Ultrasound Update

A year ago I had a routine u/s and they found 2 7mm lesions that appeared to be benign hemangiomas.  I had a follow up MRI and only one was visualized and it again, appeared to be hemangioma.  A u/s 6 months later showed it to be completely stable and the second one was still not visualized.

Last week, I had a follow up u/s shows that there are now THREE lesions.  The previous 2 are measuring 9mm and the third one is 8mm.  Again, they still give the appearance of hemangioma.

I'm a little alarmed.  Here's what the doc says:  the difference b/n 7mm and 9mm is within the margin of error for lesions that small and do not necessarily indicate growth.  The third lesion was probably there all along and just not visualized.  He and the radiologist want to follow up with ultrasound in 6 months.  He says he cannot rule out HCC without actually removing them but that no surgeon would mess with 3 tiny lesions that look like hemangioma (and I wouldn't elect that option if it were presented) but that he feels these are harmless.

Any thoughts?  

[cajim]

Is it correct that MRI has a higher resolution than US hence will see things missed by the latter?  Your description seems to indicate your MRI saw less than the US before and the US after saw more than the MRI.  Do you think it is worthwhile having an additional MRI to confirm both the number and sizes of the lesions?

That MRI is a sharper assessment than US seems to be confirmed in my case:  while all my previous US tests gave normal results, my 10/20/08 MRI did report the presence of a hemangioma.  However, the hemangioma appeared so insignificant to my hepatologist that she did not even discuss it with me.

As for HCC, have you had series of AFP and are they stable?  Even though biopsy is the ultimate assessment that can answer your question black and white, I agree with you and your doctor that it is not a good idea to play with hemangiomas.

Hope this helps, zellyf.

[zellyf]

I'm not sure about MRI v US in this case.  The first u/s showed 2 7mm.  The MRI I had a few weeks following showed one 7mm.  The MRI 6 months later showed 1 7.5mm.  The u/s 6 months later shows 3.  2 9mm and 1 8mm (or the other way around, I don't remember now).  AFP is stable.

[cajim]

I hope they are just hemangiomas.  From what I read, they grow on different organs, are benign, and tend to be found more in females than in males.

For my October test, my hepatologist recommended MRI or CT rather than US for the reason that the first two are clearer in image.

Stable AFP is a good thing.  What I am concerned about is the change in size.  From what I read, hemangiomas are benign and stay unchanged for a long time.  I am confused here.

Hope Steve will come soon.

[zellyf]

I asked my doc about the change and he said the difference b/n 7mm and 9mm was insignificant and could have to do with the angle of the image or other things and that in measurements that small you can be off a little bit one way or another.  He said a 2mm change in one year wasn't worrisome to him.  That seems reasonable but I'm looking for confirmation of that.

[zellyf]

cajim, did you see Steven's note about his daughter in the hospital?

[cajim]

I agree the difference between 7mm and 9mm is very small.  I tend to think our doctors who see patients after patients have a better understanding than us who learn from reading and are emotionally involved in our interpretations.

I did not know about Steven's daughter being in the hospital.  I pray everything will be fine with her.

[NashPred]

I’ll admit that I don’t know very much about liver lesions, but from what little I have read on the subject, I tend to agree with your doctors explanation. I know it may not have been the result you were hoping for, but I still don’t think it is anything to be too alarmed about.

You say that your AFP has remained stable and the lesions are being regularly monitored by ultrasound and MRI so it sounds like you are in good hands and all signs point toward hemangioma.

I know that I have said it before, but the waiting for a definite answer is often the hardest part. With hepatitis there is always so much “wait and watch” that you’d think we would start to get used to it, but we don't. I sometimes still get anxious just waiting for simple blood test results. The good news is that the odds are very much in your favor of them just being hemangioma’s.

Did your doctor happen to mention how long it would be before they could give you a definite answer on the status of the lesions? Just curious because I don’t know how long they have to monitor them before they can say that it is definitely hemangioma’s.

