Which is best- MRI or CT?

• By joyceg98
• Posted September 12, 2009 at 10:15 am
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The best advice I could give you would be to send copies of both to Dr. Libutti in New York and ask him. Radiology is an art, not a science. It's not the scan itself that declares it to be fish or fowl, it's the radiologist reading the scan who makes that declaration. It's his/her opinion -- an educated opinion to be sure, but don't forget that most radiologists in the field have limited experience with pancreatic cysts and tumors -- most of the pancreatic cancer they see has already metastasized, and we are asking different questions.

MRI's and CT's provide slightly different kinds of information about the nature of the tumor, but again it takes practice to understand the nuances of the different shades of gray, and what lights up differently in the presence of which contrast medium.

So here is the contact information for Dr. Libutti. He has posted a note in this list saying that he is willing to review scans for people with VHL in order to assist with this very tricky question.

Steven K. Libutti, M.D., FACS
Montefiore Medical Center
Greene Medical Arts Pavilion
3400 Bainbridge Avenue, 4th Floor
Bronx, NY 10467

718-920-4231

Best wishes,
Joyce

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• By TinaDiane
• Posted September 12, 2009 at 12:00 pm
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I completely agree with Joyce. My MRI's say pancreatic cysts. My CT scans and PET scans (from NIH also) say pancreatic neuroendocrine tumors. I had surgery 8 years ago and the tumors they removed were pancreatic neuroendocrine tumors, so we know what they are. I went to see Dr Libutti in NY, and he is THE BEST!! Brilliant, kind, has done most of the research at NIH about these tumors, done surgeries, watched outcomes, everything. 2 docs at NIH said I needed to have my pancreas removed (imagine my scare) and the next day, Dr Libutti told me NO. My tumors are under 2 cm, and their doubling time is slow. He said he could pop out the tumors during surgery (if and when I have to have it done) and save some of my pancreas (to ward off diabetes and malabsorption of food). Now, I just send him my CT/PET scans every 3-6 months and he is watching me closely. This is a HUGE relief because I live in Central Oregon, where there are no docs familiar with VHL.

Good Luck Kim, hope this helps!!
Tina

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• By kimbre
• Posted September 12, 2009 at 5:58 pm
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Wow! Thank you Tina and Joyce. You guys have been super helpful. I will get my scans to Dr. Libutti right away. I so appreciate your help on this.
Kim

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• By Ieva
• Posted September 13, 2009 at 4:42 am
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Everything depends on the equippment used-the more modern are able to provide more precise information. However CT is believed to be better for discovering cysts, though the best method still can be ultrasound, especially endoscopic. But as to the type of malformations-cysts, especially tail cysts can be precancerous or even cancerous.

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• By joyceg98
• Posted September 14, 2009 at 12:23 pm
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Hi, Leva,

Ultrasound is not considered adequate for monitoring cysts and tumors of the pancreas and kidney. Ultrasound is highly dependent on the quality of the machine and the experience of the operator. We have seen all too many cases where ultrasound has missed important information in these critical organs.

We recommend ultrasound for children because there is no radiation, it's not at all scary, and the likelihood of finding anything that needs action is low.

Ultrasound is used for asymptomatic screening in some countries because the cost is significantly lower than MRI or CT.

But once we know that there is something add on the ultrasound, follow-up by CT or MRI is highly recommended, in order to get a clearer picture of what is happening.

Most people by now have seen an ultrasound picture -- that first prenatal baby picture if nothing else. It looks like underwater photography with a poor camera. Like a submarine, they bounce sound waves and calculate by computer the distance and the nature of the structure bouncing the waves back.

This is certainly helpful for lots of things, but not precise enough to measure the size of a growing tumor.

Best wishes,
Joyce

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• By jmathison
• Posted September 15, 2009 at 1:09 am
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Hi Kim, I just experienced the exact situation myself with one report stating cysts and the other stating tumors on the pancreas. I too will be sending my films to Dr. Libuitti. Thanks for bringing the issue to the forefront!

Keep in touch. :)

Jenny

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• By kimbre
• Posted September 15, 2009 at 10:24 am
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It's interesting that this is such a common thing. I am just so glad he is available, what would we do?? Let me know what happens for you Jenny. I ordered my scans this week to come to me, then I will send them together with a note to him. Is that how you are doing it?
Kim

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• By joyceg98
• Posted September 16, 2009 at 12:24 pm
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Sometimes the Medical Records people will charge you for the copy if they hand it to you, but not if it is mailed directly to a reviewing doctor for a second opinion. Depending on their policy, you might want to contact the reviewing doctor's office, ask if he would review the scans, and then tell them they will be coming from Medical Records. You can put your cover note into a separate message.

Either way is fine from the perspective of the reviewing doctor.

Best wishes,
Joyce

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