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What Do My Lab Test Reports Indicate?
Question: Hello,
Symptoms are:
--Shortness of Breath (3 months)
--Nail Clubbing (3.5 months)
I am concerned about lung malignancy. Mainly Bronchoalveolar Carcinoma worries me.
Below I have listed the relevant studies with Online Viewing links. Please let me know if I can get a reading and evaluation of these scans.
Thank you!
Relevant Symptom History: Shortness of breath, Coughing, Nail Clubbing for 3.5 months
Note: Everything to the right of the ">" symbol should be click-able as a URL Link
>>(12/22/16) CT Chest With Contrast (PE contrast XXXXXXX protocol) -- http://www.dicomlibrary.com/?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000
If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaeXAyWFZ4M2hGeEE
>>(12/02/16) Noncontrast CT Chest (Helical, with HRCT reformats also taken) -- http://www.dicomlibrary.com/meddream/index.php?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000
If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaR19FRUx2R2hJMkk
=======
1) The original radiologist had seen a geographic ground glass opacity on the Chest CT w/ Contrast. Can you please tell me if that GGO looks malignant? I am wondering about the following likely malignant characteristics...
--How large would you estimate it? Say 10 mm, 2 cm, etc.?
--Are the margins clear-cut or ill-defined?
--As for shape, is it nonpolygonal or is it polygonal?
--Is there any apparent radial growth?
--Is there any spiculation on the border?
--Is "bubble lucency" present?
2) Why was that Ground glass opacity (or any other abnormality) not seen on the Noncontrast Chest CT?
Both studies were done at roughly the same scan parameters, in supine position...only difference was use of contrast XXXXXXX
Symptoms are:
--Shortness of Breath (3 months)
--Nail Clubbing (3.5 months)
I am concerned about lung malignancy. Mainly Bronchoalveolar Carcinoma worries me.
Below I have listed the relevant studies with Online Viewing links. Please let me know if I can get a reading and evaluation of these scans.
Thank you!
Relevant Symptom History: Shortness of breath, Coughing, Nail Clubbing for 3.5 months
Note: Everything to the right of the ">" symbol should be click-able as a URL Link
>>(12/22/16) CT Chest With Contrast (PE contrast XXXXXXX protocol) -- http://www.dicomlibrary.com/?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000
If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaeXAyWFZ4M2hGeEE
>>(12/02/16) Noncontrast CT Chest (Helical, with HRCT reformats also taken) -- http://www.dicomlibrary.com/meddream/index.php?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000
If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaR19FRUx2R2hJMkk
=======
1) The original radiologist had seen a geographic ground glass opacity on the Chest CT w/ Contrast. Can you please tell me if that GGO looks malignant? I am wondering about the following likely malignant characteristics...
--How large would you estimate it? Say 10 mm, 2 cm, etc.?
--Are the margins clear-cut or ill-defined?
--As for shape, is it nonpolygonal or is it polygonal?
--Is there any apparent radial growth?
--Is there any spiculation on the border?
--Is "bubble lucency" present?
2) Why was that Ground glass opacity (or any other abnormality) not seen on the Noncontrast Chest CT?
Both studies were done at roughly the same scan parameters, in supine position...only difference was use of contrast XXXXXXX
Brief Answer:
It surely does not look malignant
Detailed Answer:
Hi Sir,
Thanks for writing in to us.
1. The GGO is surely not malignant from what is visualised.
The GGO which was told by the radiologist is diffise and the size is cannot be quantified with certainty.
Margins are not well defined.
It is non polygonal.
There is no radial growth.
There are no spiculations on the borders.
There is no bubbly lucency.
2. Thee is a subtle difference in techniques and that is the probable cause for the difference in results.
Regards,
It surely does not look malignant
Detailed Answer:
Hi Sir,
Thanks for writing in to us.
1. The GGO is surely not malignant from what is visualised.
The GGO which was told by the radiologist is diffise and the size is cannot be quantified with certainty.
Margins are not well defined.
It is non polygonal.
There is no radial growth.
There are no spiculations on the borders.
There is no bubbly lucency.
2. Thee is a subtle difference in techniques and that is the probable cause for the difference in results.
Regards,
Above answer was peer-reviewed by :
Dr. Kampana
Thank you doctor.
1) What is this subtle difference in techniques you had mentioned?
2) I have heard BronchoAlveolar carcinoma has a very wide range of presentation, and that one presentation can be a ground glass opacity. How do we know that this is/is not the case?
3) Can you tell me which series, slice, and location I can see this ground glass for myself?
1) What is this subtle difference in techniques you had mentioned?
2) I have heard BronchoAlveolar carcinoma has a very wide range of presentation, and that one presentation can be a ground glass opacity. How do we know that this is/is not the case?
3) Can you tell me which series, slice, and location I can see this ground glass for myself?
Brief Answer:
Images 78 to 84 series 2 for better understanding
Detailed Answer:
Hi,
Thanks for writing back with an update.
The techniques involve slice thickness, voltage of the xray and the image reconstruction. These are different when doing a non contrast CT for screening and when doing a pulmonary embolism contrast CT scan.
The haziness is there in other areas too and a typical bronchoalveolar carcinoma will show a more focused involvement in the beginning keeping in mind that your previous CT scan is normal.
Please view contrast CT scan chest images 78 to 84 series 2 for better understanding.
Regards,
Images 78 to 84 series 2 for better understanding
Detailed Answer:
Hi,
Thanks for writing back with an update.
