What Do My Lab Test Reports Indicate?

Posted on Sun, 15 Oct 2017

Question: Hello,

I am trying to decide whether to go ahead with a scheduled MRI
of the abdomen or not. The reason for my hesitancy is that I'm
afraid of it detecting some kind of 'false positive' or questionable
finding that may need a biopsy to determine whether it's cancerous
or benign. A similar thing happened to me a few years ago with
a ct scan of the lungs: it showed some small 'nodules'. One doctor
thought it might be TB, another one speculated it might be asbestos
related. It was finally determined to be just 'scarring'. But the whole
ordeal caused extreme anxiety and took quite a toll on my health.
I don't want to go through that again.

Also, the MRI was only ordered to settle some ambiguity in the wording
of a recent Ultrasound report(ie. it indicated in the summary that my
pancreas was unremarkable,but the details section said 'dilatated
pancreatic duct'). So the doctor had the MRI to get clarity on this, as he
was not able to reach the radiologist who produced the report. Several
days later, the radiologist got back to him and said the text above was
a typo, and that the test showed a perfectly normal pancreas. The doctor
who ordered the MRI then asked if I'd like him to cancel it. I said no at
the time.

I realize an ultrasound is not as good as an MRI, but I hear it's pretty
good, especially for imaging the liver. And it was done only a few months ago.
Attached is a copy along with some blood work.

I should add that I've been steadily losing weight over the years(my health
went downhill suddenly about 5 years ago after a bad experience with beta blockers).
I'm down to about 130 pounds at a height of 5' 11''. Part of the reason is that food
intolerances have forced me to follow a very restricted diet(mostly vegetables and
a little meat), but still this weight loss is concerning.

So my questions to you are:
1) how often do questionable findings occur with
an abdominal MRI, and how are they usually resolved(eg. biopsy)?

2) do you think an MRI is urgently warranted given all of the above
(normal Ultrasound except for fatty liver, unexplained weight loss,
and risks of questionable results)?

Thanks so much! I hope you can help solve this dilemma for me.

Best regards,
XXXXXXX

Answered by Dr. Ramesh Kumar (57 minutes later)

Brief Answer:
No further investigation required.

Detailed Answer:
Hello XXXXXXX
Have gone through your details and i can very well appreciate the level of frustration you must be feeling.

Answer 1-MRI uses water molecule.Water molecules are splitted in presence of very strong magnetic field therefore the reports are almost 99.9% accurate.Positron emmission test is the only available test more sensitive then MRI.
When there is an abnormal growth in a particular area blood supply to that area increases leading to increase in water contents of the area.So MRI is a very specific test.
But in case of pancreas ERCP is done further.

No MRI is not at all required.Mild fatty liver is a normal finding after age of 30.Your usg is fully normal.Nothing else is required.

Hope i am helpful.
Thanks!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ramesh Kumar (9 hours later)

Hello Dr XXXXXXX and thanks for your reply.

Regarding your answer to my first question: would something benign
like a cyst be interpreted as an 'abnormal growth' on an MRI? And
does that kind of finding usually lead to other tests(eg. ERCP or biopsy)?
My concern is they may find something that turns out to be perfectly
benign, but I end up taking one of these invasive tests and suffer physical
damage as a result.

Regarding your answer to my second question: I'm very glad to hear you don't
think an MRI is required, But I want to make sure of one thing: does my Ultrasound provide pretty solid evidence that I don't have cancer in the liver or pancreas?

Answered by Dr. Ramesh Kumar (6 hours later)

Brief Answer:
Follow up answer.

Detailed Answer:
Hello dear,
Yes definitely a cyst would appear as a abnormal growth on a MRI.

No whether to go for further tests like biopsy depends on intensity of images formed size of mass,Depending on the results the doctor could opt for another scan 3-6 months apart to see if thee is growth or spreading involved(malignant masses grow fast).

See dear and ultrasound is a preliminary examination which is almost 80% sensitive to rule out any abdominal problem however as it is a manual test results depends on the quality of machine,The quality of images technician is capturing and their interpretation by radiologist.

However specifically taking about pancreas CT abdomen should be done. Usg is not that reliable when it comes to pancreas.

So if you want a 100% clearance go for a MRI scan otherwise UAG is 80-85% sensitive test.

Regards.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Ramesh Kumar (8 hours later)

Hello and thanks again.

Finally, just to home in the key question for me:
how common would you say it is that 'benign'
findings requiring a followup test like a biopsy
occur with an abdominal MRI?

I'd like to take the MRI to get a definite answer, but
on the other hand I'm afraid it may actually raise more
questions than it answers(which happened to me with a ct scan
of the lungs a few years ago). Do you think this is
a valid concern, or is it very uncommon for such
ambiguous findings to occur?

Thanks so much,
XXXXXXX

Answered by Dr. Ramesh Kumar (39 minutes later)

Brief Answer:
follow up.

Detailed Answer:
Hi dear,No i don't feel thats a valid concern.
Sole role of every investigation in medical science is too rule out any possibikity of disease as early as possible.Having some problem inside you nd not investigating it won't help.
So if there is a problem with MRI report then depending on the nature of problem whether benign or malignant further course of action would be decided.

However in clinical practice about 20-30% cases may require further investigations.

Thanks!

Above answer was peer-reviewed by : Dr. Prasad