I wish I could offer better advice or answers but since I have very limited knowledge on this subject, I can only offer you my support and positive thoughts that everything is going to turn out just fine.

[zellyf]

I have the radiologist's findings:

"The 2 previously seen nodules are again identified and are not significantly changed in the interval.  This is accounting for slight differences in imaging and measurement error.  However, a third lesion is seen adjacent to the diaphragm which was not visualized on the previous study.  This may have been present on the previous exam, but the dome of the diaphragm area is difficult to image."

Recommendation is another u/s in 6 months.

Thanks for all of the comments and reassurances.  They truly helped.  I so appreciate all of you.  

NP - I'm not sure how long.  I've heard 18 mos or longer.  I guess it depends on what they see.  The two MRI's done 6-months apart showed the one seen on MRI to be "completely stable".  I'm concerned that the other two don't show up on MRI b/c it makes me think they are different in nature from the one that does.  On the other hand, the one seen on u/s but not on MRI a year ago hasn't changed so that is reassuring.

Any thoughts on what the radiologist says?

[cajim]

Sounds like the radiologist does not think the findings are serious enough to deserve worry.  He even can wait for 6 months rather than 3.  Do you agree?

[zellyf]

Sounds like, but I'm wondering if that's good enough.

[cajim]

It's best to share your thought with the radiologist and see what he says.

[Peteshine]

Anymore news on the lesions findings? I'm thinking of you mate...

[zellyf]

Not for another 6 months! Bleh.

[zellyf]

Bump

[stevenNYer]

Gosh...if a .1 or .2 jump in AFP makes me worry, I could only imagine what it feels like to follow this up and the waiting.

It is comforting to know that after 1 year, the change is really not significant.  I read some time ago that HCC is really aggressive in the beginning.  It could double in size 6 month to 1 year.  So by this logic, if it's HCC, it would have really show itself to your radiologist by now.   And if you have a hemangioma, your risk of getting a couple more goes up, but risk of HCC stays the same low.

I know it's hard, stay positive, stay strong, for yourself, for us :)

[karensuemac]

I have 7 hemangiomas in both lobes. They are all less than 2 cm so they are bigger than yours. My ordeal started in Feb 08 with one 2 cm lesion discovered incidentally from a cat scan for something else. 6 months later had follow-up scan. Showed 3 or 4 lesions in right lobe. Had liver biopsy. came back hemangiomas. Primary physician sent me to liver doc.Had a MRI. Didn't jive with hemangiomas. Came back 6 or 7 lesions in both lobes. Had a second biopsy even though biopsies are not recommended for hemangiomas because of the risk of bleeding. (They are just clusters of blood vessels that are always benign). Had all kinds of tests because they were worried it was cancer because of having multiple lesions. I had no symptoms at all. Felt great the whole time. Well, second biopsy came back hemangiomas too. The radiologist doc told me while he was doing the biopsy that he had looked at all my previous scans, and MRI. Said it was so unnecessary for me to be there having a second biopsy. Said he saw all 7 lesions on original cat scan back in Feb of 2008 and there had been no change in size at all. Ultra sound guy said he sees hemangiomas all the time and could see that's what my lesions were. Radiologist did not like doing second biopsy because they're hemangiomas and could cause dangerous bleeding. Had follow-up MRI Dec 30,2008 and was told no change and no more follow-up needed! So I went through 2 months of worry and freaking out and mega medical biils. If the radiologist that did my second biopsy had been the one to read my first cat scan maybe I would not have had to go through this. They thought I had one, then 3 or 4, then 6 or 7. And  I had the 7 all along. But the bright side is that I found out I'm pretty darn healthy and I feel so very lucky that it wasn't cancer. I have a whole new appreciation for life now!
Best wishes to you. I hope my story was helpful in some way. I hope yours are just hemangiomas too. Sounds like it.

[stevenNYer]

Thanks for sharing your story.  Good results give hope.  We have to remember it's not always bad.

[zellyf]

Thank you for sharing your story.  It really eased my mind.  I'm sorry you had to go through that but I'm glad your story has a happy ending.  

