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Saving lives with M.R.I.


The magician's act of sawing aperson in half is, of course, only an illusion. No illusion is the new "Star Wars' technology known as Magnetic Resonance Imaging (MRI). When aimed across the abdomen, it can give physicians a picture as if the body were actually cut in two. The "knife' can cut through the body and give a picture of all the insides just as they are.

There is no need to move one partto see another or to deal with blood, as in an operation. For both the doctor and the patient, this information can be priceless. MRI can make "cuts' anyplace in any direction, depending upon the area of the body that is suspected of causing the affliction. The results--had I not seen them with my own eyes--would be unbelievable.

For Bob Silvers, MRI was a lifesaver.Bob is our religion editor at the Post. When a sudden onslaught of lower-back pain sent him to his small town community hospital, the doctors thought his problem was no more than a pulled muscle and muscle spasms. He was hospitalized and given what was considered a complete work-up with X-rays, CT scans, and blood work. All tests being negative, two weeks later he was sent home with muscle relaxants and painkillers.

Now, Bob Silvers is not one tocomplain easily. His pain, I thought, was too excruciating to be merely a pulled muscle causing spasms. So I called Dr. Gene Klatte, chairman of the department of radiology at the Indiana University Medical Center, to ask for MRI to help in searching out the cause of Bob's torment.

Dr. Klatte did the procedure at 9a.m. At 10 a.m., he phoned me to say the problem had been found. MRI revealed a bone infection called osteomyelitis in Bob's third and fourth vertebrae. The bacteria causing the abscess and bone infection proved to be staph aureus. This mass had failed to show on X-rays or on the CT scan during his former hospital work-up. Now, thanks to MRI, it was disclosed in time. "Even one more day,' Dr. Klatte explained, "and the staph aureus abscess could have gone on to cause permanent paralysis.'

In fact, had the abscess penetratedthe sheath covering Bob's spinal cord, bacteria could have entered his spinal fluid, giving him meningitis or encephalitis. The result could well have been death or permanent brain damage.

Neurousurgeons discovered thestaph aureus by putting a biopsy needle into the bacteria-laden abscess that had set up housekeeping in Bob's bones during his agonizing weeks without an accurate diagnosis. With a powerful antibiotic, the right one to which staph aureus is sensitive, Bob's severe pain soon disappeared. Six weeks of hospitalization and intravenous (I.V.) therapy would do the rest.

Although the cost of the MRI exam(perhaps $500 to $800) might be considered expensive, you have only to ask Bob Silvers how inexpensive it is compared to the pain and the cost of hospitalization without a correct diagnosis. Or compare the cost percentage-wise to the cost of the equipment, about two million dollars plus another three-quarters of a million for a room completely insulated from external radio frequencies. (New York Hospital personnel found this to be necessary when their new MRI began receiving shortwave Vatican Radio.)

The explosive growth in the use ofthis exciting diagnostic equipment (some 400 in operation in the United States today) can be credited with a growing number of "Bob Silvers' miracles across the country. But one doesn't have to traverse the country to find examples. My office is adjacent to our lobby and our very attractive receptionist, Beth Knight. Unknown to me, Beth and her pediatrician had been struggling with a very intractable infection in her little two-year-old daughter Brianna's left ear.

In days before antibiotics, childrendied or became brain damaged from ear infections that didn't get well while their physicians watched helplessly. This doesn't happen in these days of antibiotics. Even now, however, mothers are always cautioned, because of the ear's proximity to the brain, that you can't wait around when a child tugs on his ear in pain. Beth hadn't waited. But something strange happened to Brianna while her ear infection was being treated: her eyes suddenly crossed.

When Brianna's day-care centercalled in early November to say the child's eyes had crossed, Beth and her husband rushed over and took Brianna to her pediatrician, who gave Brianna a thorough exam. Finding no neurological problems, he suggested that she see an ophthalmologist about the problem. His staff made an appointment with a local ophthalmologist, stating that it was not an emergency. The appointment was set for three weeks later. Beth tried to get in earlier, but there were no cancellations.

In the meantime, the pediatriciancontinued to treat the ear infection. It was the day before Thanksgiving when the ophthalmologist finally saw Brianna. He gave her a routine eye exam and dilated her eyes, when lo and behold he discovered papilledema (a swelling of her optic nerve). He immediately notified Brianna's pediatrician, and Brianna was referred to the neurology department at Indiana University Medical Center. Beth was told, "Don't stop for stop signs or anything--it's an emergency and the neurologists are waiting.'

Pressure on the brain causedthe papilledema that the ophthalmologist saw. Brain tumors can cause this pressure. Whether malignant or benign, they are fearsome, for they are space-occupying objects in a limited space. Even a benign tumor is a dreaded development. Too much pressure can cause the base of the brain to be pushed into the spinal column in the neck and cause sudden death.

Brianna was admitted immediatelyto Riley Hospital for Children at the Indiana University Medical Center. The pediatric neurologist and the ear, nose, and throat doctors pondered her condition, conferring about whether or not to give her a spinal tap.

