Triphasic CT results/Keytruda

[boxhill]

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.

[CRguy]

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

[Pyro70]

Do you mind sharing what insurance denied the MRI? I’ve never run into this.

[CRguy]

Pyro70

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

Insurance Cos increasingly resistant to scans

[LPL]

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.

[Green Tea]

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]

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.