Pelvic MRI (without contrast)

What it is

This is a magnetic resonance scan of the region between the hip bones. MRI is the imaging test that reads soft tissue best, so a pelvic MRI is usually ordered when ultrasound or CT has already been done and has left something unsettled — the outline of a mass, the layer of the uterine wall a fibroid sits in, whether a shadow on the prostate is worth a second look, or whether a bone in the pelvic ring has a crack that a plain x-ray cannot show. The patient lies on a table that slides into the scanner, the machine is loud, and nothing is injected.

Why it is done

• To map fibroids in the uterus — how many, how big, and which layer of the wall they involve — before deciding how to treat them
• To look more closely at an ovarian or adnexal finding that ultrasound could not fully characterize
• To assess the prostate, the bladder wall, or the rectum when a rectal exam, a blood test, or another scan has raised a question
• To find a fracture or an area of bone bruising in the hip or sacrum that does not appear on plain films
• To look at the pelvic floor, the muscles, and congenital differences in pelvic anatomy

What to expect

Nothing is injected for this study, so there is no IV line and no kidney blood test beforehand. Metal has to come off and any implanted device has to be declared, because the magnet is always on. The scan usually runs somewhere between twenty and forty-five minutes, and the machine knocks and buzzes loudly the whole time — ear protection is standard. Patients are asked to hold still, and for some sequences to hold their breath. There is no recovery period and no sedation for a routine study. A radiologist reads the images afterward and sends a report, generally within a few days.

Questions worth asking

• Is the order written for a pelvic MRI without contrast, or with and without? Those are two different codes at two different prices, and the decision is often made before you arrive.
• If the radiologist decides partway through to add gadolinium, does the study get rebilled at the higher code, and will I be told before it happens?
• Is this being done in a hospital radiology department or at a freestanding imaging center? The same scan on the same machine model is often priced very differently between the two.
• Will I get a second bill from the radiologist who reads the images, and is that radiology group in my network even if the facility is?