Figure 12c. Lymph node metastasis in a 73-year-old man with prostate cancer. Viewer CT scans can also show the organs near the stomach, such as the liver, as well as lymph nodes and distant organs where cancer might have spread. (a) On a CT scan, a soft-tissue metastasis in the left paraspinal muscles (arrow) is inconspicuous due to its similar attenuation to that of muscle. In a person with colorectal cancer, a CT scan can check for the spread of cancer to the lungs, liver, and other organs. So far everything is clear. Perhaps the best example is the effect that combination chemotherapies have on the liver in patients being treated for breast cancer (,20). The scan may have missed it but the treatment plan will most likely take it down. So, with a normal CT scan, you can safely relax and this normal result is reassuring. The type of scroll function can be selected as “diagnostic quality” or “image navigation.” The image navigation display allows faster scrolling through an image set; however, it will cause blurring of the images and thus can make lesions less conspicuous. Lymphadenopathy in a 63-year-old woman with a history of lymphoma. how accurate is pet scan?" 5, Radiologic Clinics of North America, Vol. I believe that the cancer, which developed in such a stealth fashion in my patient, also hid from the radiologist. (b) On a nonenhanced image, it is difficult to distinguish the tumor (arrow) from the pelvic floor muscles. I don't think there were any mistakes in your brothers treatment. Paraspinal mass in a 76-year-old woman with a history of lymphoma and renal cell carcinoma. (b) On an image obtained at 6-month follow-up, the lesion is slightly increased in size (arrow) but is difficult to detect due to lack of oral and intravenous contrast material. PET scans are much better at pinpointing a Cancer and I confess to never having heard of a Meckel's scan. (a) On a CT scan, it is difficult to differentiate retrocaval lymphadenopathy (arrow) from the inferior vena cava. Soft-tissue mass in a 58-year-old man with bladder cancer who underwent cystectomy and creation of a neobladder. This can be avoided by using the diagnostic quality scroll function or paging through the images one at a time. : yes. As more and more therapeutic interventions are introduced, including focused radiofrequency and microwave ablation, readers must be aware of the expected imaging findings in their patients. Several problem areas have been described where lesions are most commonly overlooked. This occurs most commonly when two-dimensional or three-dimensional reformations are performed with some time delay after the initial image acquisition. Figure 8b. A positron emission tomography (PET) scan combined with a CT scan is a specialised imaging test. There may be a palpable mass either from the torsed ovary itself, the twisted vascular pedicle, or a mass that caused the torsion in the first place. Now I went for my recent check up and again issues. (a) On a CT scan, it is difficult to detect a small recurrent tumor (arrow) in the prostate bed. (b) Contrast-enhanced image shows some enhancement in the inferior aspect of the mass (arrow), which makes the mass more conspicuous.Download as PowerPointOpen in Image Guidelines for determination of lymph node enlargement are helpful to avoid reader variability. Gastrointestinal stromal tumors as well as lymphoma and melanoma may produce cavitary masses, and good bowel opacification may aid in their detection. (c) On an image obtained at 7-month follow-up, a second lesion (arrow) is visualized in segment 8. (a) On a CT scan, it is difficult to perceive a metastasis to the small bowel (arrow) owing to lack of oral contrast material and abnormal adjacent bowel loops with wall thickening and mural edema (arrowhead), which are … Tumor recurrence in an 83-year-old man with prostate cancer. Systematic viewing of all organs in a standardized sequence ensures that areas are not overlooked (,17). Colorectal cancer is the second-leading cause of cancer-related death in the U.S. Fortunately, it is preventable through proper screening. Figure 2b. (a) Nonenhanced CT scan shows a soft-tissue structure (arrow) adjacent to the esophagus. (b) On an image displayed with a liver window, the lesions (arrows) are better visualized.Download as PowerPointOpen in Image Or Irritible bowel syndrome? Figure 9b. However, these adjustments will increase the patient’s