Ruling out the spinal tap, theydecided to give her a CT scan. It showed nothing abnormal. They scheduled an MRI for that evening at the earliest moment the equipment would become available. It was being serviced but would be available at 11 p.m. that night. So, fortunately, little Brianna underwent MRI where Dr. Klatte is chairman of the department and had helped to save Bob Silvers' life.

The surprise the MRI revealedwas that Brianna's problem was not a brain tumor at all. Then when a tube was put into her left ear to drain the infection, spinal fluid that surrounds the brain was discovered to be draining from her left ear. The ear infection had perforated the coverings of the brain, allowing the fluid to leak into the ear. The residents of Indiana University Medical School had never seen such an ear infection, and the older faculty members hadn't seen one in recent years.

For Beth's little Brianna, MRI hadbeen a godsend, saving her from having to endure further time-wasting, invasive tests to rule out a suspected brain tumor when fast treatment of the infection was of the essence. Just in time, the proper antibiotics brought her around. Her speech has come back, and her eyes are no longer crossed, although her left eye still points inward when she gets tired. For the most part, however, she is on the road to complete recovery. But I still get goose flesh just thinking about what could have happened had it not been for MRI right across the creek from our offices.

To better appreciate thismiracle, let's turn back the pages of medical history for a moment.

At one time, if the cause of amedical problem wasn't readily apparent, "exploratory surgery' often became the next step. Unfortunately, despite these surgeries, or perhaps because of them, the patient didn't always improve. Then the question arose, how to look inside the body without first cutting it open. This led to the area of medical science called radiology, beginning with X-ray images. In recent years, medicine has ridden the wave of high technology. Researchers have developed dramatic new ways to look inside our bodies. Thus, in addition to ordinary X-rays, we have X-rays using materials for contrast, such as barium; X-rays assisted by computers (CT scans); radioactive elements that can be sent to various places in the body and then counted; and sound waves (ultrasound). And now Magnetic Resonance Imaging or MRI.

The incredibly complicatedtechnology behind MRI can be explained by a few examples. Our bodies are made up of chemicals, and chemicals are composed of atoms. Each atom has at its center a nucleus. If we visualize the nucleus as a ball with a stick driven through it, we can pretend it is a spinning top. All of us have seen how, when a top spins, the stick wobbles or swings in a circle. The stick is called the spin axis, and the path the stick follows as it wobbles is called the precessional path.

Normally the spin axis of an atomcould point anywhere, and its neighbors' could point anywhere else. But if we put this group of atoms in a strong magnetic field, the sticks tend to move around until they all point in generally the same direction. Remove the magnetic field, and the sticks will move independently until they are again arranged randomly. The speed with which an axis lines up and with which it falls away is affected by two conditions: the kind of atom and the kind of "world' it is in.

MRI takes advantage of theseproperties. A person, composed of lots of different atoms in different worlds, is placed inside a huge magnet. This magnet is turned on and off very rapidly, creating pulses of magnetism. The atoms line up and fall away with each pulse, each type of atom behaving a lottle differently from the others. The energy of all this change is picked up, and that information is fed into a computer. Then the computer can make a picture.

For example, the wall of the intestineis different from what is inside it; fat is different from the intestine; the stomach is different from fat or the intestine; and water or blood is different from the rest. Using these facts, the computer can create a picture looking exactly like the way we are arranged inside.

With the aid of these magnets andcomputers, the equipment can see through bone to the soft tissue underneath. Thus it is especially valuable in diagnosing brain and nervous-system disorders such as multiple sclerosis, brain tumors, and strokes. It can see into the heart and into aneurisms. It can spot cancers and infections, even in the bone.

MRI is especially useful in the cervicaland lumbar spine. It also is the best way of seeing into the lower, back part of the skull. It can be used to analyze the flow of blood in arteries. It has a future in the examination of arms and legs and their ligaments. In some cases, more invasive studies done today may be replaced by MRI.

Consider another of the wonderfuldiagnostic results that occurred in Phoenix, Arizona. At age two, Nathan Tower developed severe aches in his left ear and frequently vomited. In June 1985, when he was nearly five, those earaches were joined by terrible headaches, for which painkillers brought no relief. Trying to trace the cause of this constant pain eventually took the frantic mother to 11 different doctors, some of whom viewed her as neurotic or worse.

In the meantime Nathan's healthwas deteriorating rapidly. He lost the use of his left hand and arm and began losing the use of his left leg. In July, his distraught parents took him to Reno, Nevada, for tests. The results showed evidence of a tumor on the brain stem. The doctors agreed that it was inoperable.

However, through a roundaboutchannel of communication, the desperate mother finally contacted a doctor who urged the Towers to take Nathan to Phoenix's Barrow Neurological Institute at St. Joseph's Hospital and Medical Center, where MRI equipment had been installed only two months before. As he was being eased into the six-foot-long "torpedo tube' for the MRI scan, little Nathan looked up at his mother and asked, "Mommy, is this a spaceship?'

