Aa
MRI Abdomen with/without Contrast Results
Hi everyone..just received my MRI results from last week. I was wondering if some of the "smarties" could respond and interpret these results. Also today I was suppose to have a liver biopsy but it was canceled due to paperwork mix up. So hopefully I will get it done next week. I also have included some additional blood test results that were done after I met with the Hepatologist.
MRI-the liver measures 16cm in craniocaudal length. There is no evidence of steatosis on chemical shift imaging. There is no intraheptic biliary ductal dilatation. There is a cyst in the posterior segment of the right hepatic lobe measuring approx 6 mm in diameter. There is minimal nodularity of the hepatic contour without evidence of hypertrophy of the caudate lobe, or atrophy of the medial segment of the left hepatic lobe. The findings may represent mild cirrhosis. No hepatic mass lesion or suspicious enhancement identified. The gallbladder is present. There is no MR evidence of cholelithiasis. The common bile duct is normal in course and caliber.
(The spleen, pancreas, adrenal glands, kidneys-were all normal in size and positions)!
There are mildly prominent periportal and portal-caval lymph nodes which may be reactive in etiology. The largest node is a portal-caval node measuring approx 1.5 x 1.2 cm. There is no retroperitoneal lymphadenopathy. A retroaortic left renal vein, a normal anatomic variation, is noted.
There is no ascites. The visualized osseous structures demonstrate no abnormality.
IMPRESSION:
1. There is mild nodularity of the hepatic contour which may be secondary to mild cirrhosis.
2. There is no hepatic mass or suspicious enhancement. There is no evidence of steatosis.
3. 6mm cyst in the posterior segment of the right hepatic lobe.
4. Mildly prominent periportal and portacaval lymph nodes which may be reactive in etiology.
The following tests were flagged on the blood tests:
HGB 16.8 H
HCT 50.8 H
MCV 103.3 H
NEU % 43.6 L
LY % 45.2 H
POTASSIUM 5.5 H
AST 93 H
ALT 114 H ( last ck ALT was 263, AST 233 on 9-27-11)..major change from last time
Special Chemistry for Iron and Ferritin
% SAT 45 H
CEA 8.93 H (now this is concerning)?!
FERRITIN 319 H
HEP A IgM Antibody - Non reactive
Anti Smooth Muscle Ab- positive 1:160 ???? what in the hell is this?
Anti Nuclear Antibody - Negative .38
So with the Ferritin levels tripled I guess PCT is included with the Hep C.
Thank you for your help in breaking all of this down. Geez I haven't even started tx and I feel overwhelmed! THanks to all!
Jules
MRI-the liver measures 16cm in craniocaudal length. There is no evidence of steatosis on chemical shift imaging. There is no intraheptic biliary ductal dilatation. There is a cyst in the posterior segment of the right hepatic lobe measuring approx 6 mm in diameter. There is minimal nodularity of the hepatic contour without evidence of hypertrophy of the caudate lobe, or atrophy of the medial segment of the left hepatic lobe. The findings may represent mild cirrhosis. No hepatic mass lesion or suspicious enhancement identified. The gallbladder is present. There is no MR evidence of cholelithiasis. The common bile duct is normal in course and caliber.
(The spleen, pancreas, adrenal glands, kidneys-were all normal in size and positions)!
There are mildly prominent periportal and portal-caval lymph nodes which may be reactive in etiology. The largest node is a portal-caval node measuring approx 1.5 x 1.2 cm. There is no retroperitoneal lymphadenopathy. A retroaortic left renal vein, a normal anatomic variation, is noted.
There is no ascites. The visualized osseous structures demonstrate no abnormality.
IMPRESSION:
1. There is mild nodularity of the hepatic contour which may be secondary to mild cirrhosis.
2. There is no hepatic mass or suspicious enhancement. There is no evidence of steatosis.
3. 6mm cyst in the posterior segment of the right hepatic lobe.
4. Mildly prominent periportal and portacaval lymph nodes which may be reactive in etiology.
The following tests were flagged on the blood tests:
HGB 16.8 H
HCT 50.8 H
MCV 103.3 H
NEU % 43.6 L
LY % 45.2 H
POTASSIUM 5.5 H
AST 93 H
ALT 114 H ( last ck ALT was 263, AST 233 on 9-27-11)..major change from last time
Special Chemistry for Iron and Ferritin
% SAT 45 H
CEA 8.93 H (now this is concerning)?!
