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Help with Brain MRI report from MD Anderson

Forums Mucosal Melanoma Community Help with Brain MRI report from MD Anderson

  • Post
    lrkg1234
    Participant

      We had a pretty crazy week at MD Anderson and not very good luck with our MRI, varying reports etc.  We still don't totally understand it and have had 3 opinions.  Please read below and let me know what you think. 

      We had a pretty crazy week at MD Anderson and not very good luck with our MRI, varying reports etc.  We still don't totally understand it and have had 3 opinions.  Please read below and let me know what you think. 

      First doctor Patel calls us and says there are several areas on the brain that look like tumors, not sure how many, maybe some are scar tissue. She says that the radiologist says there was no contrast, but there clearly was and that she had other doctors agree that saw contrast.  She begins to tell us about possible SRS or Whole brain radiation.  I asked if she remembered that Scott has already had both SRS and Whole brain radiation.  She had not remembered that so things would obviously be different now.  She was not sure then if she could possibly be looking at scar tissue from the previous treatment.  NOT comforting, or cool waiting for several more days for an explanation.  The scan was done on Sunday and we didn't have an amended written report until yesterday, after we were back home in Indy.  

       

      Here are the two reports, the preliminary and the amended. 

       

      Technique, MRI of the brain without IV contrast-diffusion, axial T2 and axial flair were included. 

      Findings:  There are areas of new T2 FLAIR hyperintensity in the left insula and bilateral left greater than the right anterior temporal lobes concerning for new foci of metastatic disease.  The previous enhancing lesions demonstrated are not well evaluated due to the noncontrast technique.  There is likely numerous enhancing lesions that have increased or that are new, however, cannot be evaluated due to noncontrast technique.  The orbital structures are unremarkable.  There There is no evidence for acute infarction.  The paranasal sinuses are clear.  There is mucosal thickening in the right mastoid air cells.  The left mastoid air cells are clear. 

      Impression.  LIkely other foci of metastatic disease, however cannot be seen due to current technicque.  MRI with contrast is recommended. 

       

      OK, then nothing else happens, no new MRI, just a change in report.  Here is the new ammended report. 

      ADDENDUM:

      It appears that the patient had IV contrast, which was not pushed over to PACS and given that now these images have been pushed over, it is noted theat the patient is status post IV contrast.  Multiple enhancing lsions as dtailed below:  then goes on to list a total of 7 lesions.  Some of these are new when compared with the prior. 

      So, my question is what is reality? 

      We got the disc yesterday in the mail and gave it to the radiation oncologist office here.  He calls my husband last night and says that it might not be so bad as 7 tumors, it might just be 2 and then treatment would be possible.  He is home with a busted knee until for a week and a half and says that we can deal with it then, or see someone else.  He does not believe it will make a difference in Scott's treatment to wait a week or so. 

      This is just craziness. I think they clearly screwed up the MRI at MD Anderson.  Bad news is hard enough to take, but it would be nice not to be told a few different things.  What does everyone think of these reports?  What does it exactly mean to "push" these images over? 

      Thanks for the help.  Lisa

    Viewing 11 reply threads
    • Replies
        MattF
        Participant

          Do you know if he got IV contrast?

          I have had a few MRI and always know when I get contrast because they pull you out of the tube and run an IV.

          MattF
          Participant

            Do you know if he got IV contrast?

            I have had a few MRI and always know when I get contrast because they pull you out of the tube and run an IV.

              lrkg1234
              Participant

                Hi,

                It was ordered to have IV contrast and I know that he had the IV put in his arm before the scan for that reason. 

                He is sleeping right now, so I can't ask him if he was ever pulled out of the tube for anything.  Should he have been?  Do you think that they forgot to do something involving the contrast? 

                This is where the whole problems is.

                lrkg1234
                Participant

                  Hi,

                  It was ordered to have IV contrast and I know that he had the IV put in his arm before the scan for that reason. 

                  He is sleeping right now, so I can't ask him if he was ever pulled out of the tube for anything.  Should he have been?  Do you think that they forgot to do something involving the contrast? 

                  This is where the whole problems is.

                  MattF
                  Participant

                    Well they did my MRI like this .

                    with and without contrast. 20 to 25 min in tube with out just the IV hanging in my arm…then they com in the room pull me out and start iv…takes about 60 sec.

                    then they put me back in tube and go for about 15 min

                    my reports come back as MRI done with and without contrast

                    your report seems to not really answer that question or address it.

