Veterinary care has undergone an explosion over the past 25 years. Many pet owners now seek the best possible therapies for veterinary care. In the realm of veterinary neurology, special imaging (MRI or CAT scans) is integral to providing non-invasive diagnostic modalities.
Veterinary medicine has evolved into a hierarchy such as that seen in human medicine. There are family or primary care practitioners (PCPs), and there are specialists. Many residency-trained veterinary specialties include areas such as neurology, surgery, oncology, cardiology, internal medicine, dermatology, and ophthalmology.
In recent years, specialty centers have developed to provide services to the PCPs and their clients/patients. These specialty centers use leading technologies to deal with the constantly evolving, complex medical problems seen in veterinary patients. Clients are normally referred by their PCP to the centers to see a specialist. Most specialty centers do not see general practice problems and strictly see patients referred for a particular problem.
MRI technology has only been around since 1980 and did not gain widespread use in the human field until the late 1980's and early 1990's. In veterinary medicine, high costs prohibited the use of MRI in animals until the mid 1990's.
In earlier times, many veterinary specialists had been forced to rely on local human diagnostic facilities to provide them with after-hours MRI availability for their patients. Only a limited number of MRI units had been operated by veterinarians as dedicated patient units. Cost and caseload were the two primary reasons for this. Even as equipment costs had declined, other costs that are often overlooked include MRI technologist salaries, maintenance contracts, facility set-up, electricity, etc. serve as deterrents to establishing dedicated MRI facilities. In addition, the PCP is usually not qualified to interpret the results since there is virtually no training in veterinary school on this subject, and most PCPs do not have the facilities or expertise to deal with the medical problem once diagnosed For example, the patient may require advanced surgery or other diagnostics not available to the PCP.
For these reasons many PCPs are wary of referring patients to diagnostic imaging centers that may charge $2000-$2,500 for an MRI as they are often limited by what other diagnostics or treatments they can provide. Instead, when PCPs refer their clients to veterinary specialists, they can perform the MRI and any additional testing i.e. CSF, EMG or proceed to neurosurgery if indicated.
For example, without an MRI available, animals that have spinal cord problems are evaluated with a myelogram and possibly CT scan. A myelogram is necessary because the spinal cord cannot be visualized on a regular radiograph or CT alone. A myelogram is performed by injecting a contrast substance (dye) around the spinal cord through a spinal tap. Radiographs or CT are then taken to evaluate the spinal cord. The dye injected may potentially exacerbate the underlying disease or result in seizures. In addition to be ing more invasive, myelogram is far more limited in the diagnostic information it provides when compared to MRI.
The purpose of an advanced imaging modality is threefold:
As a diagnostic tool, MRI has a lower incidence of false negative results than with other imaging modalities. MRI improves the ability to diagnose a variety of CNS diseases (i.e. vascular accidents, syringohydromyelia, inflammatory conditions, gliomas), orthopedic, soft tissue, and internal medicine cases that are difficult or impossible to diagnose with CT or myelography. For example, we have seen MRI images of some dogs with multifocal lesions consistent with encephalitis that have had negative CSF taps. These lesions would have been missed on CT and an inappropriate therapy may have been instituted.
MRI is a superior imaging modality for nervous system disease and many other organ systems. It not only is non-invasive but it produces multiplanar images (i.e. sagittal, axial, coronal) of the region evaluated and a variety of study sequences (i.e. T1WI, T2WI, PD, STIR, FLAIR, etc). This provides the specialist with more information than can be attained from other imaging modalities including myelography and CT scan. These MRI imaging features make it ideal for oncologic cases because of its utility in presurgical planning, treatment response with follow-up MRI scans and prognosis based on extent of disease.
MRI is also more versatile then CT or myelography. It allows the specialist to image the brainstem and cervical spine in one study thereby increasing the ability to make a diagnosis of an occasional tetraparetic animal that presents without intracranial deficits. Without MRI, one would be have to myelogram in such a patient and when found to be negative do a CT scan of the brain.
Magnetic Resonance Imaging for the neurologist is what the ultrasound is for the internist and the echocardiogram is for the cardiologist. It has elevated the quality of care that we can provide for our patients.
Animal MR works in partnership with our referral centers to provide clients with exceptional and comprehensive services. To discuss how Animal MR can work with your organization to incorporate MRIs into its service offerings, contact Nuda Sarcone at email@example.com or 914-767-0141.