Triphasic CT results/Keytruda

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boxhill
Posts: 335
Joined: Fri Apr 06, 2018 11:40 am

Triphasic CT results/Keytruda

Postby boxhill » Fri Jun 07, 2019 10:33 am

Well, as I noted in the thread about insurance companies and scans, they wouldn't let me have an MRI, so I had a "triphasic" CT scan instead. This is supposed to do a better job of imaging the liver. Apparently the dye is taken up in the arterial system and portal veins at different times, and what they do is take two sets of images timed to hit each phase. The two phases are less than a minute apart.

Lo and behold, it would appear that it actually worked better than the standard CT. The radiologist was able to see the presumed met, and by some kind of measurement wizardry compare the size to the MRI. He said it was "Substantially unchanged." The two enlarged lumph nodes in the porta hepatis, which were what I was most worried about, have shrunk down to normal size. Yeah! Apparently Keytruda is working!

There are no new issues.

Now I'm wondering if it is possible that the node is dead. I plan to push for having it removed, which should be possible laparscopically, I hope, because it is small, subcapular, and not near anything important. I'd be interested in other people's opinions and experiences with this kind of thing.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED
11/20/18 CT NED. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met? and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LN and spleen normal, Liver node stable
6/28/19 Pause Keytruda, predisone for joint pain
7/31/19 Restart Keytruda
9/10/19 CT stable

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CRguy
Posts: 9968
Joined: Sun Feb 10, 2008 6:00 pm

Re: Triphasic CT results/Keytruda

Postby CRguy » Sat Jun 08, 2019 12:58 pm

I've only had regular CTs with contrast and MRIs .... BUTT
thanks for bringing this info to the forum.

Biphasic and triphasic CTs really can have a very specific advantage
over some other scans, so I am glad your team is on board with what you need !

Cheers
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
12 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Pyro70
Posts: 142
Joined: Mon Jan 21, 2019 4:25 pm

Re: Triphasic CT results/Keytruda

Postby Pyro70 » Sat Jun 08, 2019 4:49 pm

Do you mind sharing what insurance denied the MRI? I’ve never run into this.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

User avatar
CRguy
Posts: 9968
Joined: Sun Feb 10, 2008 6:00 pm

Re: Triphasic CT results/Keytruda

Postby CRguy » Sat Jun 08, 2019 6:00 pm

Pyro70

boxhill's insurance topic with more info and inputs is here :

Insurance Cos increasingly resistant to scans
Caregiver x 4
Stage IV A rectal cancer/lung met
12 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

User avatar
LPL
Posts: 650
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Triphasic CT results/Keytruda

Postby LPL » Sun Jun 09, 2019 1:46 am

boxhill wrote:Well, as I noted in the thread about insurance companies and scans, they wouldn't let me have an MRI, so I had a "triphasic" CT scan instead. This is supposed to do a better job of imaging the liver. Apparently the dye is taken up in the arterial system and portal veins at different times, and what they do is take two sets of images timed to hit each phase. The two phases are less than a minute apart.

Lo and behold, it would appear that it actually worked better than the standard CT. The radiologist was able to see the presumed met, and by some kind of measurement wizardry compare the size to the MRI. He said it was "Substantially unchanged." The two enlarged lumph nodes in the porta hepatis, which were what I was most worried about, have shrunk down to normal size. Yeah! Apparently Keytruda is working!

There are no new issues.

Now I'm wondering if it is possible that the node is dead. I plan to push for having it removed, which should be possible laparscopically, I hope, because it is small, subcapular, and not near anything important. I'd be interested in other people's opinions and experiences with this kind of thing.

Sounds as your treatment is working boxhill
Congratulations ! :)
Thank you for explaining what a "triphasic" CT scan is, I was unaware of that test.
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb lung met

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Green Tea
Posts: 202
Joined: Mon Oct 24, 2016 10:48 am
Location: Nusa Tenggara

Re: Triphasic CT results/Keytruda

Postby Green Tea » Sun Jun 09, 2019 3:36 am

Thank you for posting this and for mentioning the term "Triphasic CT". I had never heard of this procedure before.

I'm still not quite sure what is involved in all of this, but it is my impression that it is a procedure that can be done on most CT scanners, provided the radiation technologist knows how to set up the scanner defaults and how to deliver the contrast agent in the required time sequence.

What is a Tri-Phasic CT scan?
https://www.answers.com/Q/What_is_a_Tri-phasic_ct_scan

TPCT - Tri-Phasic CT scan of the liver (slideshow)
https://www.slideshare.net/mobile/drpankajs/tpct-triphasic-ct-scan-liver

boxhill
Posts: 335
Joined: Fri Apr 06, 2018 11:40 am

Re: Triphasic CT results/Keytruda

Postby boxhill » Sun Jun 09, 2019 9:27 pm

Some of those descriptions are cryptic or confusing, to say the least.

But I can report that when you are having the scan it proceeds pretty much exactly like any other CT with contrast. You drink the barium yucky stuff in the waiting room, go in and have the IV placed for the contrast--and OMG do I really, really wish they could use my power port, because the IV really hurts--then they run some images with just the barium, then they inject the dye in the usual manner, you feel that special glow :)
, and they take two more sets. Those sets are evidently timed/programmed to image the portal vein phase and the arterial phase.

It seems so simple that I wonder why they don't do it that way as a matter of routine. Of course, it would appear that the phased images only really work in the liver...but I could be wrong.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/4/18 FOLFOX
Neulasta 6/28
7/9/18 CT NED
11/20/18 CT NED. Enlarged spleen.
12/20/18 Liver MRI 5mm liver met? and 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/5/19 Triphasic CT LN and spleen normal, Liver node stable
6/28/19 Pause Keytruda, predisone for joint pain
7/31/19 Restart Keytruda
9/10/19 CT stable


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