How to Get a More Detailed Radiologist Report?

Hope I don't have my head in the clouds on this one.

I am scheduled for a repeat MRI of the brain next Monday (9/27). I was very disappointed with the last radiologist report due to its vagueness. The radiologist did not quantify anything (see two reports in my pix). There's no indication in the last MRI of the largest lesions, number of new lesions, etc. It was only in reading my neuro's notes that I read that I have at least one new lesion.

I found a website that gave guidance for radiologists in terms of writing reports and one thing that was advised was "Quantify, Quantify, Quantify".

I have to fill out a form prior to the MRI listing sx/reasons for the MRI. This might give me the opportunity to request more detail in the report? If so, what should I be asking? I have my own ideas, but would like input from others.

Audrey

[HVAC]

Every Radiologist report I have ever gotten is vague. They get more than the Neurologist who reads it. Most of my Neurologist look at the CD and ignore the report. Most do not even say how many lesions.

Of course if they are looking for MS the amount of slices is important. They will not do an MRI under MS protocol unless the Neurologist asks for it.

Don't know if that helps.

Alex

[Cosmobirdy]

I worked in medical imaging (XRay and then Ultrasound) for 25 yrs - unfortunately, radiologist's reports are almost always somewhat vague.  There are variations between radiologists, with some being more wordy or specific than others.  What they try to do is describe what they see, point out anything of concern, and then give a differential diagnosis - the various things that could cause whatever they see.  I would be surprised if a radiologist would be any more specific based on a patient request - it just usually doesn't work that way ... :-)  They can sometimes be prodded to be more specific by the referring doctor - the one who requested the exam in the first place.

In all fairness to radiologists, you have to bear in  mind that these guys have very little info on the patient when they are reading the study.  All they know is what is on the actual request from the referring doc, (which is usually very brief), and whatever info the patient has provided ... so they can usually only report on what they see, not so much on how it fits into the context of that specific patient.  Because of this, something may not look too impressive to the radiologist, but it may be VERY significant to the referring neuro, who knows the whole story about that particular patient.    

That is why it is SO IMPORTANT that the neuro looks at the MRI scans himself.  A good neuro will give very little weight to what the radiologist says - he wants to see those images first hand ... how many lesions are there .... where are they located ... what do they look like?  In my own case, the radiologist (who I knew very well and who was VERY good) virtually dismissed the few lesions I had, but when my neuro looked at the scan in context with my symptoms, history and his own clinical exam, he felt they were very important.  The more information the doctor looking at the images has about that particular patient, the more important the findings (or lack there of) become.

And, like Alex said, it is very important that the referring neuro requests the MRI be done with an MS protocol - that dictates the thickness of the slices, the way they do the contrast, and what actual scans are done, and that makes a difference.  Plus, it pops a flare to the radiologist that MS is a concern, so that is in their mind while reviewing the images.

I hope this all made sense - if you have any other questions or if I can help in any way, feel free to PM me ... :-)

Bye for now,
Rita  

[essdipity]

Rita, thanks for that timely reminder. My own diagnosis was delayed many years because radiologists made assumptions based on my age, and neuros failed to do their own analyses.

In those days I didn't know better, but I do now, so perhaps we can help others to avoid this situation.

What the radiologist says may not be all that important. But BEWARE the neuro who doesn't do an independent study of the patient's MRIs. These types either can't (incompetent) or won't (lazy) come up with a good result.

ess

[RedFlame]

The radiologists reports are incredibly vague.  I was stunned when I was told that the neuro is usually finished looking at the films by the time I was getting dressed.  I have had two sets of MRI's with similar findings.  

The first MRI done on a 1.5 open Tesla, and read by a regular neurologist was long and very informative.

My second, done on a 3.0 bore Tesla and read by a neuro radiologist was pathetic.  It contained 4 sentences and he had completely missed the borderline chiari malformation that I have.  

I agree with ess.  The findings of the radiologist are always tempered by my age.  I know that becuase references to my age are on the report numerous times.  They see your age and then view everything through that glass period.

Red

[sllowe]

If you Dr. asks for specifics, he/she should get them. i.e, (at least) size of lesions, and location. Think it would carry more weight if request come from the office.

I was fortunate that mine included the quantity, size and location.

Heck, that's not too much to ask for. Ask your Dr. if he'll do it, and if not, tell the rads office that your Dr. wants specifics. Hold them to the fire, Audrey!

-shell

[Audrey_M]

The order is already in for the MRI, so I don't hold a lot of hope that I can get in touch with the neuro to change it requesting more detail in time, especially because she does go over them herself.

What if I sneak the word "lawyer" into my personal request? Would that grab some attention?

The discs are great in that even a novice identify visible lesions, but I don't know if us regular people know how to use the tools accurately. With my last disc, I counted at least 12 lesions and measured quite a few that were 4 mm or larger. Was I measuring properly? First report notes the largest lesion was 7 mm.

I'd like more information rather than less, especially because the MRI is being done next week and my neuro appointment is not until February.

Audrey

[doublevision1]

I've looked at my CDs but wouldn't even attempt to assess the results.  There are other causes for lesions aside from MS and can be differentiated by a trained professional based on shape, location, size, etc.  My neuro told me he reads the radiology report but doesn't rely on it.  He examines the film himself and makes his own assessment, always more detailed than the initial report, and writes this up in the report of my subsequent visit to him.  Having said that, most of my radiology reports aren't bad, ie: do talk about quantity, shape, location and comparison to the previous MRI.  

[sllowe]

You can mention to the tech when you go in for it.
Just play dumb and say, my doc mentioned the report didn't include lesion count, or size.

Maybe the word will spread your asking....just thinking out loud....

[Audrey_M]

Thanks for the advice. I yucked it up with the tech and went along with what you said.

IT WORKED!!!

Definitely more detailed, and yes, changes have taken place over the past six months:

“There are several small foci of increased FLAIR signal seen in the periventricular and subcortical white matter bilaterally. Compared to the prior study, 1 of these lesions in the left frontal white matter has increased in size now measuring 10 mm compared to the previous measurement of 7 mm. This also appears more intense. There is a new tiny focus seen toward the vertex in the left frontal lobe. No additional new foci are seen. A focus in the left frontal periventricular white matter appears lightly more intense. There is a small focus of stable increased FLAIR signal in the genu of the corpus callosum. There is not mid brain involvement. Diffusion-weighted sequences demonstrate no evidence for restricted water diffusion. There is no parenchymal mass or evidence of hemorrhage. The ventricles are normal in size and contour. Cerebral cortical sulci are unremarkable. There is no extra-axial collection.”

My next appt. with the neuro is supposed to be in February. Don't know if this will change things or not.

Given that the small lesion is 10 mm, I wonder what size the tiny lesion is? Doesn't really sound like a typical radiologist terminology.

Audrey

[sllowe]

YAY!!!!!! So glad it worked!

From this doesn't sound they are referring to the 10mm as small.

Tiny would be not so measurable, I'm guessing