How to instruct the radiologist to look for occult hernia in the MRI?

[itac]

Hello,

Following up on my introductory thread:
https://www.medhelp.org/posts/Gastroenterology/What-can-cause-lower-abdominal-pain-triggered-by-certain-physical-movements/show/3048113

This study made by Dr Towfigh:
https://jamanetwork.com/journals/jamasurgery/fullarticle/1893806

Mentions the treatment algorithm:
https://cdn.jamanetwork.com/ama/content_public/journal/surg/930960/soi140032f3.png?Expires=2147483647&Signature=0-tVhc7RyJmPM-CNZfzcHb-7mCI64qUVrKuQOjZ2qtcpwiUa2sx28nVCIlkBONsi5wxP4f5G1I~x2TK54TTnuWTvRVN5UGpfSAXWFS0zckmiD5qsJzaJHvKFILWm-vNMP~QyqubCkXw65~GBCEmw0l9WxSyUy~gcbmX-LHzyfvzYa28HLap-~~Fl7Fu931h~NcD8PC-r53k-GjhKijQ5VQrD0Mwgp-N9T1vWX-n0QXznvMyzr9kciox5fSbZazpCRNztlNm7G-UFFi9Tmm78IMvVlQhUeMQFmhG1G6N-gOW~nZwW8XPm3cWEwR0IA58g3aYtY8qISE2CiNKQxOt55g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

I'm currently at the MRI stage:

High clinical suspicion for inguinal hernia => Nondiagnostic examination (possible hidden hernia?) => Ultrasonography or CT => Negative => MRI

So I got an MRI scheduled on Saturday:

*MRI Abdomen with and without contrast
*MRI Pelvis with and without contrast

Is MRI of the abdominal and pelvis should be enough to diagnose a hidden hernia? Because the study mentions groin pain, so I wonder if I also need a separate MRI of the groin or it's already included in the MRI of the pelvis?

Study mentions that a hidden hernia can be missed by a CT scan:
https://cdn.jamanetwork.com/ama/content_public/journal/surg/930960/soi140032f1.png?Expires=2147483647&Signature=fLYlRcgoFhc4nuIuS6il8hd5KO5rG2XEwRntgwFm2yHVDVdXmzB8IGGqy~6~mxWx7G5urq6O~Ge5WBRRy2p8vcPinBowFpwGsfEfmVn8hf38Ct9L8~7HKK2OdMv2EIrxp9G~yoGLUbmsjECrcqqxGyp6whd8Nhjf1UVBrtbLelxzutTbEjhPAnb7dOXJSF-XpFx-31ovFUNZ8Pavk~hdQBTaV7lHnBa5WUpx8Ftq1gEZ~Fmn5mlL95WYeWKjwlxDsWycr0iAH7pIWd6lG9EDFKZS5~0Vh60YYC-ndvWg-GfiyYSbofV1CT5LQml3oID7Sq3ENM4CicVoVr3CW~CVrA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

"Nondiagnostic Computed Tomography (CT)

Axial CT through the pelvis is nondiagnostic for an operatively confirmed right inguinal hernia."

But can be seen by an MRI:
 https://cdn.jamanetwork.com/ama/content_public/journal/surg/930960/soi140032f2.png?Expires=2147483647&Signature=37hWTmwKTNpNYJhOaWDaHsMjTXYcfCP-lgbB-zL1TYocfS8Lnuj-v-uoiQEk~5EV5nEsKD8IuP~d95clG~ARydAcKF72PzZn7Y9CPKqJaPlNIJjUKg0~Oo51aALvcThfX4pfDqZn8wff9I~jiH-szGfNaF5n5fWwsLQkoE4AtrA97wKKoSiLCTujSyiTfaiIwdXy68orLYoNm9a8GoObik92cdVKAwwEQMjQsD7SyKdTnCv4A0nA3vvfwcn5p8XHcqLKdsr9-w~uYiDN8klVhvNmQiYeZfpwpnpyb1fWjF96Gc7qLmhskKxSiYgq8axw-sjk-2eiVrXNkl9DMbsJsQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

"Diagnostic Magnetic Resonance Imaging (MRI)

Axial (A), sagittal (B), and coronal (C) T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI through the pelvis in the same patient reveals right inguinal hernia (arrowheads)."

So should I show the radiologist this study, and ask him to try to make a similar angle shot as described here: "Axial (A), sagittal (B), and coronal (C) T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE) MRI through the pelvis in the same patient reveals right inguinal hernia (arrowheads)."?

Also, given that I didn't have pain when I got the ultrasound and CT scan, because I was keeping the pain at bay by avoiding physical activities that trigger it, should I activate the pain like a day before (i.e. by doing some physical activity like playing table tennis), so that way, when I come to do the test, they will able to find the source to the my pain? Perhaps by seeing some indirect sack of fluids generated by the hernia that only the MRI could see?

I really want to find a diagnosis to my pain that I've been experiencing for the last 4 months, and I think that communication with the radiologist is very important, so any advice would be appreciated.

​​​​​​​Thanks!

[CHIN_C]

You do not need to "activate" the pain the day before. If you want to accentuate the hernia during imaging, you can attempt a Valsalva maneuver (bear down, as if you are having a bowel movement without actually defecating).

[CHIN_C]

You are making this way more complicated than it needs to be. If you want to rule out inguinal hernia, this is easily seen on CT or MRI pelvis, no need for MRI abdomen. You do not need a special groin protocol; MRI pelvis includes this region by default. Prior to the scan, you can tell the technologist where your pain is and he/she can place a marker on the area of palpable abnormality so the interpreting radiologist will know to focus on this area when reviewing the images.

[specialmom]

These are good questions.  I know it is hard when it feels like a doctor is having a hard time diagnosing us correctly.  I guess if it helps you describe to them where the pain is and the intensity level, seeing it in action would help. Is the MRI this Saturday or last?

[itac]

Thank you. I was able to get an MRI protocol that kinda describes what you mentioned. I’m still in the process of scheduling it, since I just got it, and found a place that can follow it.

[specialmom]

Oh good,  let me know what happens!