radiation dose. Viewer Figure 22a. Differentiation of early local tumor recurrence from postsurgical scarring is challenging and can often be achieved only in subsequent follow-up examinations. Specifically, the fibrotic response that these drugs produce in the liver causes features of cirrhosis with regenerative nodules that should not be mistaken for hepatic metastases. My tumors seem to grow inside the wall of the colon in such a way that the CT has a hard time seeing them. The content on this site is for informational purposes only. Oncology protocols most commonly use a section thickness of 5 mm when follow-up imaging is performed. (a) On a CT scan, mesenteric lymphadenopathy (arrow) is not recognizable due to suboptimal bowel opacification (arrowhead). (b) On an image displayed with a bone window, small sclerotic lesions (arrows) are seen in the lumbar spine, an appearance suggestive of metastatic disease. I am glad that he has a GI Doctor who pushed for further testing. CT findings were compared with histopathologic results as a reference standard. Awareness of these problem zones and dedicated analysis of these areas is recommended. Viewer. Criteria for the evaluation of lymphadenopathy are controversial, and varying assessments of lymph node status are the most common sources of differences in interpretation of oncologic CT scans, accounting for 52% of studies in which a discrepancy was found (,4). Torsion is the twisting of an organ around its blood supply. (a) On a CT scan, it is difficult to detect a small soft-tissue mass (arrow) at the anastomosis of the neobladder with the urethra. Viewer Our routine protocols use an automated triggering approach with region-of-interest placement over the hepatic parenchyma with an automatic trigger once the liver parenchyma reaches 50 HU (,13). CT scan. (a) On a CT scan, it is difficult to perceive a metastasis to the small bowel (arrow) owing to lack of oral contrast material and abnormal adjacent bowel loops with wall thickening and mural edema (arrowhead), which are likely due to ischemia. Viewer Large bowel mass in an 80-year-old woman with colon cancer. Care has to be taken when positioning the region of interest to avoid inadvertently placing this over a vessel or a focal liver lesion, which would alter study quality. Ovarian torsion presents with sharp lower abdominal pain/tenderness and adnexal tenderness on bimanual exam. If you can get a PET, I would...they may sometimes suggest things are worse than they are, but they don't usually miss things like apparently the CT can. CT scan shows a retrocrural metastasis (arrow), which is clearly depicted due to its differential enhancement from that of the diaphragmatic crus (arrowhead). Having you and friends and loved ones beside him as he starts this journey, will help him immensely. CT scan shows slight bulging of the crura bilaterally (arrows) with tapering at the muscular attachments to the spine. (a) On a nonenhanced image displayed with a soft-tissue window, two liver metastases (arrows) are barely perceptible. If your CT was clear you can at the very least rule out a later stage of colon cancer. 6, American Journal of Roentgenology, Vol. Tumor recurrence in an 83-year-old man with prostate cancer. Identifying these lesions on CT performed for nonspecific symptoms can help identify interval CRC and improve patient outcome. Because the borders of a mass are better outlined on a contrast-enhanced scan, more accurate tumor measurements can be performed and evaluation for tumor response to treatment is improved. (a) On a CT scan, it is difficult to detect a small soft-tissue mass (arrow) at the anastomosis of the neobladder with the urethra. Figure 1d. Recognized pitfalls may result in findings being overcalled (false positive) or undercalled (false negative). Viewer Paraspinal metastasis in a 58-year-old man with renal cell carcinoma. This can be avoided by following the course of the structure throughout the mediastinum and establishing the connection with the aorta. No you're not alone in this. (c) On a delayed image obtained after satisfactory opacification of the bladder (arrowhead), the mass (arrow) is easily detected.Download as PowerPointOpen in Image The patient presented 11 months later with hematuria. Thus, ergonomics in the reading environment have become increasingly important. The soft-tissue structure could be mistaken for mediastinal