FERRITIN 319 H
HEP A IgM Antibody - Non reactive
Anti Smooth Muscle Ab- positive 1:160 ???? what in the hell is this?
Anti Nuclear Antibody - Negative .38
So with the Ferritin levels tripled I guess PCT is included with the Hep C.
Thank you for your help in breaking all of this down. Geez I haven't even started tx and I feel overwhelmed! THanks to all!
Jules
Hi, I am a hep c specialist at a famliy health center. I imagine you have proceeded in your workup. I did not see if you have hep C but that is what it looks like. I don't know why the cea was done. we don't do them in our hep clinic. the asma means you need to get your biopsy done to rule out autoimmune hep C. The rest of your labs look sort of common for a hep C patient. Make sure you see a qualified Hep C treater, as the new meds are highkly effective, but need expertise to use correctly. Cure rates are >70% for genotypes 1, and > 80% for GT 2 and 3. where do you live? why so far to a hepatologist?
Hi Eureka...I was checking over my bloodwork and the PLT was 198. It says the reference range is 142-424. So I guess a little on the low side but within range.
Thanks again!!!
Jules
Thanks again!!!
Jules
Thank you all for the breakdown. I was a little concerned about the CEA test because everytime I googled it Colon Cancer came up. So I wonder if that was elevated because of the Hep C. Also a couple of years ago, I started to get blisters on the back of my hand. This normally happened in July - Sept when it was warm and humid. Went to dermatologist and at first he thought it was Poison Oak. I took steroids and used a topical steriod and it went away. Next year same thing happened but I was on jury duty for two weeks and couldn't get out of it. So didn't go back to derm because it went away on its own. This year the weather was pretty rainy and I wore gloves when I was outside 24/7. So I really didn't have a major breakout this year. Someone on this forum saw my previous post and said to look into PCT (porphyria cutanea tarda)..sp?. So mentioned it to my Hep and did the blood work on it. Since the ferritin levels were triple I am assuming PCT. But the IRON test was normal @ 143 (range is 37-170).
The biopsy was canceled because the hospital did not receive the proper information from my Hepatologist who is 3 hrs away. I tried to call them all day yesterday and only got emergency answering service. Maybe they are still on holiday I really don't know. Will try again today.
Also my ALT and AST really dropped. Do they normally flucuate like that? That really surprised me.
Thank you all once again. Have a great day!
Jules
The biopsy was canceled because the hospital did not receive the proper information from my Hepatologist who is 3 hrs away. I tried to call them all day yesterday and only got emergency answering service. Maybe they are still on holiday I really don't know. Will try again today.
Also my ALT and AST really dropped. Do they normally flucuate like that? That really surprised me.
Thank you all once again. Have a great day!
Jules
Jules, don't be overwhelmed.
You are taking positive steps to address health concerns that could become a bigger problem in the future if you don't. That is a good thing. We are lucky to have Eureka and HectorSF on this forum, because they are both obviously very knowledgeable about reading medical reports and lab results.
Overall, as both above said, you apparently don't have fatty liver, which is good, because fat in the liver makes it that much harder for your liver to function properly. You don't have liver cancer, so that's fabulous. You probably have a benign cyst on your liver (my husband does) and your doctor will want to look at that with ultrasound or scan every few years. That's no big deal, and they usually cause no problem. You probably have beginning Cirrhosis. My husband does, and that is the way that it was described to us (bridging fibrosis - scarring - with nodules - places where the scars connect). The more scarring there is on the liver, the less the liver is able to do its job.
It's good that you are planning to start therapy soon. This is the best time ever for people like you and my husband to treat with triple therapy.
Advocate1955
You are taking positive steps to address health concerns that could become a bigger problem in the future if you don't. That is a good thing. We are lucky to have Eureka and HectorSF on this forum, because they are both obviously very knowledgeable about reading medical reports and lab results.