As for my u/s on Tuesday I think it went well.  The tech was training someone but I'm okay with that.  But, they were clearly struggling to visualize the lesions. I heard, "Its hard because they are so tiny" and then, "Take pictures of the two you can see and I'll help you find the third."

Then, silence for a looooong time.  Then saying, "We have to go and review your last u/s because we are having a hard time locating the third lesion."  Okay, I liked the sounds of that.

They came back and found it after about 5 - 10 more minutes of looking.  She said, "There it is! And it doesn't look like its changed at all since 6 months ago."

So, if I can take the tech's word for it...it looked good.  I have to say that I felt good as I left.  Thanks for all your support!

[britgirl477]

That sounds really good zelly. Bet you're pleased with that visit. If they actually had to strain their eyes to find the thing then you must be in fine condition.
Brit

[hep76]

I had an Ultra-Sound done on my liver about two years ago and they found 3 lesions, but I was told I had nothing to worry about.  Not sure what type or size they were...my doc didn't really go to any details about it

[cajim]

Happy for you!

[zellyf]

My doctor called this evening and the lesions have not changed.  Good news!  I still have to follow up in 6 months but 2 have not changed in 18 months and the third in 6 months (and looks just like the other 2).

The adoption continues to move forward...slowly.

[stevenNYer]

What great news :)  Keep bringing good news updates :)

[britgirl477]

Chuffed to bits for you zelly! Funnily enough I was just thinking about you at work today and thinking it must have been time for you to get your ultrasound results. Well done.
Brit

[xyun08]

Hi everyone

I see this thread is dead for quite long but I just needed to vent it out so let me try posting here. Reading through all the posts about going for countless scans and waiting endlessly for results.
I am waiting for my mom's US results too. Sonographer said she saw lesions when I probed her. I was in the room when my mom was doing the US. I did not know what to expect since this was the first time I have seen an US being done. I saw some black masses but not sure if these were the lesions. My mom's liver function blood test shows one of the liver enzymes elevated. Not sure which is the one elevated as I have yet to see the detailed report. Physician wanted to wait till US is done to give us her full report. AFP was normal according to her. My aunt passed away from liver cancer last month. My mom is Hep B carrier with HB e antigen positive. I am sick with worry everyday.

If US shows lesions what kind of tests will the doc order? CT or MRI? Does these 2 involve some recovery period?

Not expecting any answers here, guess I just need to vent out all my worries.

[stef2011]

if any focal liver lesion show up start an antiviral right away and consider gcmaf treatment, since there is a family history of liver cancer she should have been on antivirals already

make sure the following:
vitamin d serum level as high as possible, minimum 50ng/ml and max 100ng/ml, better on the high range.monitor serum calcium while taking vit d3 supplements, 5000 to 10000iu daily are necessary

cholesterol must be low both for cancer, liver damage and hbv:
tot chol <150
ldl60

consider heptech products like fibroguard and heptech, they both work regressing liver damage and fibroguard has many antifibrotic anti cancer foods

in case of liver cancer
check gcmaf at gcmaf.eu
a probiotic version with kefir grains that produces gcmaf should be available soon, this is more potent and cheap that injectable

a nagalase test might help see cancer and hbv activity and immune suppression

[xyun08]

Hi stef2011

Thanks for you reply.My mom's US results are out now. There's a 3cm mass which requires further testing possibly CT scan according to my physician. I am not sure if CT scan alone is going to be enough to determine if this is going to be a benign or malignant case? What are other tests to be considered?

What does it mean by "focal" liver lesion?

On the vitamin D serum level, how do we monitor and keep this high? Will be seeing a liver specialist, if he does prescribe antivirals, I should make sure I ask him about vit D serum levl=els I suppose?

When you say cholestrol must be low, what does it mean? My mom's cholestrol level is high that the doc says she should take med but because of the liver situation this is not going to be priority.

Thanks so much for your advice! I am really so scared now.