Need some help with CT results (What is ill defined soft tissue attenuation?)

Please feel free to read, share your thoughts, your stories and connect with others!
tater
Posts: 114
Joined: Wed Jul 19, 2017 5:53 pm

Need some help with CT results (What is ill defined soft tissue attenuation?)

Postby tater » Fri Jun 14, 2019 6:23 pm

Quick update and sorry I’m using my phone so spelling maybe bad. Three months ago my wife’s CEA rose from 1.3 to 1.8. The CT scan showed a restriction of the right uereter most likely scarring from radiation. She also has a stint placed there from her resection surgery where they removed her eight external iliac nodes. One has cancer the rest clean. Fast forward to today CEA is up to 2.5. Onc says don’t worry kidney issues can elevate it. The CT from this week says this and I need help understanding how worried I should be.
At location of the urethras narrowing there is some ill- defined soft tissue attenuation along right pelvic sidewalk measuring 1.2-1.0 cm in axial dimensions. An enlarged lymph node could give this appearance. Ureteral stricture would be an additional consideration.

If it is rectal cancer in the node should it grow that fast from on scan three months ago to now? What the odds it scarring? Can the node be enlarged due to kidney issues?

My wife does over heal and has had some granulations removed from vaginal wall.

Not sure how to feel right now. Plan is to have small surgery in two weeks to look at ureter and possible stint after testing.
Last edited by tater on Mon Jun 17, 2019 12:37 pm, edited 1 time in total.
DH to 38 wife w/kids
Stage 3C DX 3/3/17 CEA 29
5-fu and radiation ended May 17, 2017
Stage 4 External iliac node July 17, 2017
FOLFOX + Avistan July 18 2017 CEA 2.3
Nov 9, 2017 Coloanal Anastomosis, Hysterectomy & External Nodes Removed W/ileostomy
Clear Margins NED
CEA 1.5 12/17, 2.1 2/18, 2.3 6/18, 1.1 9/18, 1.3 12/18, 1.8 3/19, 2.5 6/19
Clear CT and MRI on 2/5/2018, 9/18 Clear Scans
Reversal Surgery 6/26/18

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

Re: Need some help with CT results

Postby Green Tea » Sat Jun 15, 2019 6:48 am

tater wrote:... Three months ago my wife’s CEA rose from 1.3 to 1.8... Fast forward to today CEA is up to 2.5. Onc says don’t worry kidney issues can elevate it...

You asked about help on CT interpretation, but this reply is about interpreting rises in CEA instead, since you mentioned a sequence of 1.3 to 1.8 to 2.5.

First of all, these CEAs are all within normal range, so there's not an obvious problem there. But you have a sequence of successively increasing CEAs, so you could use this information to see if this rate of increase is excessively high or not.

There are some rules of thumb for evaluating rates of CEA increase over time, where increases of over 12.6% per month are considered somewhat troublesome. You can keep this in mind when evaluating a series of CEA measurements.
http://coloncancersupport.colonclub.com/viewtopic.php?t=53702&p=426284#p426284

Some additional information on CEA interpretation is given here:
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60075&p=476909#p476909

tater
Posts: 114
Joined: Wed Jul 19, 2017 5:53 pm

Re: Need some help with CT results

Postby tater » Sat Jun 15, 2019 9:34 am

Green Tea wrote:
tater wrote:... Three months ago my wife’s CEA rose from 1.3 to 1.8... Fast forward to today CEA is up to 2.5. Onc says don’t worry kidney issues can elevate it...

You asked about help on CT interpretation, but this reply is about interpreting rises in CEA instead, since you mentioned a sequence of 1.3 to 1.8 to 2.5.

First of all, these CEAs are all within normal range, so there's not an obvious problem there. But you have a sequence of successively increasing CEAs, so you could use this information to see if this rate of increase is excessively high or not.

There are some rules of thumb for evaluating rates of CEA increase over time, where increases of over 12.6% per month are considered somewhat troublesome. You can keep this in mind when evaluating a series of CEA measurements.
http://coloncancersupport.colonclub.com/viewtopic.php?t=53702&p=426284#p426284

Some additional information on CEA interpretation is given here:
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60075&p=476909#p476909



Sorry for the confusion I was just trying to give the history and that’s part of it. The section from the CT that I need help with is the statement below.

At location of the urethras narrowing there is some ill- defined soft tissue attenuation along right pelvic sidewalk measuring 1.2-1.0 cm in axial dimensions. An enlarged lymph node could give this appearance. Ureteral stricture would be an additional consideration.

What is ill defined soft tissue ? On my wife’s CT scans that had nodes affected with rectal cancer they were able to say that. Not sure if that’s because of the PET scan results or if their is a difference in the way the tissues look.