lymphadenopathy. Errors in oncologic CT can be reduced by means of standardized imaging protocols that use intravenous and oral contrast material. My point here for patients is that scans are imperfect. With its combined anatomic and physiologic capabilities, fluorodeoxyglucose positron emission tomography (PET)/CT is commonly used for tumor staging. "can a pet scan miss cancer? In many situations, the benefit of a CT scan greatly outweighs the risk. Some fear that the ionizing radiation emitted from CT scans can harm DNA and cause tumors. It is one of the tests that doctors use to learn how extensive your colon cancer is – known as staging and grading cancer. The short answer is no, PET-CT scans are not suitable substitutes for mammograms. (a) On a CT scan, it is difficult to detect a metastasis to the descending colon (arrow) owing to lack of oral contrast material (arrowhead). Viewer CT scans can also be used to guide needles into tumors for some types of cancer treatments, such as radiofrequency ablation (RFA), which uses heat to destroy a tumor. Figure 11b. Figure 14b. A colonoscopy needs to be done. We are meeting with an oncologist on Friday. Liver metastases in a 76-year-old woman with renal cell carcinoma. (c) On a contrast-enhanced image, the lesion (arrow) is easily identified. Figure 14a. Viewer. (b) On an image obtained at 2-month follow-up, the mass (arrow) is easily distinguished from the loops of small bowel (arrowhead), which are now well opacified with oral contrast material. For certain malignancies, especially those likely to metastasize to the bowel, complete opacification of the gastrointestinal tract is desirable because metastases to the small bowel (,Fig 6,) and large bowel (,Figs 7,, ,8,) are difficult to detect, especially if the bowel is not distended (,Fig 7,). Buyer beware. Small bowel metastasis in a 53-year-old woman with colon cancer. Mesenteric lymphadenopathy in a 50-year-old man with a history of renal cell cancer. Large bowel mass in an 80-year-old woman with colon cancer. Figure 4a. Bone scan: If you are experiencing bone pain or blood tests reveal elevated calcium levels, your radiation oncologist may perform a bone scan to detect whether liver cancer has spread to the bone. But, it’s very important to tell your doctor and the technologist (the person who does the test) if you have any metal in your body. Our routine protocols are performed with 120 kVp and 320 mAs. Your doctor may recommend this investigation earlier if there are symptoms or if there is a positive family history. For staging protocols that require analysis of vascular invasion, thinner sections (down to 0.625 mm and depending on available CT scan technology) are required. The reader should also never forget that benign lesions may coexist with malignant tumors. The patient presented 11 months later with hematuria. Thank you! Before interpreting the results of a study, it is therefore helpful to confirm the status of an examination as completed and to double-check under the series directory that all standard reformations have been performed. The accuracy for non-vascular CRFs was 99.1%. (b) On a nonenhanced image, it is difficult to distinguish the tumor (arrow) from the pelvic floor muscles. However, more recent multicenter trials have reported changes in patient treatment in as many as 23% of patients due to discordant readings (,5). Note the subtle distortion of the muscle architecture in comparison with that on the other side. (b) On an image obtained at 6-month follow-up, the lesion is slightly increased in size (arrow) but is difficult to detect due to lack of oral and intravenous contrast material. A nodular appearance of this enhancement (arrow) should not be mistaken for metastatic disease. This was negative as well. Figure 20. Colonoscopy found a polyp in my appendix which after surgery was found to be cancerous. A change in patient treatment may affect outcome, whether this is positive or adverse. (a) On a CT scan, it is difficult to differentiate retrocaval lymphadenopathy (arrow) from the inferior vena cava. (b) On an image obtained at 2-month follow-up, the lesion (arrow) is slightly larger and more conspicuous due to rim enhancement.Download as PowerPointOpen in Image (b) On an image obtained at 9-month follow-up, the lesion (arrow) is more conspicuous due to an increase in size and slightly different attenuation from that of the vein.Download as