Obtaining Informed Consent in Bangladesh

In the Clinical Problem-Solving article by Lurie et al. (Sept.7 issue), 1 the authors describe an 80-yearold man with unexplained back pain, an elevated erythrocyte sedimentation rate, plain films that showed only degenerative changes, and normal findings on neurologic evaluation.I believe magnetic resonance imaging (MRI) with gadolinium should have been performed before computed tomographic (CT) myelography was performed.CT myelography is invasive and expensive, and it does not provide nearly the range of diagnostic information provided by MRI.As the discussant stated, the differential diagnosis in this case included chronic infection, a metastatic tumor, vasculitis, and multiple myeloma.MRI with gadolinium could have led to the diagnosis of all these conditions except vasculitis, whereas CT myelography would not have been diagnostic of these…