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Measurement on CT Scans

sandy23
Posts: 143
Joined: Jan 2017

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's picture
icemantoo
Posts: 3362
Joined: Jan 2010

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
Posts: 143
Joined: Jan 2017

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's picture
Bay Area Guy
Posts: 522
Joined: Jun 2016

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.

sandy23
Posts: 143
Joined: Jan 2017

Do you remember what your CT scan measurements were?

Bay Area Guy's picture
Bay Area Guy
Posts: 522
Joined: Jun 2016

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.

DAC677's picture
DAC677
Posts: 60
Joined: Feb 2017

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.

Kat23502's picture
Kat23502
Posts: 179
Joined: Feb 2016

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.

sandy23
Posts: 143
Joined: Jan 2017

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

Kat23502's picture
Kat23502
Posts: 179
Joined: Feb 2016

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

sandy23
Posts: 143
Joined: Jan 2017

I still would have had to google it!!

sucotai
Posts: 19
Joined: Jan 2017

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

sandy23
Posts: 143
Joined: Jan 2017

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.  

Steve.Adam's picture
Steve.Adam
Posts: 463
Joined: Oct 2016

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
Posts: 143
Joined: Jan 2017

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's picture
Steve.Adam
Posts: 463
Joined: Oct 2016

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.

stub1969's picture
stub1969
Posts: 934
Joined: Jul 2016

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

Kat23502's picture
Kat23502
Posts: 179
Joined: Feb 2016

You're welcome!

todd121's picture
todd121
Posts: 1449
Joined: Dec 2012

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
Posts: 143
Joined: Jan 2017

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

todd121's picture
todd121
Posts: 1449
Joined: Dec 2012

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

DAC677's picture
DAC677
Posts: 60
Joined: Feb 2017

One thing to add is that most people dont relaize they have a right to every one of their medical records, from scans to bllodwork to path reports. you paid for it and its yours. some hosptials make getting it easy and in some cases its harder and you have to fill out a form with the medical records department. The trick is reading it correctly and thats why we need to experts. But if you want to see what they are reading or take it to another doctor or take it home and study so you can go back in to see the doc with some questions tee'd up thats your right. If your doc doesnt like answering all your questions then you need a new doc

todd121's picture
todd121
Posts: 1449
Joined: Dec 2012

I get copies of everything and take them home with me. Sometimes they won't release them until the doctor has seen them, but you have a right to them for sure. In the beginning, I even got copies of my CT scans. And I don't mean the test report/summary. I'd go and actually get the CD with the images on them. I don't do that anymore, but you can and do have a right to them. When you go get a second opinion, they are probably going to want you to have all the test results sent over.

Todd

sandy23
Posts: 143
Joined: Jan 2017

Moved this to new thread - sorry for posting in the wrong thread.

Ree_Maryland's picture
Ree_Maryland
Posts: 161
Joined: May 2014

Well I am on my third year of having my right kidney removed ,having MRI done and dreading the MRI .takes 1 hr and I do not do well with inclosed areas . So I take a valuim[ msp] one hr before tests. But I will be glad when it is done and my Dr reads the results April 5th. I am nervous. anxity is high right now . HOPE ALL IS WELL WITH THE FOLKS ON HERE , WISHING EA AND EVERYONE NED . 

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