Once again for being vague on previous post. Yes the rise in CES has me worried but google and onc say it could be kidney function cause the rise due to the restriction in the ureter.
DH to 38 wife w/kids
Stage 3C DX 3/3/17 CEA 29
5-fu and radiation ended May 17, 2017
Stage 4 External iliac node July 17, 2017
FOLFOX + Avistan July 18 2017 CEA 2.3
Nov 9, 2017 Coloanal Anastomosis, Hysterectomy & External Nodes Removed W/ileostomy
Clear Margins NED
CEA 1.5 12/17, 2.1 2/18, 2.3 6/18, 1.1 9/18, 1.3 12/18, 1.8 3/19, 2.5 6/19
Clear CT and MRI on 2/5/2018, 9/18 Clear Scans
Reversal Surgery 6/26/18

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

Need some help with CT results: What is "soft tissue attenuation"?

Postby Green Tea » Sat Jun 15, 2019 10:54 pm

tater wrote:... The section from the CT that I need help with is the statement below.

    At location of the urethra's narrowing there is some ill- defined soft tissue attenuation along right pelvic sidewall measuring 1.2-1.0 cm in axial dimensions. An enlarged lymph node could give this appearance. Ureteral stricture would be an additional consideration.

What is ill defined soft tissue ? On my wife’s CT scans that had nodes affected with rectal cancer they were able to say that. Not sure if that’s because of the PET scan results or if there is a difference in the way the tissues look...

tater
Posts: 114
Joined: Wed Jul 19, 2017 5:53 pm

Re: Need some help with CT results (ill defined soft tissue attenuation)?

Postby tater » Mon Jun 17, 2019 11:31 am

tater wrote:Quick update and sorry I’m using my phone so spelling maybe bad. Three months ago my wife’s CEA rose from 1.3 to 1.8. The CT scan showed a restriction of the right uereter most likely scarring from radiation. She also has a stint placed there from her resection surgery where they removed her eight external iliac nodes. One has cancer the rest clean. Fast forward to today CEA is up to 2.5. Onc says don’t worry kidney issues can elevate it. The CT from this week says this and I need help understanding how worried I should be.
At location of the urethras narrowing there is some ill- defined soft tissue attenuation along right pelvic sidewalk measuring 1.2-1.0 cm in axial dimensions. An enlarged lymph node could give this appearance. Ureteral stricture would be an additional consideration.

If it is rectal cancer in the node should it grow that fast from on scan three months ago to now? What the odds it scarring? Can the node be enlarged due to kidney issues?

My wife does over heal and has had some granulations removed from vaginal wall.

Not sure how to feel right now. Plan is to have small surgery in two weeks to look at ureter and possible stint after testing.
DH to 38 wife w/kids
Stage 3C DX 3/3/17 CEA 29
5-fu and radiation ended May 17, 2017
Stage 4 External iliac node July 17, 2017
FOLFOX + Avistan July 18 2017 CEA 2.3
Nov 9, 2017 Coloanal Anastomosis, Hysterectomy & External Nodes Removed W/ileostomy
Clear Margins NED
CEA 1.5 12/17, 2.1 2/18, 2.3 6/18, 1.1 9/18, 1.3 12/18, 1.8 3/19, 2.5 6/19
Clear CT and MRI on 2/5/2018, 9/18 Clear Scans
Reversal Surgery 6/26/18

tater
Posts: 114
Joined: Wed Jul 19, 2017 5:53 pm

Re: Need some help with CT results (What is ill defined soft tissue attenuation)?

Postby tater » Mon Jun 17, 2019 11:31 am

tater wrote:
tater wrote:Quick update and sorry I’m using my phone so spelling maybe bad. Three months ago my wife’s CEA rose from 1.3 to 1.8. The CT scan showed a restriction of the right uereter most likely scarring from radiation. She also has a stint placed there from her resection surgery where they removed her eight external iliac nodes. One has cancer the rest clean. Fast forward to today CEA is up to 2.5. Onc says don’t worry kidney issues can elevate it. The CT from this week says this and I need help understanding how worried I should be.
At location of the urethras narrowing there is some ill- defined soft tissue attenuation along right pelvic sidewalk measuring 1.2-1.0 cm in axial dimensions. An enlarged lymph node could give this appearance. Ureteral stricture would be an additional consideration.

If it is rectal cancer in the node should it grow that fast from on scan three months ago to now? What the odds it scarring? Can the node be enlarged due to kidney issues?

My wife does over heal and has had some granulations removed from vaginal wall.

