Tailbone MRI Versus CT scan for Coccyx Pain

Which is better when evaluating tailbone pain (coccyx pain), an MRI or a CT scan?
  • CT scan can be very good at showing bone, but MRI can show not only bone but ALSO give good definition of soft tissue structures.
  • Some of the soft tissue structures that show up clearly on MRI include:
    • abscess (which is essentially an infection like a pocket/collection of pus)
    • pilonidal cyst
    • other fluid collections or areas of inflammation
    • soft tissue malignancies
    • other soft tissue masses [e.g., retrorectal hamartoma, which is a mass that happens behind the rectum and immediately in front of the sacrum and coccyx],
    • fluid/inflammation within the bones (e.g., due to osteomyelitis = bone infection, which can especially occur after bed sores [pressure ulcers] or surgical removal of the elbow and [coccygectomy].
  • MRI is more expensive than CT scan
    • so insurance companies usually require people/doctors to go through more hurdles to get an MRI rather than a CT scan.
  • Radiation risks:
    • Also, CT scans unfortunately deliver radiation to the patient, whereas MRI delivers no such radiation.
  • Either can be helpful:
    • For all these reasons, I generally prefer MRI instead of CT scans.
    • I do order CT scans sometimes, but usually it is in those where the MRI can not be done (due to metal in the patient that can prevent putting them in the MRI magnet), or if the MRI shows something that needs a different type of clarification, etc.

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