                    1st part says without…..then an ammendment to say he had it…..it just reads funny.

                    if he got it…and you usually know if they squeez an iv or even a small syringe in your blood. then it may all be fine and just written up poorly

                    if he didnt then why is there an ammendment saying he did have it. and the images should "look" different with and without contrast so I would think someone would be able to tell.

                    MattF
                    Participant

                      Well they did my MRI like this .

                      with and without contrast. 20 to 25 min in tube with out just the IV hanging in my arm…then they com in the room pull me out and start iv…takes about 60 sec.

                      then they put me back in tube and go for about 15 min

                      my reports come back as MRI done with and without contrast

                      your report seems to not really answer that question or address it.

                      1st part says without…..then an ammendment to say he had it…..it just reads funny.

                      if he got it…and you usually know if they squeez an iv or even a small syringe in your blood. then it may all be fine and just written up poorly

                      if he didnt then why is there an ammendment saying he did have it. and the images should "look" different with and without contrast so I would think someone would be able to tell.

                      kylez
                      Participant

                        Matt, that's exactly how my MRIs go. I'm in the tube for awhile, then they pull me out and put in the contrast, then I'm back in the tube, then I'm done. About 40 minutes altogether, like yours.

                        kylez
                        Participant

                          Matt, that's exactly how my MRIs go. I'm in the tube for awhile, then they pull me out and put in the contrast, then I'm back in the tube, then I'm done. About 40 minutes altogether, like yours.

                          kylez
                          Participant

                            Matt, that's exactly how my MRIs go. I'm in the tube for awhile, then they pull me out and put in the contrast, then I'm back in the tube, then I'm done. About 40 minutes altogether, like yours.

                            MattF
                            Participant

                              Well they did my MRI like this .

                              with and without contrast. 20 to 25 min in tube with out just the IV hanging in my arm…then they com in the room pull me out and start iv…takes about 60 sec.

                              then they put me back in tube and go for about 15 min

                              my reports come back as MRI done with and without contrast

                              your report seems to not really answer that question or address it.

                              1st part says without…..then an ammendment to say he had it…..it just reads funny.

                              if he got it…and you usually know if they squeez an iv or even a small syringe in your blood. then it may all be fine and just written up poorly

                              if he didnt then why is there an ammendment saying he did have it. and the images should "look" different with and without contrast so I would think someone would be able to tell.

                              lrkg1234
                              Participant

                                Hi,

                                It was ordered to have IV contrast and I know that he had the IV put in his arm before the scan for that reason. 

                                He is sleeping right now, so I can't ask him if he was ever pulled out of the tube for anything.  Should he have been?  Do you think that they forgot to do something involving the contrast? 

                                This is where the whole problems is.

                              MattF
                              Participant

                                Do you know if he got IV contrast?

                                I have had a few MRI and always know when I get contrast because they pull you out of the tube and run an IV.

                                kylez
                                Participant

                                  As far as what is reality, PACS stands for Picture Archiving and Communication System. It's the repository where all the image scans end up after the scan, and it's also where the images are available to be accessed by radiologists and doctors afterwards — if I have that right. It sounds like you did get IV contrast (like you say, why else would you have an IV?), but somehow at first the only pictures available to the doctors from the PACS were without contrast, and then somehow the contrast pictures "turned up" later, or simply were combined later in the PACS ,with the non-contrast images. Based on that I would say the addendum is the more accurate reading, at least from MDA.

                                  FWIW that kind of mixup never happened during the 20+ MRIs I've had.

                                  Can't say how to resolve the differences in opinions between the different docs. Who has the most expertise and who do you trust the most? 

                                   

                                   

                                  kylez
                                  Participant

                                    As far as what is reality, PACS stands for Picture Archiving and Communication System. It's the repository where all the image scans end up after the scan, and it's also where the images are available to be accessed by radiologists and doctors afterwards — if I have that right. It sounds like you did get IV contrast (like you say, why else would you have an IV?), but somehow at first the only pictures available to the doctors from the PACS were without contrast, and then somehow the contrast pictures "turned up" later, or simply were combined later in the PACS ,with the non-contrast images. Based on that I would say the addendum is the more accurate reading, at least from MDA.

                                    FWIW that kind of mixup never happened during the 20+ MRIs I've had.

                                    Can't say how to resolve the differences in opinions between the different docs. Who has the most expertise and who do you trust the most? 

                                     

                                     

                                      lrkg1234
                                      Participant

                                        Thanks.  Knowing what PACS is helped.  He said that he did come out of the tube for the IV and everything was correct in that manner.  I guess the problem came when the doctor read the scans without contrast and then came upon the contrast scans at a later date for some reason. 