Overall, as both above said, you apparently don't have fatty liver, which is good, because fat in the liver makes it that much harder for your liver to function properly. You don't have liver cancer, so that's fabulous. You probably have a benign cyst on your liver (my husband does) and your doctor will want to look at that with ultrasound or scan every few years. That's no big deal, and they usually cause no problem. You probably have beginning Cirrhosis. My husband does, and that is the way that it was described to us (bridging fibrosis - scarring - with nodules - places where the scars connect). The more scarring there is on the liver, the less the liver is able to do its job.
It's good that you are planning to start therapy soon. This is the best time ever for people like you and my husband to treat with triple therapy.
Advocate1955
My MRI also showed a liver cyst which I had follow up after 6 months to see if it changed, it didn't. Once we start scanning there always seems to be something. Afterall we are human.
First let me state the obvious. I am no doctor of radiologist. So take whatever I say with a large grain of salt. Well maybe not salt as sodium can be a problem for us cirrhotics.
Do you have chronic hepatitis C?
You don’t say what type of MRI you had. I assume it had contrast and non-contrast images? A MRI is used primarily to diagnose cancers including liver cancer (HCC). Also it can see your internal organs and can detect any physical abnormalities.
There are mildly prominent periportal and portal-caval lymph nodes which may be reactive in etiology (origin). The largest node is a portal-caval node measuring approx 1.5 x 1.2 cm. There is no retroperitoneal lymphadenopathy. A retroaortic left renal vein, a normal anatomic variation, is noted.
* Portacaval node is a lymph node that is in the portacaval space. This is a narow space shielded anteriorly by the pancreas, stomach, gallbladder & liver & posteriorly by the inferior vena cana. (Porta hepatis is an area on the undersurface of liver).
* Normal node at this site is usually 1cm or less in size. Enlargement of this lymph node may be due to infection, tuberculosis, sarcoidosis, colon cancer, gastric & esophageal cancer & lypmhoma.
“There is no retroperitoneal lymphadenopathy”
* Retroperitoneal lymph nodes are lymph nodes located in the retroperitoneum. The retroperitoneum is an area at the back of the abdomen behind the intestines.
There is no ascites. The visualized osseous structures demonstrate no abnormality.
* Abdomen fluid retention seen when a person has decompensated cirrhosis, sometimes called End-Stage Liver Disease.
IMPRESSION:
1. There is mild nodularity of the hepatic contour which may be secondary to mild cirrhosis.
2. There is no hepatic mass or suspicious enhancement. There is no evidence of steatosis.
3. 6mm cyst in the posterior segment of the right hepatic lobe.
4. Mildly prominent periportal and portacaval lymph nodes which may be reactive in etiology (cause).
* Summary:
You appear to have very early cirrhosis of the liver. Indicated by the nodular appearance on the surface of the liver. The biopsy will clarify the stage of your cirrhosis.
No lesions including tumors or harmless growths were from within the liver.
You have a cyst in the liver’s right lobe. Liver cysts have been estimated to occur in 5% of the population and cause no harm.
The following tests were flagged on the blood tests:
HGB 16.8 H
HCT 50.8 H
MCV 103.3 H
NEU % 43.6 L
LY % 45.2 H
POTASSIUM 5.5 H
AST 93 H
ALT 114 H ( last ck ALT was 263, AST 233 on 9-27-11)..major change from last time
Special Chemistry for Iron and Ferritin
% SAT 45 H
CEA 8.93 H (now this is concerning)?!
FERRITIN 319 H
HEP A IgM Antibody - Non reactive
Anti Smooth Muscle Ab- positive 1:160 ???? what in the hell is this?
Anti Nuclear Antibody - Negative .38
* POTASSIUM 5.5 H this can be a problem. Your doctor should investigate the cause and try to reduce potassium level.
Potassium is critical for the normal functioning of the muscles, heart, and nerves. It plays an important role in controlling activity of smooth muscle (such as the muscle found in the digestive tract).
high blood potassium levels (hyperkalemia) can lead to abnormal heart rhythms.
* CEA = Creatinine
This is very high and could indicate a decline in kidney function. You should take to your doctor about this result as soon as possible.
* Ferritin levels are usually high in cirrhotics. Mine level has been over 1000 and is now 670. You should be checked for iron problems such as Hemochromatotsis. If it has already been done. Are your other irons levels within range?
* % SAT 45 H is just over range.
