A Little Bit About Scans

This past Sunday I had my 10th and 11th scans, an MRI and a chest X-ray.  The results were not good, but they were what we were expecting.  I'll explain later.

First, I want to provide a little background and a history of all of the scans I have received so far.  From a health insurance perspective, I am a radiology expense nightmare!

Since June, I have have received 3 MRIs, 2 PET scans, 1 CT scan, 4 ultrasounds/sonograms, and 1 X-ray.  Why all the different scans?  Here are some definitions of the different types of scans (from WebMD):

• Magnetic Resonance Imaging (MRI): is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body.  In many cases MRI gives different information about structures in the body than can be seen with an X-ray, ultrasound, or computed tomography (CT) scan. MRI also may show problems that cannot be seen with other imaging methods.  

• Positron Emission Topography (PET) is a test that uses a special type of camera and a tracer (radioactive chemical) to look at organs in the body. The tracer usually is a special form of a substance (such as glucose) that collects in cells that are using a lot of energy, such as cancer cells.  During the test, the tracer liquid is put into a vein (intravenous, or IV) in your arm. The tracer moves through your body, where much of it collects in the specific organ or tissue. The tracer gives off tiny positively charged particles (positrons). The camera records the positrons and turns the recording into pictures on a computer.  PET scan pictures do not show as much detail as computed tomography (CT) scans or magnetic resonance imaging (MRI) because the pictures show only the location of the tracer. The PET picture may be matched with those from a CT scan to get more detailed information about where the tracer is located.  A PET scan is often used to evaluate cancer, check blood flow, or see how organs are working.  

• Computed Tomography (CT) scans use X-rays to make detailed pictures of structures inside of the body.

• Ultrasound/Sonogram: During an ultrasound test, high-frequency sound waves, inaudible to the human ear, are transmitted through body tissues using an instrument called a transducer, which transmits the information to a computer that displays the information on a monitor. Ultrasound is used to create images of soft tissue structures, such as the gallbladder, liver, kidneys, pancreas, bladder, and other organs and parts of the body.

Here is a history of all 11 scans I have received so far:

6/24/2012
The day I went to the hospital, I had three scans.
1) An abdominal ultrasound/sonogram - this showed "spots" in my liver and that my liver was significantly enlarged, likely the source of the pain I was feeling.
2) An abdominal and pelvic MRI - this one confirmed the spots in my liver and suggested cancer.
3) A CT scan of my head/neck, abdomen, and pelvis.  This confirmed the presence of tumors in my liver and the lymph node in my neck. 

7/3/2012
4) A little over a week later, I had a PET scan - this showed my liver covered with tumors.

7/7/2012
5) I ended up in the ER with severe abdominal pain and they did an ultrasound.  I had moderate ascites (fluid collection) in the abdomen that was likely the result of the pain.

7/17/2012
6) I had another ultrasound that showed increased ascites but a decrease in the presence of liver tumors.

9/5/2012
7) Whole body PET scan - this test showed a remarkable decrease in tumor activity.

11/7/2012
8) Abdominal MRI - showed a decrease in the size and quantity of tumors in the liver.

12/10/2012
9) Abdominal ultrasound showed some ascites.

2/10/2012
10) MRI of the abdomen - showed an increase in size and number of tumors since the 11/7 MRI, but no tumors in the spleen, gall bladder, or pancreas.
11) Chest X-ray - showed that my lungs are also clear.

Although the MRI showed an increase in tumors (meaning the current chemotherapy regimen is no longer working), I am happy that there hasn't been further spread of the disease to other organs.  Every time I would cough or feel a pain in my side, I would worry that the tumors were spreading.  So far, this is not the case.  As it has been from the beginning, we really need to find a way to shrink the tumors in my liver.  I have lost a lot of liver function over the past few weeks, which I will talk about another time.  When the tumors shrink, my liver should start to work again.

Now we are tasked with figuring out what to do next.  We are going to Johns Hopkins this Thursday to see if there are any clinical trials that might be an option and what other treatments the doctor there might suggest.  I am going to push for something aggressive, even if it means more side effects.  I think I can handle the side effects if it means that we will be giving the tumors the best fight possible.