                                        Unfortunately the second amended scan is probably the accurate scan.  The problem will be how to treat 7 brain mets when you have already had whole brain radiation and SRS in the past.

                                        When he meets with the radiation oncologist here and does the treatment plan scan then we will know. 

                                        Does anyone know if they will go after 7 brain mets or say that radiation/gamma knife is out of the question???

                                        Very depressing stuff.

                                        Lisa

                                        lrkg1234
                                        Participant

                                          Thanks.  Knowing what PACS is helped.  He said that he did come out of the tube for the IV and everything was correct in that manner.  I guess the problem came when the doctor read the scans without contrast and then came upon the contrast scans at a later date for some reason. 

                                          Unfortunately the second amended scan is probably the accurate scan.  The problem will be how to treat 7 brain mets when you have already had whole brain radiation and SRS in the past.

                                          When he meets with the radiation oncologist here and does the treatment plan scan then we will know. 

                                          Does anyone know if they will go after 7 brain mets or say that radiation/gamma knife is out of the question???

                                          Very depressing stuff.

                                          Lisa

                                          lrkg1234
                                          Participant

                                            Thanks.  Knowing what PACS is helped.  He said that he did come out of the tube for the IV and everything was correct in that manner.  I guess the problem came when the doctor read the scans without contrast and then came upon the contrast scans at a later date for some reason. 

                                            Unfortunately the second amended scan is probably the accurate scan.  The problem will be how to treat 7 brain mets when you have already had whole brain radiation and SRS in the past.

                                            When he meets with the radiation oncologist here and does the treatment plan scan then we will know. 

                                            Does anyone know if they will go after 7 brain mets or say that radiation/gamma knife is out of the question???

                                            Very depressing stuff.

                                            Lisa

                                            kylez
                                            Participant

                                              Lisa,
                                              I've read of people having many more than 7 brain mets treated with gamma knife. The limit for Gamma Knife, I've heard, is the total volume of all the mets combined, not the number. Also I believe he can still have SRS after all the radiation he's had, but not WBR a second time. 

                                              It sounds like none are large enough for them to be talking craniotomy (I've had 2 of those). Per what I just read on another bulletin board, radiation still is the standard of care for brain mets.  Also to combining or follow radiation with some promising systemic therapy could have potential benefit (at least as a percentage play).

                                              Sorry he's going through this, and you too. Best wishes, and jointly developing a good treatment plan when you next meet with his oncologist.
                                              – Kyle

                                              kylez
                                              Participant

                                                Lisa,
                                                I've read of people having many more than 7 brain mets treated with gamma knife. The limit for Gamma Knife, I've heard, is the total volume of all the mets combined, not the number. Also I believe he can still have SRS after all the radiation he's had, but not WBR a second time. 

                                                It sounds like none are large enough for them to be talking craniotomy (I've had 2 of those). Per what I just read on another bulletin board, radiation still is the standard of care for brain mets.  Also to combining or follow radiation with some promising systemic therapy could have potential benefit (at least as a percentage play).

                                                Sorry he's going through this, and you too. Best wishes, and jointly developing a good treatment plan when you next meet with his oncologist.
                                                – Kyle

                                                kylez
                                                Participant

                                                  Lisa,
                                                  I've read of people having many more than 7 brain mets treated with gamma knife. The limit for Gamma Knife, I've heard, is the total volume of all the mets combined, not the number. Also I believe he can still have SRS after all the radiation he's had, but not WBR a second time. 

                                                  It sounds like none are large enough for them to be talking craniotomy (I've had 2 of those). Per what I just read on another bulletin board, radiation still is the standard of care for brain mets.  Also to combining or follow radiation with some promising systemic therapy could have potential benefit (at least as a percentage play).

                                                  Sorry he's going through this, and you too. Best wishes, and jointly developing a good treatment plan when you next meet with his oncologist.
                                                  – Kyle

                                                kylez
                                                Participant

                                                  As far as what is reality, PACS stands for Picture Archiving and Communication System. It's the repository where all the image scans end up after the scan, and it's also where the images are available to be accessed by radiologists and doctors afterwards — if I have that right. It sounds like you did get IV contrast (like you say, why else would you have an IV?), but somehow at first the only pictures available to the doctors from the PACS were without contrast, and then somehow the contrast pictures "turned up" later, or simply were combined later in the PACS ,with the non-contrast images. Based on that I would say the addendum is the more accurate reading, at least from MDA.

                                                  FWIW that kind of mixup never happened during the 20+ MRIs I've had.