PowerPointOpen in Image Figure 19a. But the risk associated with these tests is worth the benefit, in most cases. However, errors in the interpretation of oncologic computed tomographic (CT) scans can have significant effects on patient care. Figure 10b. (a) On a CT scan, it is difficult to detect a small soft-tissue mass (arrow) at the anastomosis of the neobladder with the urethra. (b) On an image obtained at 6-month follow-up, the lesion is slightly increased in size (arrow) but is difficult to detect due to lack of oral and intravenous contrast material. Polyps less than 6mm can be missed due to various factors. Clearly, discordant readings affect patient care and treatment. (b) Image obtained at 6-month follow-up shows some mass effect on the inferior vena cava (arrowhead), a finding that allows differentiation of the lymphadenopathy (arrow) from the normal anatomic structure. What a blessing! Only thing left to do was a colonoscopy which I was due for anyways. 57 years experience Endocrinology. 13, No. However, it can miss very early cancer and for this reason, after the age of 50, a colonoscopy is recommended. Figure 1c. In patients undergoing thermal ablative therapies, the larger coagulated zone should not be mistaken for an enlarging mass. I am so sorry that you have found yourself on this fourm, and yes, it is the right place for you to be posting. Sometimes a special dye called a contrast medium is given before the scan to provide better detail on the image. In addition, mesenteric lymphadenopathy (,Fig 9,) and omental masses can be mistaken for normal-sized unopacified bowel (,4). Aberrant subclavian artery mimicking mediastinal lymphadenopathy. (b) Image obtained at 6-month follow-up shows some mass effect on the inferior vena cava (arrowhead), a finding that allows differentiation of the lymphadenopathy (arrow) from the normal anatomic structure.Download as PowerPointOpen in Image Liver metastases in a 66-year-old woman with endometrial carcinoma. Figure 9a. Figure 3a. Dedicated bone windows (window width, 3000 HU; window level, 500 HU) are critical for the detection of osseous metastases. The preceding categories of errors may combine to produce interpretive errors. The list of patients was obtained from the tumor registry at Banner MD Anderson Cancer Center (Gilbert, AZ) from 1/1/2012 to 12/31/2015. Viewer Abdominal CT Scan and the Detection of Bladder Cancer “CT scan is able to detect large bladder irregularities, but not always small lesions,” says Dana Rice, MD, a board certified urologist and creator of the UTI Tracker mobile app , which helps patients catalog daily urinary tract symptoms, medication and behavioral patterns, and offers personalized tips for UTI prevention. Your doctor may recommend this investigation earlier if there … A CT scan of the pelvis may be used to measure how far a rectal tumour is from the anus. Hi All, my name is Carol and i have Cancer i found out 3 weeks ago today and i have had quite a few things done allready, Colon Cancer and i have so far had a CT scan, and am having another one tomorrow and then i have too have Radiothearapy every day for 5 day, then i have to have a Major Operation glad its all happing fast would just like to say good luck to you all. (a) CT scan shows normal heterogeneous enhancement of the spleen. When he went to get it removed, the pathology said that it was actually a carcinoid tumor and not a diverticulum. The evaluation of lymphadenopathy is the single most common source of interreader variability (,24). Figure 8b. The patient is placed on an examination table and the CT machine moves around his or her body taking images for study. Figure 12c. Tumor recurrence in an 83-year-old man with prostate cancer. Paraspinal metastasis in a 58-year-old man with renal cell carcinoma. Enter your email address below and we will send you the reset instructions. If something doesn't feel right, make noise until somebody pays attention. Large bowel metastasis in an 87-year-old woman with a history of colon cancer. (a) On a CT scan, it is difficult to detect a small recurrent tumor (arrow) in the prostate bed. Figure 1b. Paraspinal muscle metastasis in a 66-year-old man with a history of melanoma. Retrocaval lymphadenopathy in a 47-year-old man with lymphoma. Intravenous contrast material is invaluable in differentiating lymphadenopathy from poorly opacified or nonenhanced vessels (,Fig 2,). (a) On a CT