4. “We are all X-men” series: 4. MRI imaging and scintigraphy: diving into
The following days were an attempt to make sense of the only evidence I had: a series of hard-do-interpret MRI images. I began by collecting publications about AN in general, AN and steroid use, AN and athletes and concluded that if that was actually what I had developed, then it was both idiopathic (with no evident cause) and asymptomatic (since I felt no pain). I searched AN MRI images wherever I could. Most were hips and femur head images. I found no shoulder AN image on the net. However, all AN MRI images I found were quite different from what I saw in my own shoulder image.
Next I decided to understand T2 contrast MRI imaging. I read something about the technique and started collecting images. I found one specific shoulder image that called my attention: http://www.mr-tip.com/serv1.php?type=img&img=Shoulder%20Sagittal%20T2%20FatSat%20FRFSE
On this image, the dark area was lighter than mine and the bone cortex thinner, but the overall pattern did not look much different. Fabiano had mentioned that strength athletes’ bone cortex was supposed to be thicker. It occurred to me that maybe the darker area on my MRI would be an analogous adaptation to function that could result in an increased absorption of contrast. Thus, a darker medular area.
I remembered that the previous week I had played with 200lb benching. If that dark area was an AN, then it was enormous and my humerus head would have collapsed under the weight.
I showed all this both to Fabiano (Rebouças), my orthopedist, and César (Fernandes), my obgyn. I trust very few physicians, especially concerning their lack of flexibility concerning the concept of “normality” and its application to clinics. For some reason, present medical education fails to get students to understand that “normality” is a statistical concept, not a physiological reality. That is why they must stay technically updated on advances in their field and use information as a tool to understand individual situations where billions of variables create uniqueness – not “normality”. Fabiano and Cesar are exceptions to this rule: they are both knowledgeable and critical.
Both tended to agree that we were looking at something on the line I was arguing, but Fabiano felt he needed to discuss this with other colleagues. We still had the scintigraphy to help clearing the case.
Friday, February 15, I checked in Delboni’s Sumaré unit. Delboni is a huge clinical laboratory facility in Brazil with many units scattered over the country. I have a special VIP treatment there because of my sports records, which is really cool: considering you must spend hours with nothing to do, having some nice treats makes all the difference. We get internet access, a nice living-room and (the best part) very nice snacks. If your tests do not require fasting, then you can spend the whole time eating and drinking, if you want (ok, you can disregard this comment, but I am permanently hungry and this is a salient feature for me).
Scintigraphy consists of the intra-venous administration of a radioisotope indicator which binds to bone tissue. The images recorded in different times reflect bone physiological activity. Images are recorded at zero time, five minutes and two hours.
I know I am good at what I do (retrive technical information) and I was confident that I was right concerning the MRI image interpretation. But “confident” is one thing, “certain” is quite another.
I must admit I was anxious to see the result, which would be ready the following day.
Don’t miss the next chapter on “the envelope”!
