunions?

[nomoreheels in reply to Cornishrex]

No treatment as such was needed as I started my meds which halted further development. My Consultant recommended I changed footwear though not sure that made any difference. They were more obvious before diagnosis & I'm now left with just a slight drifting of both big toes which has remained but the bunion didn't form there's just a protrusion of bone.