Measurement on CT Scans

sandy23

Do any of you know if there is only one measurement on the printed report of the CT scan if that is the largest measurement?  Or where does that number come from?

I am asking because my husband had his presurgery physical today and the doctor said his back pain is from having a little arthritis.  He also had a chiropractor appointment today and the chiropractor asked for a copy so he could see the report on the arthritis.  The chiropractor showed me the reports.  His original CT scan in the middle of January shows the tumor at 7.3cm (which is larger than the 6cm that the original urologist had told us when he saw the CT scan, not sure why there is a difference).  The one he had last weekend at the ER (same hospital and equipment), shows it at 5.7cm.

He has been doing a special protocol that is supposed to help fight cancer naturally.  While I would love to believe that it is helping, that would be a heck of a reduction in such a short time.

Any insight is appreciated!!

icemantoo

CT Scan

Sandy.

 

My observation is as a layman so take it with a grain of salt. The CT measures 3d dimensions and variances do occur. A mm is such a tinylength. At 5.7-7.3 cm it is time to get it out.

 

 

Icemantoo

sandy23

icemantoo said:

CT Scan

Sandy.

 

My observation is as a layman so take it with a grain of salt. The CT measures 3d dimensions and variances do occur. A mm is such a tinylength. At 5.7-7.3 cm it is time to get it out.

 

 

Icemantoo

Yes, he is having it out on

Yes, he is having it out on the 6th.  I just am a worrier and was concerned about the 7.3cm measurement.  And also, why there is such difference.

Thanks icemantoo!!

Bay Area Guy

Measurements are sometimes as

Measurements are sometimes as much an art as a science, although I must say 1.6 cm is quite an artistic license.  But even with the same equipment at the same hospital, a different radiologist reading the report can cause some discrepancy in the measurements.  I could see a potential discrepancy if an ultrasound was give, but the test modes were the same.

when it's taken out, the path report will include all three dimensions.  Mine was something like 1.8 x 1.5 x 1.3.

Kat23502

Honestly it depends who looks

Honestly it depends who looks at the films. We don't put a measurement on the actual CT, that is something done post scan. One doctor may have included the margin, one may have included the surrounding portion of perinephroc fat. Also, these are thin slices so one may be measuring at a slightly different level. Masses aren't perfectly shaped so variances in measurement happen regularly in my field.

sucotai

Many things can change the

Many things can change the measurement: positioning of the patient, breathing, landmarking by the CT tech, choosing which slice/image to measure the tumor, choosing where the start/end is for the tumor etc. Basically anything/anyone from the machine to the patient to the operator to the radiologist can affect the measurement, which is why the ultimate measurement depends on the pathology report (although even that one is subjected to measurement error). It is hard to say whether the tumor actually shrank or it's just a measurement deviation. But either way, a couple important reminders if you haven't done so: 1) inform your doctor and pharmacist of the naturopathic treatment he's on, drug interaction is very common even when people think their treatment is "natural"; 2) do let naturopathy supplement the traditional treatment approach, but please don't ever let it become the main treatment without talking with a doctor

Steve.Adam

Differences

Hi Sandy,

My first ct scan from a local radiology clinic estimated the size as 4.5 x 4.5 x 5 cm.

The second scan, done at the hospital, had the size as 4.2 x 4.2 x 3 cm.

The pathology report says the actual tumour was 3.9 x 4.3 x 2.5 cm.

sandy23

sucotai said:

Many things can change the

Many things can change the measurement: positioning of the patient, breathing, landmarking by the CT tech, choosing which slice/image to measure the tumor, choosing where the start/end is for the tumor etc. Basically anything/anyone from the machine to the patient to the operator to the radiologist can affect the measurement, which is why the ultimate measurement depends on the pathology report (although even that one is subjected to measurement error). It is hard to say whether the tumor actually shrank or it's just a measurement deviation. But either way, a couple important reminders if you haven't done so: 1) inform your doctor and pharmacist of the naturopathic treatment he's on, drug interaction is very common even when people think their treatment is "natural"; 2) do let naturopathy supplement the traditional treatment approach, but please don't ever let it become the main treatment without talking with a doctor

Thank you so much for taking

Thank you so much for taking the time to give such a thorough answer.  I guess my concern is that something was misread somewhere as far as if it has spread anywhere else.  My mind tends to jump to farthest extremes in all situations.

