Pelvic MRI (with contrast)

What it is

The pelvis packs a great deal into a small space — the uterus and ovaries or the prostate, the bladder, the rectum, the muscles of the pelvic floor and the ring of bone around them all. MRI reads that soft tissue better than any other scan, and adding gadolinium adds a second layer of information on top of the anatomy: which of those structures is drawing blood and which is not. That is how a nodule of living tumor is separated from the scar left behind by an earlier operation, how an abscess is told from a simple cyst by the bright rim around it, and how an implant of endometriosis is traced through tissue it has grown into. This code covers a study imaged after contrast. In practice many pelvic protocols acquire a plain set first and belong under the with-and-without code, so if this code is the one on your paperwork it is reasonable to ask which images were actually made.

Why it is done

• To characterize a pelvic mass by how it takes up dye, when an earlier ultrasound or CT stopped short of an answer
• To stage a cancer of a pelvic organ and to see whether it has reached the structures next to it
• To separate recurrent disease from scarring in someone treated with surgery or radiation
• To look for an abscess, a fistula or an area of infection, which typically shows a bright enhancing rim
• To map deep endometriosis or complex inflammatory disease where the extent matters more than the outline

What to expect

An IV line is placed in the arm or hand, and kidney function is usually checked before gadolinium is given. Some pelvic protocols also involve medication to quiet bowel movement, or instructions about how full the bladder should be — these come from the facility and vary by what is being looked at. Inside the scanner the demands are stillness and, for some sequences, holding a breath on command. A study with contrast commonly runs between forty-five minutes and an hour on the table. The injection is felt as a brief coolness up the arm. Afterward the IV is removed and there are no restrictions.

Questions worth asking

• Ask whether the order is for the pelvis alone or for the abdomen and pelvis together. Those are separate codes and both will appear on the bill.
• Ask which code the facility intends to bill. A pelvic MRI with contrast and one with and without contrast are priced differently, and the difference is simply whether a plain series was also run.
• Ask what the facility charges a self-pay patient for this study, and compare that figure against your remaining deductible before scheduling.
• If a bowel-quieting medication or an enema is part of the protocol, ask whether it is billed as a separate drug or supply charge.
• Ask how long the images stay available to you, and in what form, so a referral to a specialist center does not begin with a repeat scan.