The techniques involve slice thickness, voltage of the xray and the image reconstruction. These are different when doing a non contrast CT for screening and when doing a pulmonary embolism contrast CT scan.
The haziness is there in other areas too and a typical bronchoalveolar carcinoma will show a more focused involvement in the beginning keeping in mind that your previous CT scan is normal.
Please view contrast CT scan chest images 78 to 84 series 2 for better understanding.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doctor,
Thanks for the update.
--I would like to clarify that the pulmonologist who ordered the Noncontrast CT wanted to look at Interstitial Lung Disease, but also wanted to avoid the typical HRCT limitation of not covering the entire lungs. So he ordered High Resolution Helical to assess both interstitial lung disease and get good overall assessment of lungs.
I think Noncontrast parameters were: 2.5mm slice thickness. I am not sure about voltage, but I think it was above 100 kVp? Also was inspiratory.
On the other hand, the Contrast CT was 2mm slices at 90 kVp. The contrast CT machine did not ask for deep inhale.
--What differences are there between that type of Noncontrast scan described above and the Contrast CT for pulmonary embolism?
--I am not sure what to believe. Which scan do I trust?
Thanks for the update.
--I would like to clarify that the pulmonologist who ordered the Noncontrast CT wanted to look at Interstitial Lung Disease, but also wanted to avoid the typical HRCT limitation of not covering the entire lungs. So he ordered High Resolution Helical to assess both interstitial lung disease and get good overall assessment of lungs.
I think Noncontrast parameters were: 2.5mm slice thickness. I am not sure about voltage, but I think it was above 100 kVp? Also was inspiratory.
On the other hand, the Contrast CT was 2mm slices at 90 kVp. The contrast CT machine did not ask for deep inhale.
--What differences are there between that type of Noncontrast scan described above and the Contrast CT for pulmonary embolism?
--I am not sure what to believe. Which scan do I trust?
Brief Answer:
Trust your non contrast lung CT scan
Detailed Answer:
Hi,
Thanks for writing back with an update.
There are settings specific for every CT scan and these are different when looking for lung conditions and in a case of suspected pulmonary embolism. There is something called image kernel which makes an image grainy or smooth and this is based on image noise. For lung imaging we need a grainy image and for pulmonary embolism we require a smooth image. Therefor you see the differences technically.
I trust the non contrast lung CT scan for the lung findings. You can get a chest xray done right now and get any lung opacities ruled out.
Regards,
Trust your non contrast lung CT scan
Detailed Answer:
Hi,
Thanks for writing back with an update.
There are settings specific for every CT scan and these are different when looking for lung conditions and in a case of suspected pulmonary embolism. There is something called image kernel which makes an image grainy or smooth and this is based on image noise. For lung imaging we need a grainy image and for pulmonary embolism we require a smooth image. Therefor you see the differences technically.
I trust the non contrast lung CT scan for the lung findings. You can get a chest xray done right now and get any lung opacities ruled out.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doctor,
So I just checked to confirm parameters.
The Noncontrast CT was: 2.5 mm slice thickness @ 100 kVp
Contrast CT for PE was: 2.0 mm slice thickness @ 90 kVp
--I am still not understanding the kernel differences. So is the pulmonary embolism smooth kernel not as good at visualizing lungs themselves? And does the smooth kernel have greater propensity to show ground glass-esque findings?
--If we had to choose one scan to rule in/rule out ground glass finding (superior negative predictive value), shall we choose Contrast/Embolism CT or Noncontrast exam?
--How reliable is chest xray for ruling out opacities?
So I just checked to confirm parameters.
The Noncontrast CT was: 2.5 mm slice thickness @ 100 kVp
Contrast CT for PE was: 2.0 mm slice thickness @ 90 kVp
--I am still not understanding the kernel differences. So is the pulmonary embolism smooth kernel not as good at visualizing lungs themselves? And does the smooth kernel have greater propensity to show ground glass-esque findings?
--If we had to choose one scan to rule in/rule out ground glass finding (superior negative predictive value), shall we choose Contrast/Embolism CT or Noncontrast exam?
--How reliable is chest xray for ruling out opacities?
Brief Answer:
Chest xrays are excellent to rule out any aggressive lung conditions
Detailed Answer:
Hi Sir,
Thanks for writing back with an update.
There are numbers written as 20s, 30s, 50s, 70s and are representing the kernel or sharpness of the images.
To visualise the lung structures and bones we require a sharper kernel.
We need to keep in mind that during contrast scan there was no deep inhalation requested and this with the different kernel can cause the ground glass opacities.
If we had to choose one scan to rule in/rule out ground glass finding (superior negative predictive value), I will prefer your Noncontrast exam.
Chest xrays are preliminary investigations but they are excellent for follow up to rule out any aggressive lung conditions.
Regards,
Chest xrays are excellent to rule out any aggressive lung conditions
Detailed Answer:
Hi Sir,
Thanks for writing back with an update.
There are numbers written as 20s, 30s, 50s, 70s and are representing the kernel or sharpness of the images.
To visualise the lung structures and bones we require a sharper kernel.
We need to keep in mind that during contrast scan there was no deep inhalation requested and this with the different kernel can cause the ground glass opacities.
If we had to choose one scan to rule in/rule out ground glass finding (superior negative predictive value), I will prefer your Noncontrast exam.
Chest xrays are preliminary investigations but they are excellent for follow up to rule out any aggressive lung conditions.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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