Basically he is just juicing vegetables -- carrots, celery, beets and ginger.  He also cut out refined sugar and all junk food.  He isn't doing anything too out there, just diet changes.  

sandy23

Bay Area Guy said:

Measurements are sometimes as

Measurements are sometimes as much an art as a science, although I must say 1.6 cm is quite an artistic license.  But even with the same equipment at the same hospital, a different radiologist reading the report can cause some discrepancy in the measurements.  I could see a potential discrepancy if an ultrasound was give, but the test modes were the same.

when it's taken out, the path report will include all three dimensions.  Mine was something like 1.8 x 1.5 x 1.3.

Do you remember what your CT

Do you remember what your CT scan measurements were?

sandy23

Kat23502 said:

Honestly it depends who looks

Honestly it depends who looks at the films. We don't put a measurement on the actual CT, that is something done post scan. One doctor may have included the margin, one may have included the surrounding portion of perinephroc fat. Also, these are thin slices so one may be measuring at a slightly different level. Masses aren't perfectly shaped so variances in measurement happen regularly in my field.

Thanks Kat, that is very

Thanks Kat, that is very helpful!!  Although, admittedly, I had to google perinephroc fat to see where that is located exactly!!

sandy23

Steve.Adam said:

Differences

Hi Sandy,

My first ct scan from a local radiology clinic estimated the size as 4.5 x 4.5 x 5 cm.

The second scan, done at the hospital, had the size as 4.2 x 4.2 x 3 cm.

The pathology report says the actual tumour was 3.9 x 4.3 x 2.5 cm.

Hi Steve,

Hi Steve,

I was wondering what your's actually ended up measuring.  Just curious, why did they do a radical rather than partial?  I apologize if you already explained that in another post.

Steve.Adam

sandy23 said:

Hi Steve,

Hi Steve,

I was wondering what your's actually ended up measuring.  Just curious, why did they do a radical rather than partial?  I apologize if you already explained that in another post.

Radical

The reason was that a partial would have been difficult and only about a third of the kidney would have remained.  The tumour was on the lower lobe but growing in to the area where the ureter attaches.

I would have preferred a partial at the time but now I don't mind the whole thing being gone because the whole tumour is gone too.

DAC677

Bay Area Guy said:

Measurements are sometimes as

Measurements are sometimes as much an art as a science, although I must say 1.6 cm is quite an artistic license.  But even with the same equipment at the same hospital, a different radiologist reading the report can cause some discrepancy in the measurements.  I could see a potential discrepancy if an ultrasound was give, but the test modes were the same.

when it's taken out, the path report will include all three dimensions.  Mine was something like 1.8 x 1.5 x 1.3.

CT measurement

As you said we are all just giving our opinion based on experience.

I did ask some people the exact same question. My tumor was measured from 9.9 to almost 11 CM's on different scans. When they got it out and did the path report it turned out to be 9.5 CM. The entire mass kidney included was larger. I asked about it and was told that the scans are pretty darn close but they way your body is facing or the tumor inside you is facing or even the difference in the way different docs read and measure the scan and many small factors in the difference from one scan to the next can make the picture look just a little different. I wouldnt expect drastic differences but i think some are to be expected.

Bay Area Guy

sandy23 said:

Do you remember what your CT

Do you remember what your CT scan measurements were?

My first CT scan was in

My first CT scan was in December, 2013, and at that time, they reported it as 1.5cm.  Just the one dimension.  Subseuqent measurements by other hospitals and by other modes (I had both CT and ultrasound) either showed roughly the same measurement in the case of the CT (1.5 or 1.6 cm) or, in the case of the ultrasound, it didn't show any lesion at all.  My urologist came in after the US and exclaimed "It's a miracle!" in a loud booming voice all up and down the hallway and after we both had a laugh, he said I would need to get a CT instead.  That's when he told me that measurements are as much an art as a science.

Kat23502

sandy23 said:

Thanks Kat, that is very

Thanks Kat, that is very helpful!!  Although, admittedly, I had to google perinephroc fat to see where that is located exactly!!

I actually had a typo! Should

I actually had a typo! Should have said perinephric, around the kidney:)

sandy23

Kat23502 said:

I actually had a typo! Should

I actually had a typo! Should have said perinephric, around the kidney:)

I still would have had to

I still would have had to google it!!

stub1969

Kat's our expert

Sandy, my original scan indicated my tumor was larger than it actually was after they took it out.  I think the original measurement was at 6 cm and it measured 5.3 on the pathology report.   I'm glad we have a person to turn to for these type of questions.  Thanks again, Kat!