% of saturation above 45% (fasting) suggests iron loading, although elevated TS% could be a transient (passing) situation. Various foods and conditions can influence serum iron. You may wish to request a repeat fasting test with a stricter 72 hour pre-test avoidances of foods and substances: red meat, supplements, alcohol, vitamin C rich juices or high sugar foods/beverages. These items can increase iron absorption or alter results. A fasting TS% below 20 suggests iron deficiency or anemia of inflammatory response also called
anemia of chronic disease.
“Anti Smooth Muscle Ab- positive 1:160 ???? what in the hell is this?”
* The smooth muscle antibody (SMA) test is primarily ordered along with antinuclear antibodies (ANA) to help diagnose AUTOIMMUNE HEPATITIS. ANA is reported as a "titer." Low titers are in the range of 1:40 to 1:60. Other autoantibodies, such as liver-kidney microsomal type 1 (LKM1) antibodies and antimitochondrial antibodies (AMA), may also be ordered to help diagnose autoimmune hepatitis and distinguish it from other causes of liver disease or injury.
Anti Nuclear Antibody - Negative .38
* Talk to your doctor about this result.
* Overall advice you need to have a big sit down with your doctor after biopsy. A hepatologist I hope, so you can discuss your diagnosis and prognosis.
Where do I send the bill? ;-)
Good luck Jules.
Hector
Do you have chronic hepatitis C?
You don’t say what type of MRI you had. I assume it had contrast and non-contrast images? A MRI is used primarily to diagnose cancers including liver cancer (HCC). Also it can see your internal organs and can detect any physical abnormalities.
There are mildly prominent periportal and portal-caval lymph nodes which may be reactive in etiology (origin). The largest node is a portal-caval node measuring approx 1.5 x 1.2 cm. There is no retroperitoneal lymphadenopathy. A retroaortic left renal vein, a normal anatomic variation, is noted.
* Portacaval node is a lymph node that is in the portacaval space. This is a narow space shielded anteriorly by the pancreas, stomach, gallbladder & liver & posteriorly by the inferior vena cana. (Porta hepatis is an area on the undersurface of liver).
* Normal node at this site is usually 1cm or less in size. Enlargement of this lymph node may be due to infection, tuberculosis, sarcoidosis, colon cancer, gastric & esophageal cancer & lypmhoma.
“There is no retroperitoneal lymphadenopathy”
* Retroperitoneal lymph nodes are lymph nodes located in the retroperitoneum. The retroperitoneum is an area at the back of the abdomen behind the intestines.
There is no ascites. The visualized osseous structures demonstrate no abnormality.
* Abdomen fluid retention seen when a person has decompensated cirrhosis, sometimes called End-Stage Liver Disease.
IMPRESSION:
1. There is mild nodularity of the hepatic contour which may be secondary to mild cirrhosis.
2. There is no hepatic mass or suspicious enhancement. There is no evidence of steatosis.
3. 6mm cyst in the posterior segment of the right hepatic lobe.
4. Mildly prominent periportal and portacaval lymph nodes which may be reactive in etiology (cause).
* Summary:
You appear to have very early cirrhosis of the liver. Indicated by the nodular appearance on the surface of the liver. The biopsy will clarify the stage of your cirrhosis.
No lesions including tumors or harmless growths were from within the liver.
You have a cyst in the liver’s right lobe. Liver cysts have been estimated to occur in 5% of the population and cause no harm.
The following tests were flagged on the blood tests:
HGB 16.8 H
HCT 50.8 H
MCV 103.3 H
NEU % 43.6 L
LY % 45.2 H
POTASSIUM 5.5 H
AST 93 H
ALT 114 H ( last ck ALT was 263, AST 233 on 9-27-11)..major change from last time
Special Chemistry for Iron and Ferritin
% SAT 45 H
CEA 8.93 H (now this is concerning)?!
FERRITIN 319 H
HEP A IgM Antibody - Non reactive
Anti Smooth Muscle Ab- positive 1:160 ???? what in the hell is this?
Anti Nuclear Antibody - Negative .38
* POTASSIUM 5.5 H this can be a problem. Your doctor should investigate the cause and try to reduce potassium level.