Not sure how to feel right now. Plan is to have small surgery in two weeks to look at ureter and possible stint after testing.
DH to 38 wife w/kids
Stage 3C DX 3/3/17 CEA 29
5-fu and radiation ended May 17, 2017
Stage 4 External iliac node July 17, 2017
FOLFOX + Avistan July 18 2017 CEA 2.3
Nov 9, 2017 Coloanal Anastomosis, Hysterectomy & External Nodes Removed W/ileostomy
Clear Margins NED
CEA 1.5 12/17, 2.1 2/18, 2.3 6/18, 1.1 9/18, 1.3 12/18, 1.8 3/19, 2.5 6/19
Clear CT and MRI on 2/5/2018, 9/18 Clear Scans
Reversal Surgery 6/26/18

Punky44
Posts: 379
Joined: Mon Oct 01, 2018 4:29 pm

Re: Need some help with CT results (What is ill defined soft tissue attenuation?)

Postby Punky44 » Tue Jun 18, 2019 12:19 am

I wish I could shed some light on what that means, but hopefully it is nothing—I will be praying for you and your wife that you get good news. I remember how much you helped me in the early days with my mom.
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17 at diagnosis
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
CEA 4/23: 2.1; 7/24: 1.9; 10/22: 2.6
6/28/19 Reversal and port out
10/22 — nodules on lungs—possible infection or mets—PET scheduled for 11/25

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

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

Re: Need some help with CT results: What is "soft tissue attenuation"?

Postby Green Tea » Tue Jun 18, 2019 2:51 am

BUMP
Bumping this up. Hopefully, someone with pelvic CT-scan experience will chime in with a few comments or observations on the topic of "attenuation". The radiologist here seems to be concerned about "attenuation", but what exactly is "attenuation"?

tater wrote:... The section from the CT that I need help with is the statement below.

    At location of the urethra's narrowing there is some ill- defined soft tissue attenuation along right pelvic sidewall measuring 1.2-1.0 cm in axial dimensions. An enlarged lymph node could give this appearance. Ureteral stricture would be an additional consideration.

What is ill defined soft tissue ? On my wife’s CT scans that had nodes affected with rectal cancer they were able to say that. Not sure if that’s because of the PET scan results or if there is a difference in the way the tissues look...

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

Re: Need some help with CT results (What is ill defined soft tissue attenuation?)

Postby Green Tea » Wed Jun 19, 2019 2:30 pm

tater -

I have a question. Did the doctor who ordered your wife's CT scan specify on the CT-scan requisition that the patient has a ureteric stent? I read somewhere that patients with stents should always inform the radiologist that they have a stent. This is so that the radiologist can take this into account while interpreting the scan images.

The fact that there was a stent in very close proximity to your wife's ureteric stricture might mean that the scanner produced an artifact in the image next to the stricture (i.e., some kind of mirage due to the scattering of x-ray beams there) . Maybe this is something you could ask the doctor about next time.

https://www.radiologymasterclass.co.uk/gallery/abdo/abdomen_xray_artifact/ureteric_stent

tater
Posts: 114
Joined: Wed Jul 19, 2017 5:53 pm

Re: Need some help with CT results (What is ill defined soft tissue attenuation?)

Postby tater » Thu Jun 20, 2019 8:52 am

Green Tea wrote:tater -

I have a question. Did the doctor who ordered your wife's CT scan specify on the CT-scan requisition that the patient has a ureteric stent? I read somewhere that patients with stents should always inform the radiologist that they have a stent. This is so that the radiologist can take this into account while interpreting the scan images.

The fact that there was a stent in very close proximity to your wife's ureteric stricture might mean that the scanner produced an artifact in the image next to the stricture (i.e., some kind of mirage due to the scattering of x-ray beams there) . Maybe this is something you could ask the doctor about next time.

https://www.radiologymasterclass.co.uk/gallery/abdo/abdomen_xray_artifact/ureteric_stent


The stent was originally placed in her 18 months ago when the did the resection surgery. THey removed it than. At the time of the CT she had no stent. We are going in next week to the urologist where chances are they will stent her for 6 wks to see if that does something.
DH to 38 wife w/kids
Stage 3C DX 3/3/17 CEA 29
5-fu and radiation ended May 17, 2017
Stage 4 External iliac node July 17, 2017
FOLFOX + Avistan July 18 2017 CEA 2.3
Nov 9, 2017 Coloanal Anastomosis, Hysterectomy & External Nodes Removed W/ileostomy
Clear Margins NED
CEA 1.5 12/17, 2.1 2/18, 2.3 6/18, 1.1 9/18, 1.3 12/18, 1.8 3/19, 2.5 6/19
Clear CT and MRI on 2/5/2018, 9/18 Clear Scans
Reversal Surgery 6/26/18


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: Google [Bot], NHMike and 44 guests