(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. So I found myself an oncologist who sends me for pet/cat scans. Figure 12b. Figure 5a. “In this situation the ‘defect’ may be from many causes, i.e., blood clot, prostate tissues, ureterocele [benign congenital structural abnormality], bladder tumor and more. Soft-tissue mass in a 58-year-old man with bladder cancer who underwent cystectomy and creation of a neobladder. PET was ordered. However, both a stool test and blood test showed a loss of blood, so we scheduled him for another appointment with his GI. (d) Coronal reformatted image shows infiltration of the bladder (arrow).Download as PowerPointOpen in Image For example, unless delayed images are obtained, insufficient diagnostic or staging information can be provided about cholangiocarcinoma (,7). (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. Viewer The same is true with MRI. Now I went for my recent check up and again issues. 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. Similarly, the display of images from prior and recent studies on a two-monitor display has to be double-checked to establish the correct time course of disease and avoid misinterpretation. Figure 1b. Aberrant subclavian artery mimicking mediastinal lymphadenopathy. It thus facilitates the depiction of more tumor foci (,Fig 1,,,). Large bowel metastasis in an 87-year-old woman with a history of colon cancer. Re: The role of specialist neuroradiology second opinion reporting: is there added value? (a) On a CT scan, it is difficult to differentiate retrocaval lymphadenopathy (arrow) from the inferior vena cava. On a CT scan, it is difficult to detect a left paraspinal mass (arrow) owing to its similar attenuation to that of muscle. This was confirmed by Gollub et al (,2), who reported an actual change of treatment in 3%. Figure 17b. The two scans provide more detailed and accurate information about the cancer. Viewer As examples, mouse-induced carpal tunnel syndrome, eye strain, and even musculoskeletal injuries due to repetitive stress are being encountered with increasing frequency. One test is not harmful, but radiation builds up if you are exposed many times. Interpretation of the surgical field is generally more challenging because postsurgical changes lead to increased attenuation of soft tissues as well as anatomic distortion, which may arise from scarring, radiation therapy, surgical clips, and even orthopedic hardware. (a) On a CT scan, it is difficult to differentiate retrocaval lymphadenopathy (arrow) from the inferior vena cava. Figure 3b. CT scans and ultrasound may see the body differently, and sometimes one test may reveal a problem missed by another. I am glad that he has a GI Doctor who pushed for further testing. (b) Delayed image shows homogeneous enhancement of the splenic parenchyma (arrow), an appearance that confirms the presence of a pseudolesion. Figure 1c. (b) On a delayed image, the inferior vena cava (arrowhead) is well opacified and the lymphadenopathy (arrow) is more conspicuous. (b) On an image displayed with a liver window, the lesion (arrow) is more conspicuous. Large bowel metastasis in an 87-year-old woman with a history of colon cancer. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Figure 12c. Error and discrepancy in radiology: inevitable or avoidable? Lymph node metastasis in a 73-year-old man with prostate cancer. However, on a four-monitor system, images from CT examinations may be displayed in a nonstandard way and the display on each monitor has to be double-checked prior to interpretation of the study results. Colon cancer often develops from adenomatous polyps. A CT scan usually takes only a few minutes. Figure 8a. Intravenous contrast material is invaluable in differentiating lymphadenopathy from poorly opacified or nonenhanced vessels (,Fig 2,). Errors in oncologic CT can be reduced by means of standardized imaging protocols that use intravenous and oral contrast material. The lack of contrast material makes it difficult to distinguish the lesion from a fluid-filled bowel loop.Download as PowerPointOpen in Image Figure 8b. It is also possible that the immune system successfully fought off the primary cancer while the secondary cancer continues growing. Paraspinal muscle metastasis in a 66-year-old man with a history of melanoma. (b) On an image obtained at 2-month follow-up, the lesion (arrow) is easily demonstrated due to adequate bowel opacification.Download as PowerPointOpen in Image Symptoms of Colon Cancer that you should be … Small bowel metastasis in a 53-year-old woman with colon cancer. Follow the Stream: Imaging of Urinary Diversions, CT Findings in Urinary Diversion after Radical Cystectomy: Postsurgical Anatomy and Complications, The Lowdown on Lower GU: Lower Urinary Tract Neoplasms, Preoperative and Postoperative Imaging, FDG PET/CT Pitfalls in Gynecologic and Genitourinary Oncologic Imaging. (c) On a contrast-enhanced image, the lesion (arrow) is easily identified. Mesenteric lymphadenopathy in a 50-year-old man with a history of renal cell cancer. (b) On an image displayed with a liver window, the lesions (arrows) are better visualized. (c) On an image obtained at 7-month follow-up, a second lesion (arrow) is visualized in segment 8. If you have normal bloodwork, thyroid scan, CT scan but with lumps/nodes that you can feel, then I would consider seeing an otolaryngologist/ENT surgeon. This can be avoided by establishing the contiguous connection between the crus and adjacent lymph nodes that are separate from this structure. CT scans are not always the best for finding Cancer. Paraspinal metastasis in a 58-year-old man with renal cell carcinoma. Nodular splenic enhancement. Figure 19b. Large bowel mass in an 80-year-old woman with colon cancer. False identification of cancer did not occur with PET scans, but occurred at a rate of 27% in CT scans. Since CT Scan lab result is clearer and more detailed than X-ray examination. (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. Viewer A CT scan is an X-ray that uses a special kind of dye. (a) On a CT scan, it is difficult to discern a metastasis in the left obturator muscle (arrow). (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. (c) On an image obtained at 7-month follow-up, a second lesion (arrow) is visualized in segment 8.Download as PowerPointOpen in Image A CT is not the best test to diagnose colon cancer. With the dramatic increase in the number of CT images that are now acquired, the interpreting radiologist is becoming exposed to a variety of ergonomic stresses that did not exist in the days of hard copy image review. The injection rate for routine protocols is 2.5 mL/sec. Small bowel metastasis in a 53-year-old woman with colon cancer. “For instance, a CT scan may list or read a ‘filling defect’ which means contrast dye does not fill the bladder evenly. The Catscan had missed cancer on my diaphram! 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