Potassium is critical for the normal functioning of the muscles, heart, and nerves. It plays an important role in controlling activity of smooth muscle (such as the muscle found in the digestive tract).
high blood potassium levels (hyperkalemia) can lead to abnormal heart rhythms.
* CEA = Creatinine
This is very high and could indicate a decline in kidney function. You should take to your doctor about this result as soon as possible.
* Ferritin levels are usually high in cirrhotics. Mine level has been over 1000 and is now 670. You should be checked for iron problems such as Hemochromatotsis. If it has already been done. Are your other irons levels within range?
* % SAT 45 H is just over range.
% of saturation above 45% (fasting) suggests iron loading, although elevated TS% could be a transient (passing) situation. Various foods and conditions can influence serum iron. You may wish to request a repeat fasting test with a stricter 72 hour pre-test avoidances of foods and substances: red meat, supplements, alcohol, vitamin C rich juices or high sugar foods/beverages. These items can increase iron absorption or alter results. A fasting TS% below 20 suggests iron deficiency or anemia of inflammatory response also called
anemia of chronic disease.
“Anti Smooth Muscle Ab- positive 1:160 ???? what in the hell is this?”
* The smooth muscle antibody (SMA) test is primarily ordered along with antinuclear antibodies (ANA) to help diagnose AUTOIMMUNE HEPATITIS. ANA is reported as a "titer." Low titers are in the range of 1:40 to 1:60. Other autoantibodies, such as liver-kidney microsomal type 1 (LKM1) antibodies and antimitochondrial antibodies (AMA), may also be ordered to help diagnose autoimmune hepatitis and distinguish it from other causes of liver disease or injury.
Anti Nuclear Antibody - Negative .38
* Talk to your doctor about this result.
* Overall advice you need to have a big sit down with your doctor after biopsy. A hepatologist I hope, so you can discuss your diagnosis and prognosis.
Where do I send the bill? ;-)
Good luck Jules.
Hector
You didn't list your platelet numbers... was that why they cancelled the biopsy? Would be an important number to have. I'll try to explain some of the imaging stuff because I've learned a little about it since my husband has been having them quarterly for the last 5 years (not because I'm a smartie).
"Craniocaudal length" (16cm) is liver's 'height' (top to bottom).
"There is no evidence of steatosis" means they don't see fatty liver: good. "There is no intraheptic biliary ductal dilatation" means your bile ducts are not expanded and look normal: good.
"There is a cyst in the posterior segment' means it's a cyst... no suspicion of malignancy if it's called that: good.
"There is minimal nodularity... No hepatic mass lesion or suspicious enhancement identified." The liver is usually smooth, but minimal nodularity raises concerns for cirrhosis... no suspicious enhancement means there is no concern for the cyst: good.
"No osseus"... no bone abnormalities.
"The gallbladder... no MR evidence of cholelithiasis" No gallstones: good.
"prominent periportal and portacaval lymph nodes which may be reactive in etiology"... lymph nodes a little swollen, probably due to hep c virus.
Your RBC flags for High values isn't unusual if you have iron overload. Not knowledgeable about the ferritin/iron specifics nor SMA/ANA levels, but hopefully someone who knows more about that will pop in. Hope that helps, and good luck with getting treatment started! ~eureka
"Craniocaudal length" (16cm) is liver's 'height' (top to bottom).
"There is no evidence of steatosis" means they don't see fatty liver: good. "There is no intraheptic biliary ductal dilatation" means your bile ducts are not expanded and look normal: good.
"There is a cyst in the posterior segment' means it's a cyst... no suspicion of malignancy if it's called that: good.
"There is minimal nodularity... No hepatic mass lesion or suspicious enhancement identified." The liver is usually smooth, but minimal nodularity raises concerns for cirrhosis... no suspicious enhancement means there is no concern for the cyst: good.
"No osseus"... no bone abnormalities.
"The gallbladder... no MR evidence of cholelithiasis" No gallstones: good.
"prominent periportal and portacaval lymph nodes which may be reactive in etiology"... lymph nodes a little swollen, probably due to hep c virus.
Your RBC flags for High values isn't unusual if you have iron overload. Not knowledgeable about the ferritin/iron specifics nor SMA/ANA levels, but hopefully someone who knows more about that will pop in. Hope that helps, and good luck with getting treatment started! ~eureka
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