CT Scan or MRI - Do I have a choice?

[m_strings]

I'm a 42-year old female who's recently been recently diagnosed with Hepatitis C.  I am waiting for the results of my liver biopsy.  My AFP is 16 and my doc wants to do a CT scan.  However, I am concerned about the radiation and wonder if MRI would be a better option.  I have an extensive family history of cancer.  (My mother died of breast cancer in her 40's.  I also have a sibling, maternal grandfather, maternal aunt and great aunts who have all had cancer.)  I have been exposed to numerous x-rays in my lifetime due to back and hip problems.  I'm not thrilled about the extra radiation exposure from a CT scan and wonder if an MRI would be just as effective?  Are there things a doctor can see on a CT scan that cannot be found on an MRI?  If this is indeed a better option, how can I convince my doctor to order the MRI without stepping on his professional toes?    

[m_strings]

Thanks for your comments.  That's great that your PPO allows you 2 MRI's per year.  It should be that way.

Well, I think I wimped out.  Actually, my hepatologist really put my mind at ease about getting one CT scan.  He assured me the amount of radiation isn't anything to be concerned about and he isn't planning on doing this on a yearly basis.  I hope I'm doing the right thing.  

[roscoe1]

I get 2 mri's a year. I had trouble until I changed from hmo to ppo. Now I get what I want whenever i want it. I see a complimentary care doc and he is awsome. Good luck

[m_strings]

Copyman: I wished you worked for the Health Insurance Association of America!

Jim: That is so true: We get multiple opinions on renovation of "things" we own but rarely give our bodies anywhere near the same respect and consideration.  Shouldn't this be one of our primary investments?  It sounds like you have a great liver specialist!    

[jmjm530]

Come to think of it I had a problem getting MRI approval last time around, but stuck to my guns regardless of how much the approval secretary in my doc's office screamed. What I did was make my own case based on previous Ultrasound reports, as well as studies that suggest monitoring for life. Basically fed it to her in an email, CC'd the doc who agreed, and they contacted the insurance company for appeal. Bottom line they realized it was easier to give it to me than fight me LOL. I did have the advantage of having had one liver CTScan in the past, so that may have figured in. Doctors can pretty much override the insurance reg's if there is a reasonable case to be made AND if they will take the time and interest to make that case. Part of our job as patients is to motivate them to take that time and interest. Sometimes it works, sometimes not.

[jmjm530]

While it wasn't called "Hep C" back then, I was diagnosed back in 1968, so have been seeing liver specialists over the years. The ones seen early on have since retired, and then I interviewed several others, as I would interview anyone doing work for me. Always surprised that people would get three opinions to have their kitchen renovated but only one opinion to have their body renovated, but I digress :) Anyway, the switch I referred earlier was made around the first week of treatment when I wanted to switch to a specialist who would pursue a more agressive approach. Ironically, even though this specialist was more agressive, he was less agressive when it came to the CTScans, and I thank him for the radiation he saved me.

-- Jim

[copyman]

good point jim. I just know how my ins company works, BCBS.

Ultrasound, 1st

CT, 2nd,

MRI, 3rd

It is very rare for them to wavier from that order. I fought with them saying why pay for all three when they could save money and just give me the MRI. Then they wonder why insurance costs are so high! this is a perfect example.

[m_strings]

By the way, Jim, why did you get a second liver specialist?

It's good to know to expect regular yearly scans.  That is all the more reason to advocate for something other than CT.  

[m_strings]

Copyman: Good points.  I hate to be cynical, but it appears to be all about the bottom line dollar (as opposed to patient health) with the insurance companies, isn't it?  

Thanks for your input about the AFP.  That is a comforting thought!

Jim: I did have an ultrasound about a year ago, prior to my diagnosis.  Nothing abnormal was noted at that time.  I also had an ultrasound guided biopsy recently.  I'm not sure if that counts.  I wasn't told of anything that looked abnormal at the time but I'm not sure if the technician would have disclosed that info on the spot.  I have a follow up appnt with the hepatologist on Thursday and will be certain to ask many questions.  

Boy, I sure am glad I stumbled upon this support group tonight.  I really appreciate having a place to get some input from people who have been there.    

[jmjm530]

Why not then go with ultasound first? It usually shows "something" in an HCV liver which then can build a case for a follow-up MRI.

[copyman]

most insurance companies will not pay for an MRI first. You have to get the CT  first and if that shows anything then they will authorize the MRI for further evaluation. Of course it comes down to money and the cost of the MRI being so much more. good luck

PS, just to put your mind at ease. Try not to worry about your AFP being "slightly" elevated. This can happen just from having HCV.  FYI, when someone has liver cancer the AFP usually is in the hundreds.

[jmjm530]

Depending on which liver specialist you end up with, they will probably want to screen you for liver cancer (HCC) once or twice a year for life. In the opinion of my liver specialist, yearly CatScan's for life for someone of your age is potentially dangerous. Most here only have ultrasounds for HCC screening. Some, like my doc, alternate MRI's with ultrasounds because each gives a slightly different "look" at the liver. A small minority get CT scans, but no one I know get's them yearly, although nothing would surprise me. In all fairness I should add that my first liver specialist wanted to alternate CT Scans with MRI's and Ultrasounds, but was vetoed by my second liver specialist. I don't know your docs, but I've found the liver specialists I've seen open to suggestion as long as it's reasonable, and it seems more than reasonable to get an MRI instead of a CT Scan. Just be very upfront about the radiation risk, and good luck.

-- Jim

[m_strings]

Thanks Jim.  I really appreciate your comments.  It's great to hear your specialist has chosen to eliminate CT scans.  I have really been struggling with this.  My CT was scheduled for Thursday evening, but I moved it to Friday so I'd have another day to consider other options.  My general practitioner ordered the CT but he consulted with my hepatologist both before and after I voiced my concerns.  My doc replied that my hepatologist indicated CT was the standard procedure for diagnosing liver tumors/cancer.  I will see the hepatologist on Thursday and make a case to scrap the CT in lieu of MRI.

[jmjm530]

Ultrasound alternating with MRI is much more common than CT Scan for liver cancer screening. My liver specialist in fact made a point of eliminating the CT Scan because of radiation risk, given the fact that liver cancer screening is something for life. Is your doctor a liver specialist (hepatologist). Those are the only ones that should be calling the shots. Don't worry about stepping on someone else's toes, and start worring about your toes and the rest of your body.

-- Jim