Another look at scans in diagnosis


DEAR DR. ROACH: I read your response regarding CT versus MRI scans. I have severe pain in my right hip, on the outside, radiating to my right foot. It is a hot, burning pain, hampering activity. I saw an orthopedic surgeon, who X-rayed it and said it is not surgical. I have arthritis in my hip, but not bad enough for replacement. I would really like to know what the problem is, and I wonder whether an MRI would help in diagnosis. You mentioned in your answer that a CT is better at looking at bones, and MRI is better for soft tissue. I thought it was just the opposite, as MRIs seem to be ordered all the time for athletic injuries, while CTs look at the abdomen, etc. I just want to find out what is going on and how it can be treated. I did have an injection, which helped for maybe a month, but all is as bad as ever now. — A.A.

ANSWER: Athletic injuries can involve bones and soft tissues, and MRI scans show soft tissue, such as tendons and ligaments, very well. Actually, both MRI and CT can be used for many situations, and I stand by my previous advice that the advice of your own doctor or consulting radiologist may be necessary to choose the best test for you individually.

These scans show anatomy; that is, the form of the body’s structures. There are many things they can’t show. For example, a pain that is burning in character and radiates down the leg suggests a neuropathy — pain caused by damage to a nerve. Sometimes an MRI can show the cause of neuropathy, as in the case of a nerve compression by a herniated intervertebral disk. Other times, the MRI is normal with a damaged nerve.

Another possible cause is trochanteric bursitis, inflammation of the fluid-filled bursa over the outside of the hip. The pain is right over the point of the hip on the side, which usually is tender. Injection of this area provides short-term relief, but physical therapy often is necessary to treat the underlying cause.

DEAR DR. ROACH: About 10 months ago, my husband noticed a small “bleb” on the skin near his right hip area. He used ” tag away” and alcohol swabs daily; however, the area is a giant 2-inch-diameter “blotch” with an open sore in the middle. He insists that it is almost gone. I am afraid that it is skin cancer, very serious and that it needs to be checked out by a dermatologist. How do I get him to go? — P.K.F.

ANSWER: Please tell him that I think it sounds like it might be skin cancer, such as a squamous cell carcinoma, and that he should see a dermatologist immediately. Some people have an immense capacity for convincing themselves that nothing is wrong. The sooner he gets an evaluation, the better.


DR. ROACH WRITES: I get a lot of mail, for which I am grateful, but I can’t answer all of it, nor can I answer letters personally. I am more likely to address your question if it is short and of general interest. I also get a lot of feedback on my columns. I do read every letter that I am sent, and if many people tell me about a treatment I hadn’t mentioned, I am more likely to include it in a follow-up column.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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