No, not a spaceship, but as far asthe Towers were concerned, the results were certainly as far-reaching. The remarkably clear image showed a tumor lying at the base of Nathan's brain. It was safely removed in an eight-hour operation. The surgeon said of the procedure: "With the MRI we are able to see brain structures we could never see before. Ten years ago this child would have died.'

Because MRI can depict soft tissuesin high contrast, it has proved an effective means of examining the spinal cord, as seen in Bob Silvers' case. Before MRI, doctors who wanted to look at the spinal cord had to inject an X-ray contrast agent into the fluid which surrounds it, a procedure that could be risky and painful.

Now, thanks to MRI, patients likeseven-month-old Ashleigh Slaughter are spared this risk and pain. The clear image of her malignant tumor between the kidney and spinal column was shown to be entering the spinal canal and compressing the cord. Fearing the trauma of spinal surgery on a patient so young, doctors at UCLA used chemotherapy to shrink the tumor before trying to remove it. Ashleigh responded so well to the medicine, however, that no surgery was necessary. MRI showed that the tumor had vanished from her body.

Lucky? Yes, you might call suffererssuch as Bob Silvers, Brianna Knight, Nathan Tower, and Ashleigh Slaughter lucky. Lucky that someone knew of MRI and that it was available. However, 400 MRI centers in the United States are pitifully few for giving promise of help to all whose lives are in jeopardy because of afflictions this equipment could expose. These lifesavers are thus being installed on large mobile vans so that several hospitals can share the equipment by using it one day a week.

What this means is, should youever feel that you haven't had an accurate diagnosis, ask your doctor if MRI might help reveal the problem. If so, ask him where the nearest MRI can be found. It is painless . . . it is not known to have any harmful effects . . . there is no irradiation . . . and there are no scars.

For all of MRI's many advantages,there are some restrictions to this method. It can't be done with people on pacemakers. Those who have had metal clips used inside them during an operation should not have this exam. The same goes for armed services veterans carrying bullets or shrapnel in their bodies, as the magnet pulling them out would be like being shot or injured a second time. If a joint has been replaced with a metal prosthesis, the radiologist needs to know. Someone who is very ill and in intensive care cannot be examined because the life-support equipment can't be in the same room with MRI. While there is no evidence that it is harmful to pregnant women, it's best not to take chances.

MRI is of particular value tochildren. Parents may be in the exam room with the child to comfort and hold his hand at no risk to the parents.

If you would like to learn moreabout MRI, write to the SatEvePost Society for a lost of manufacturers of this equipment and centers where MRI is available.

Photo: Bob Silvers, religion editor, had been sent home from the hospital with painkillers and muscle relaxants for severe pain. Knowing that Bob is not a complainer, Post editor asked for MRI to find a better answer--and just in time!

Photo: Dr. Gene Klatte, our MRI hero, points to the bone infectionin Bob's third and fourth vertebrae. The abscess was putting pressure on Bob's spinal column. The infection could have penetrated the covering of his spinal cord, giving Bob meningitis and encephalitis.

Photo: "Another day could have meant paralysis for Bob,' said Dr. Klatte, obviously pleased about the outcome. Said one of his MRI colleagues, "The poor man was apologizing while his back was dissolving.' After Bob's fortuitous diagnosis, staph aureus bacteria was cultured and proper I.V. antibiotics were begun immediately. His intense pain subsided.

Photo: MRI uses radio waves, a computer, and amagnet large enough to surround the patient. It can produce very precise 2- or 3-dimensional images. It takes 30 to 90 minutes.

Photo: Two-year-old Brianna, daughter of Post receptionistBeth Knight, was being treated for an infection of her left ear when her eyes suddenly crossed, and her pediatrician recommended she be taken to an ophthalmologist. The appointment, three weeks later, became an emergency when he discovered a swelling of the optic nerve. With the suspicion of a brain tumor, little Brianna was rushed to the hospital. When MRI revealed no tumor, a spreading infection, causing spinal fluid to leak from her ear, was discovered and treated.

Photo: MRI uses no X-rays, and the magneticfields MRI does use aren't known to be harmful. It can be used to monitor the success of treatment for disease. MRI is absolutely painless.

Photo: MRI is especially valuable for detecting brain and nervous system disorders. It can see through bone and clearly defines soft tissue. Multiple sclerosis can now be detected in its earliest stages. MRI can see into the heart and blood vessels. It can detect cancer of the ovaries, uterus, prostate, liver, pancreas, bladder, kidneys, vocal cords, and more.

Photo: What "Stars Wars' technology is to ournational defense, the Magnetic Resonance Imaging device is to the body's defense against inexplicable afflictions. The data obtained from this modern medical miracle will give surgeons much needed information prior to surgery, facilitating more accurate and precise procedures.
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Title Annotation:magnetic resonance imaging
Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Mar 1, 1987
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