Stub

todd121

Measurement

First of all, tumors are not a uniform shape. They can be very, very oddly shaped. What is usually given is the maximum dimension. Secondly, CTs are quite blurry. It can be difficult to find the edges. I'd say the measurement you get from a scan is more like a gross estimate.

They won't know the real dimensions until they get it out, slice it up, and find all the edges/margins (where the tumor stops and healthy tissue starts) then you'll get worst case size in 3 dimensions.

The stuff they tell you off the scans are all guesses.

The pathology will tell you dimensions, staging (you have to know where the tumor grew into to know the difference between Stage 1/2 and 3, for example. The main difference between 1 and 2 is the size, but the main difference between 1/2 and 3 is whether it grew into any of the veins/arteries. These could even be internal veins/arteries in the kidney itself. Stage 4 really means other tumors outside the kidney have been found. Then there is the "grade", which is a measure of how abnormal the cells are. Grades go 1-4, 4 being the most abnormal and thus of most concern.

Of course, there's the type of cancer. They can't really tell this either without getting it out and looking under a microscope. You might get some preliminary information from a biopsy, but tumors may not be uniform in their grade either. Renal Cell Carcinoma is the one most of us have and clear cell type is the most common. But there are other cancers you can have in the kidney.

Hope it helps.

Regards,

Todd

sandy23

todd121 said:

Measurement

First of all, tumors are not a uniform shape. They can be very, very oddly shaped. What is usually given is the maximum dimension. Secondly, CTs are quite blurry. It can be difficult to find the edges. I'd say the measurement you get from a scan is more like a gross estimate.

They won't know the real dimensions until they get it out, slice it up, and find all the edges/margins (where the tumor stops and healthy tissue starts) then you'll get worst case size in 3 dimensions.

The stuff they tell you off the scans are all guesses.

The pathology will tell you dimensions, staging (you have to know where the tumor grew into to know the difference between Stage 1/2 and 3, for example. The main difference between 1 and 2 is the size, but the main difference between 1/2 and 3 is whether it grew into any of the veins/arteries. These could even be internal veins/arteries in the kidney itself. Stage 4 really means other tumors outside the kidney have been found. Then there is the "grade", which is a measure of how abnormal the cells are. Grades go 1-4, 4 being the most abnormal and thus of most concern.

Of course, there's the type of cancer. They can't really tell this either without getting it out and looking under a microscope. You might get some preliminary information from a biopsy, but tumors may not be uniform in their grade either. Renal Cell Carcinoma is the one most of us have and clear cell type is the most common. But there are other cancers you can have in the kidney.

Hope it helps.

Regards,

Todd

Thanks Todd, that was really

Thanks Todd, that was really helpful and informative.  I appreciate you taking the time to type that all out.

Kat23502

stub1969 said:

Kat's our expert

Sandy, my original scan indicated my tumor was larger than it actually was after they took it out.  I think the original measurement was at 6 cm and it measured 5.3 on the pathology report.   I'm glad we have a person to turn to for these type of questions.  Thanks again, Kat!

Stub

You're welcome!

You're welcome!

todd121

sandy23 said:

Thanks Todd, that was really

Thanks Todd, that was really helpful and informative.  I appreciate you taking the time to type that all out.

Glad to!

This information is very important, and they don't explain it to patients very well at all. I've even heard of patients not even being told the type of cancer they have (or even that they have cancer!). I wish they did a better job of educating us. At least we have this forum so we can help each other understand it better.

You tend to think of tumors as solid and maybe shaped like a sphere like a golf ball. Actually they can grow more like a plant/roots of a plant even. With some areas branching out from the main mass. If you think of it that way, it might help you to visualise it.

I had a lymph node last year that was identified as "growing" on the CT scan because twice in a row it had increased in dimension slightly. Then I saw a pulmonologist who pulled up a scan from 2 years ago and compared the current to the previous measurement and it was the same size. That's when I got to see how they measure it. The thing they are looking at is really, really blurry. The CT scan doesn't make a clear picture. They use something like an digital measuring tape and they drag it from one side to the next, and because it's so blurry, where they place the two sides can vary a great deal based on the person doing the measuring.

I can't tell you if the variation you saw is typical or if it tells you if the thing is shrinking, growing, or staying the same. Hopefully they will get it out soon and let you know what's going on and I hope it's all good news.

Best wishes,

Todd