scan, it is difficult to differentiate retrocaval lymphadenopathy (arrow) from the inferior vena cava. One criticism of the CT scans is that they cannot find small polyps (less than 5 mm in size) that are easily seen at colonoscopy. (a) On an image displayed with a soft-tissue window, it is impossible to detect bone metastases. (a) On a CT scan, it is difficult to differentiate left iliac lymphadenopathy (arrow) from the external iliac vein owing to their similar attenuation. (c) On a delayed image obtained after satisfactory opacification of the bladder (arrowhead), the mass (arrow) is easily detected.Download as PowerPointOpen in Image (b) Delayed image shows homogeneous enhancement of the splenic parenchyma (arrow), an appearance that confirms the presence of a pseudolesion. : yes. Yes, it does and it has become one of the key investigations in diagnosing colon pathologies. 3 CEA tests were done with the highest being 11 from my baseline of around 5. To try to detect recurrences as early as possible, people who have finished colorectal cancer treatment regularly return to their doctors for imaging tests (like CT or MRI scans) and a blood test to detect CEA, a substance that can indicate if cancer is growing. Learn your real cancer risk from these scans. Thus, tumor stability may be wrongly assigned to solid masses that are in fact becoming hypo- or even avascular with treatment. Nodular splenic enhancement. Interpreting the results of oncologic examinations is often challenging and time-consuming because many abnormalities are identified in the same examination and must be compared with the findings in previous studies. Trained abdominal radiologists from 2 centers performed a blinded review of CT scans obtained to locally stage proximal colon cancer according to previously defined prognostic groups, including T1/2, T3/4, N+, and extramural venous invasion. 8, No. Imaging evaluation of patients with cancer makes up a substantial volume of the workload in most hospital radiology departments (,1). Trained abdominal radiologists from 2 centers performed a blinded review of CT scans obtained to locally stage proximal colon cancer according to previously defined prognostic groups, including T1/2, T3/4, N+, and extramural venous invasion. Figure 16a. While studies are usually performed with oral and intravenous contrast material (including preliminary nonenhanced images in many cases), image acquisition after contrast material injection varies from arterially enhanced scans only to portal venous phase and delayed imaging or may include all series as part of a multiphase examination. Bechtold et al (,3) investigated errors in interpretation of abdominal CT scans and their causes. Figure 3a. (a) On a CT scan, it is difficult to differentiate retrocaval lymphadenopathy (arrow) from the diaphragmatic crus. 208, No. Nothing picked up on the CT or PET. (c) On an image obtained at 7-month follow-up, a second lesion (arrow) is visualized in segment 8.Download as PowerPointOpen in Image MRI also can help doctors plan cancer treatment, like surgery or radiation. (b) On a follow-up image obtained 10 months later, it is still difficult to detect the mass (arrow) owing to lack of opacification of the neobladder (arrowhead). (a) On a CT scan, a soft-tissue metastasis in the left paraspinal muscles (arrow) is inconspicuous due to its similar attenuation to that of muscle. (c) On a contrast-enhanced image, the lesion (arrow) is easily identified. Discordant interpretations of computed tomographic (CT) scans are common and have been reported in 31%–37% of cases (,2–,4). Figure 11b. The use of additional window settings, particularly in evaluating the liver (,Figs 10,, ,11,,) and bones (,Fig 12,,), is very helpful (,1). As examples, mouse-induced carpal tunnel syndrome, eye strain, and even musculoskeletal injuries due to repetitive stress are being encountered with increasing frequency. Image review on picture archiving and communication system (PACS) workstations is very helpful, in particular in differentiating metastases from tubular structures such as vessels or bowel. Just as we discussed in our previous post CT Scan detect stomach cancer, You may click it since our focus post is same. Two months ago, he started having very bad stomach pain and more darker blood in his stool. For example, unless delayed images are obtained, insufficient diagnostic or staging information can