Funky MRI results and Hello Again

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Tdot

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hi everyone, i hope this message finds everyone well. I havent posted in a long while. I have been on a monitoring course for many years enjoying stable results with bi-annual MRIs so put this out of mind. (I have BAV with a dilated root 44mm). I've been getting monitored since 2014 with no real progression. I had my MRI this year on Oct.18th. I still havent heard back from my dr so I decided to sign up and download my report and see for myself and now I'm regretting it a little, but hey its my health and need to own it.

Anyway, the report noted some comparisons to the previous report from 2020. All of my ascending aorta measurements were 3 to 4 mm larger than the previous exam. When i saw this i freaked out. I downloaded all my past results from 2014 and put them in a table. i then realized that this year's results were actually similar to 2018 and prior...except one. My mid ascending aorta was measured at 42x39, previously consistent at 37x37. What's strange is that the report didn't mention how this compared to the last one it just showed the measurement...as if it wasnt worth noting the comparison. So anyway this one measurement stands out as a potential issue for me, will disucss with the dr. I've attached the table so you can see what im talking about.

My question is have any of you experienced such varying results from an MRI. 3 to 5 mm seems like a big variation, i though they were more accurate than that. I do remember that during this exam in between scans I shifted my arm a little and the camera on my chest moved and the tech told me to hold still, so im wondering if that could have affected anything. Anyway thanks for listening.
 

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pellicle

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All of my ascending aorta measurements were 3 to 4 mm larger than the previous exam. When i saw this i freaked out.
basically 3 to 4mm means "no movement"
when you see its moved to 56mm then consider getting agitated. I was something like 3 months to surgery when they found mine was that.

Stand Down from panic stations.
 

Tdot

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Hi everyone

Finally had a follow-up today wih my surgeon Dr. Verma. He wasn't too concerned about the increase in size of my ascending aorta. I asked him why this test was done using non gated mri and previous was gated. He said he didn't know and it was frustrating that they used different techniques. He noted that 2 or 3mm is in range of error but to be sure we will repeat next year instead of 2 years. He also wants me to monitor BP for a week and send him results and he may recommend medication to lower my BP if needed as it's proven to slow progression is what he said. I had a bunch of questions which he answered. He then referred me to this paper he co authored with respect to guidelines for bav and aortopathies. Seems like threshold for intervention is 55mm if there is bav with no other risk factors and functioning valve.

 

pellicle

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Hi

glad you got confirmation that all is good

Seems like threshold for intervention is 55mm if there is bav with no other risk factors and functioning valve.
pretty much.

BTW, without having looked it up did you actually know what "gated and non gated" MRI means?

With the issues are to be found in the big ticket items not the 2 or 3mm's I'd be nonchalant about the size you started with anyway.

Not sure if you're blocking me but as I said above:
basically 3 to 4mm means "no movement"
when you see its moved to 56mm then consider getting agitated. I was something like 3 months to surgery when they found mine was that.

Thanks for posting the follow up ...


I see that the American guidelines are pretty similar to ours

If an aortic aneurysm is identified, the next step will depend on the size of the aneurysm. Patients with AAAs less than 4cms in diameter would require scans at 2-5 year intervals.
For aneurysms from 4-4.4cms scans would be annually.
For aneurysms of 4.5-4.9cms scans would be at 6 monthly intervals.
For AAAs 5-5.4cms scans at 3 monthly intervals are needed.
Some authorities advocate 3 monthly scans once the aneurysm reaches 4.5cms.
Once an aneurysm has reached 5.5cms consideration should be given to treating the aneurysm and this will be appropriate in most patients. In some patients with other conditions that make treatment more hazardous it may be appropriate to wait until the aneurysm has enlarged further. This is because it is always important to balance the risk of treatment against the risk of rupture of the aneurysm. Although the risk of rupture may be slightly greater if an aneurysm is left until it is larger it may still be safer when compared with the surgical risk.

Best Wishes

PS: sorry I didn't post the guidelines in my first post
 
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Tdot

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BTW, without having looked it up did you actually know what "gated and non gated" MRI means
Hi thanks for the reply. Gated means they synchronize the image with motion of the heart so they account for movement in between beats. It's the most accurate. Non gated means they don't do that. I read an paper on this but can't find it now. The paper noted that with non gated measurements can be as much as 3mm over stated. Not sure why they don't do this all the time makes sense to me.
Not sure if you're blocking me but as I said above:
No I saw thanks for that. 3mm change is not clinically significant on its own. Need to compare many scans to understand. Then I guess if you factor in gated vs. Non gated it's even worse.
 

pellicle

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Good Morning

Not sure why they don't do this all the time makes sense to me.
I'm not a radiologist, so I can't really answer that. I didn't know your background and wasn't sure if you were the type to just recite what you've read or what your levels of actual understanding of what you recite are (no offence intended), and so was just attempting to tease that out.

However I guess my point was that the amount of error is relative to the significance factor insignificant. So, that's why I wrote what I wrote in the beginning. I see it as something like this:
1669060844883.png


especially in the light of:
For aneurysms from 4-4.4cms scans would be annually.
For aneurysms of 4.5-4.9cms scans would be at 6 monthly intervals.
For AAAs 5-5.4cms scans at 3 monthly intervals are needed.


Now I'm the kind of guy where (when sorting) I do a rough sort first and then a reach for a Vernier calliper only when I've got the metal I'm sorting even in ball park (like if its 4 and I'm concerned to find something at least 5 I know its not even worth checking if its 4.1 or 4.3

Also (from what I know an MRI no matter gated or not gated is inadequate for accurate measurement (its no vernier caliper) and so other tools but only when its considered close to the threshold.

Personally my own experience (as the patient) is that its always been CT with Contrast as being the comparison tool for deterring measurement range. I've always understood that MRI is better for differentiating tissue types and CT with contrast better for determining mm levels of accuracy (but again I'm not a radiologists.

You may find this article interesting.


Either way, my initial assessment and advice seems to hold up.

Best Wishes
 

Tdot

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Messages
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Location
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However I guess my point was that the amount of error is relative to the significance factor insignificant. So, that's why I wrote what I wrote in the beginning. I see it as something like this:
Yes good assessment. I guess why fixated on this is because this is the first time since having been monitored that something seemingly changed...first mri was 10 years ago. So I'm trying to assess is it real movement or just error. I guess I will know more after my next scan in October. Until then i will try not to worry about it
 

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