Would a radiologist falsify MRA results?

[Texanbarbie]

I know this might sound crazy, but let me explain. I live in a small town with population of approx. 800. I use to drive to San Antonio for all my doctor visits but decided I didn’t want to deal with traffic, 2 hours driving, waiting time, etc so transferred all my medical records to a closer, but smaller town that has a hospital.

The MRAs that I had in San Antonio at an imaging center consistently showed the Sinus of Valsalva at 4.07 cm and the ascending aortic aneurysm at 4.2 cm with the chest CTs showing it at 4.4 cm.

Since I have been seeing the local cardiologist, he has been sending me to the hospital for MRAs. In 2013 their MRA showed nothing for the Sinus of Valsalva and the ascending at 4.1 cm which I had no problem with. In 2014, the MRA showed 4.07 at Sinus of Valsalva and NO measurement for the ascending aortic aneurysm. Incidentally, my cardiologist had told me I was good to go for another year - - no change, so was there another report that he was looking at?

Okay, so a couple of days ago right before my MRA I talked to the technologist who was doing the procedure and told her there was nothing noted on the last report about the ascending aortic aneurysm and also that the year before, the report indicated it was getting smaller and they just don’t get smaller. So she put a note to the radiologist to make sure and measure both areas for the report.

So I just got the report today and it showed the Sinus of Valsalva at 3.75 cm and the ascending aortic aneurysm at 3.5 cm. I could not believe it. When I looked at who the radiologist was, it was the same as the previous year who didn’t note the size of the ascending aortic aneurysm at all. It also states there is no interval change compared to the previous study.

I am so mad today and don’t know if the technologist wasn’t able to obtain good images or the radiologist just messed up or wasn’t thrilled with my comments about his previous report.

Thanks for letting me vent. I know these are just numbers and the aneurysm is fairly small, but I’m a stickler for accuracy. I’ll be talking to my cardiologist about going back to the San Antonio Imaging Center for my yearly MRAs but my appointment isn’t until the end of November. After seeing him I just might be switching cardiologists too.

 

[almost_hectic]

I would, switch that is, both imaging location and cardiologist. Medical imaging no matter how advanced, still has to be interpreted by a human. In this case it sounds like you've got one who just isn't very good... And that's unacceptable when it comes time to make decisions regarding your heart. Second, I'd switch cardiologists. If you for any reason you should, then it's time. I moved and got a new cardiologist four years ago. Never liked the guy but I figured oh well. This past April he told me my valve had gotten much worse but I wouldn't need surgery for another year or two. Well initially I didn't believe him, plus I figured if it was true it was time to find a new cardio I liked and trusted to advise me and manage my care. Found a new one a month or so later who redid my tests and said yes I was in fact in need of surgery soon... But not in a year or two, he said I needed surgery in a month or two!! Well I had my surgery beginning of August and the surgeon said I was actually lucky I made it to surgery in time, that I was a walking time bomb! Had I listened to my original cardiologist I might have never even made it to my next follow up with him from what I'm told.

 

[ottagal]

I would, switch that is, both imaging location and cardiologist. Medical imaging no matter how advanced, still has to be interpreted by a human. In this case it sounds like you've got one who just isn't very good... And that's unacceptable when it comes time to make decisions regarding your heart. Second, I'd switch cardiologists. If you for any reason you should, then it's time. I moved and got a new cardiologist four years ago. Never liked the guy but I figured oh well. This past April he told me my valve had gotten much worse but I wouldn't need surgery for another year or two. Well initially I didn't believe him, plus I figured if it was true it was time to find a new cardio I liked and trusted to advise me and manage my care. Found a new one a month or so later who redid my tests and said yes I was in fact in need of surgery soon... But not in a year or two, he said I needed surgery in a month or two!! Well I had my surgery beginning of August and the surgeon said I was actually lucky I made it to surgery in time, that I was a walking time bomb! Had I listened to my original cardiologist I might have never even made it to my next follow up with him from what I'm told.

I agree with almost_hectic. This is your life and health and if you are concerned about inaccurate readings, you either need to have another test or another radiologist reading the test results. My cardiologist ordered an MRA to measure my distal ascending aorta to compare it to my echo readings from 6 months previously. The radiologist never even read the distal ascending aorta and only looked at the proximal ascending aorta. They had to call back to have it reviewed. My point is, as was already said, they are humans reading these reports and human error can happen .
All the best to you.

 

[yotphix]

Falsify is probably not the right word, but these measurements are not as simple as stretching a tape measure down a straight edge. If you ever look at what they are trying to measure, you'll see that there is definitely room for error, and the requirement of good judgement and some experience. The first time I went to my cardiologist, having been diagnosed by a family doctor as having a moderately stenotic AV with moderate to severe regurgitation and ventricular hypertrophy, I was sent directly down to the Echo Lab at the hospital for a repeat test. I asked why, and he replied 'because echos are not all equal'. Meaning a different person, or even a different machine, might produce different results.
Radiology is always a tricky business, with some techs flagging spots and such as 'tumours' (as famously happened to a doctor, who had surgery to remove what turned out not to be there), or missing fractures (like the one in my sister's back!).
Since the results are different enough that they say different things about your condition, I'd say you need to go to a third place, then decide which will be your baseline, and keep going to that one for future comparison.

 

[Texanbarbie]

yotphix Yes, maybe "falsify" was not the correct word, but it was hard to believe that the radiologist could be so far off in his measurements (down from 4.4 cm to 3.5 cm) and then state that "there is no interval change compared to the previous", since in the previous (which he also was the radiologist) the ascending aneurysm wasn't even noted. I received a call this morning from my cardiologist's nurse who told me the cardiologist signed off on the MRA and said there was no change and we'll see you in a year! So yes, this just reinforces my decision to change cardiologists and imaging centers.

almost_hectic Thank you for your comments about choosing another cardiologist !

ottagal Yes, I agree they are only human. And I have decided that just because they have MD after their name, doesn't mean they're any good at what they do !

 

[Texanbarbie]

Just an update on the confusing MRA measurements showing my ascending aortic aneurysm went from 4.2 cm to 3.5 cm. The cardiologist talked to the radiologist who said it was measured at different points this time but the aneurysm is "grossly stable and there is no change" which means it's still at 4.2 cm. So how in the world can anyone keep track of its growth if radiologists measure them at different points? The nurse said maybe he's using a different method. Waaaaaaaaa!!!!!

 

[almost_hectic]

I think it's probably time to reconsider that drive to San Antonio

 

[Duffey]

I think it's probably time to reconsider that drive to San Antonio

I agree. The drive will be less stressful than what you're dealing with now.

 

[Texanbarbie]

Yes, I most definitely will be using the imaging center in San Antonio. I'm still seeking a new cardiologist in San Antonio - - they have lots there - - but can't find one that anyone can recommend ! There was one mentioned on this forum but she retired just a few months ago. I still have a November appt with my current cardiologist regarding my SOB and cough as well as wanting to discuss my latest echo and then I can get serious about switching. Thanks everyone for your encouragement !