                                                  Can't say how to resolve the differences in opinions between the different docs. Who has the most expertise and who do you trust the most? 

                                                   

                                                   

                                                  tasjacques
                                                  Participant
                                                    Hi Lisa,
                                                    It’s very stressful what you and your husband are going thru. We got some mix reports as well, and its pretty upsetting.
                                                    Just to clarify some things about the report…”these images have been pushed over…’ Means the images with contrast were sent to the reading system at a later time than when the reader read the first set of images.
                                                    As for the questionable new lesions, I would ask your oncologist at MD anderson for a review of the images by another radiologist, or your local docs for a second opinion.
                                                    As you I wish the CT scan reports were more standard…my husband vary so much we don’t know if his tumors are really in cm or mm….big difference ๐Ÿ™
                                                    Take care … I’ll be praying for you and your husband.
                                                    tasjacques
                                                    Participant
                                                      Hi Lisa,
                                                      It’s very stressful what you and your husband are going thru. We got some mix reports as well, and its pretty upsetting.
                                                      Just to clarify some things about the report…”these images have been pushed over…’ Means the images with contrast were sent to the reading system at a later time than when the reader read the first set of images.
                                                      As for the questionable new lesions, I would ask your oncologist at MD anderson for a review of the images by another radiologist, or your local docs for a second opinion.
                                                      As you I wish the CT scan reports were more standard…my husband vary so much we don’t know if his tumors are really in cm or mm….big difference ๐Ÿ™
                                                      Take care … I’ll be praying for you and your husband.
                                                        lrkg1234
                                                        Participant

                                                          I have no idea about whether the measurements are in mm or cm.  Obviously a huge difference.  I didn't know that the max treatment with radiation is more related to the total area of the brain mets rather than the number.   That's a big factor in this too.  It will be about a week or so before we know more.  It's so hard to wait and so hard not to be able to control things.  This disease sure teaches you a lot of life lessons. We have had enough life lessons.  How about just a freaking break???

                                                          lrkg1234
                                                          Participant

                                                            I have no idea about whether the measurements are in mm or cm.  Obviously a huge difference.  I didn't know that the max treatment with radiation is more related to the total area of the brain mets rather than the number.   That's a big factor in this too.  It will be about a week or so before we know more.  It's so hard to wait and so hard not to be able to control things.  This disease sure teaches you a lot of life lessons. We have had enough life lessons.  How about just a freaking break???

                                                            lrkg1234
                                                            Participant

                                                              I have no idea about whether the measurements are in mm or cm.  Obviously a huge difference.  I didn't know that the max treatment with radiation is more related to the total area of the brain mets rather than the number.   That's a big factor in this too.  It will be about a week or so before we know more.  It's so hard to wait and so hard not to be able to control things.  This disease sure teaches you a lot of life lessons. We have had enough life lessons.  How about just a freaking break???

                                                            tasjacques
                                                            Participant
                                                              Hi Lisa,
                                                              It’s very stressful what you and your husband are going thru. We got some mix reports as well, and its pretty upsetting.
                                                              Just to clarify some things about the report…”these images have been pushed over…’ Means the images with contrast were sent to the reading system at a later time than when the reader read the first set of images.
                                                              As for the questionable new lesions, I would ask your oncologist at MD anderson for a review of the images by another radiologist, or your local docs for a second opinion.
                                                              As you I wish the CT scan reports were more standard…my husband vary so much we don’t know if his tumors are really in cm or mm….big difference ๐Ÿ™
                                                              Take care … I’ll be praying for you and your husband.
                                                              aldakota22
                                                              Participant

                                                                Sorry that you have do go through this.Many times the scans sometimes pose more questions than answers.Been there myself. Many times it is a waiting game to get  answers.Worse is that you may not truly know  till next set of scans.Prayers sent your way that  you get the answers you are looking for . Beat the Beast.  Al

                                                                aldakota22
                                                                Participant

                                                                  Sorry that you have do go through this.Many times the scans sometimes pose more questions than answers.Been there myself. Many times it is a waiting game to get  answers.Worse is that you may not truly know  till next set of scans.Prayers sent your way that  you get the answers you are looking for . Beat the Beast.  Al

                                                                  aldakota22
                                                                  Participant

                                                                    Sorry that you have do go through this.Many times the scans sometimes pose more questions than answers.Been there myself. Many times it is a waiting game to get  answers.Worse is that you may not truly know  till next set of scans.Prayers sent your way that  you get the answers you are looking for . Beat the Beast.  Al

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