be provided about cholangiocarcinoma (,7). We have had several pass through our forum, and I personally have a friend who was diagnosed at 26, treated and is NED (no evidence of disease) for five years. The study was compliant with the health insurance portability and accountability act (HIPAA). Awareness of the spectrum of factors that contribute to misinterpretation of CT scans in oncology patients may improve the performance of the individual radiologist and ultimately translate into improved patient care. Aberrant subclavian artery mimicking mediastinal lymphadenopathy. or give clues that may warrant a dr to inspect further for cancer? In a September 10 article published in the Huffington Post, two radiologists, Dr. Joel Bortz and Dr. Joseph Lebovic, argue that CT colonography, or "virtual" colonoscopy, is superior to traditional colonoscopy for colon cancer screening. The patient presented 11 months later with hematuria. It thus facilitates the depiction of more tumor foci (,Fig 1,,,). He started to complain of apin about three months post-chemo. CTC scans are generally accurate at detecting cancer and large polyps. Retrocrural metastasis in a 55-year-old woman with ovarian carcinoma. However, it can show if cancer has spread to other organs or the lymphnodes- so in a way, in can help diagnose stage 3 or 4 colon cancer. Figure 6a. (b) On an image displayed with a liver window, the lesion (arrow) is more conspicuous. CT scans are not always the best for finding Cancer. A positron emission tomography (PET) scan combined with a CT scan is a specialised imaging test. Recently, the use of low-dose protocols has gained considerable attention. Lymph node metastasis in a 73-year-old man with prostate cancer. This includes the use of several different window settings and awareness of “blind spots,” which should be analyzed carefully. A nodular appearance of this enhancement (arrow) should not be mistaken for metastatic disease. Normal appearance of the diaphragmatic crura. (b) Delayed image shows homogeneous enhancement of the splenic parenchyma (arrow), an appearance that confirms the presence of a pseudolesion.Download as PowerPointOpen in Image (a) On a CT scan, it is difficult to discern a mass in the ascending colon (arrow) owing to lack of oral contrast material. Yes it can. (a) On a CT scan, it is difficult to differentiate left iliac lymphadenopathy (arrow) from the external iliac vein owing to their similar attenuation. Obturator muscle metastasis in a 47-year-old man with renal cell carcinoma. Answered on Mar … The evaluation of oncology patients represents a substantial volume of the workload in many radiology departments. (b) Contrast-enhanced image shows some enhancement in the inferior aspect of the mass (arrow), which makes the mass more conspicuous.Download as PowerPointOpen in Image Ovarian torsion presents with sharp lower abdominal pain/tenderness and adnexal tenderness on bimanual exam. Sadly there has been an increase in Colorectal Cancers in the younger generation. (a) On an image displayed with a soft-tissue window, it is impossible to detect bone metastases. (a) On an image displayed with a soft-tissue window, it is difficult to perceive a liver metastasis (arrow) in segment 2. Surprisingly, a number of factors did not influence the error rate, including simultaneous supervision of interventional procedures (,3), level of training of assigned resident physicians or fellows (,3), or tumor type (,4). Viewer A PET-CT scan is most commonly used after surgery to help find out where the cancer has spread to in the body or if the cancer has come back after treatment. CT scan shows a hypoattenuating lesion (arrow) adjacent to the falciform ligament. Figure 14a. (a) On a CT scan, a metastasis in a left iliac lymph node (arrow) is difficult to differentiate from a pelvic vein owing to their similar enhancement. Lymphadenopathy in a 34-year-old woman with renal cell carcinoma. Radiologists agreed that CT findings definite or suspicious for pancreatic cancer were present in 50% of the scans obtained 2–6 and 6–18 months before the diagnosis of pancreatic cancer (3/6 and 4/8 scans, respectively), but they noted such CT findings in only 7% (1/15) of the scans obtained more than 18 months before diagnosis. For anyways the histologic features of the structure throughout the mediastinum young ( brother... 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