CT Scan w/Contrast or Echo....which is to be believed? More Accurate?

[Roxx]

Hi forum, it's been awhile. I have a question.
Since 2012 I have had what was said to be a stable aortic root at 4.1.... I take 50mg of

Metoprolol which keeps the Blood Pressure in check.
After having 5 consecutive annual ECHO's which have all ranged from 3.8 to 4.1 on the root measurement, my cardiologist said this year that he wanted me to have a CT Scan w/contrast and compare that with the ECHO's.

Here are the results:​

[h=3]Impression[/h] Unremarkable CT thorax. No aneurysm of the aorta is seen.

[h=3]Narrative[/h] PROCEDURE: CTA THORACIC AORTA

TECHNIQUE: 1.5 mm axial images were obtained through the chest before and after the administration of IV contrast (ISOVUE). A non-contrast localizer was obtained. 3D reconstructions were performed on the scanner to include sagittal and coronal MIP
images through the thoracic aorta.. ALL CT SCANS AT THIS FACILITY use dose modulation, iterative reconstruction, and/or weight-based dosing when appropriate to reduce radiation dose to as low as reasonably achievable.


FINDINGS:

Mediastinum and hila: Unremarkable. No hilar or mediastinal adenopathy.

Bones: Bones unremarkable.

Lungs: Unremarkable. No infiltrates or effusions are seen.

Vascular: The ace ascending and descending thoracic aorta are unremarkable. A descending thoracic aorta measures 2.9 cm. Ascending thoracic aorta measures 2.3 cm. No aneurysm or dissection is seen. No evidence for pulmonary emboli.


My doctor's office just said "everything looks good, your root is around 3.0, follow up with us next year."

Ok..... so how is this possible? Which is to believed? is the truth somewhere in between the 4.0 ECHO findings and this CT Scan?

Thanks for all your replies.

​

 

[Warrick]

I have been in your exact position, echo showed artery to be repaired and then CT scan and artery was untouched just valve replaced.
So I’m quite sure that CT is waay more acurate than echo as they get a 3D picture of things.

 

[pellicle]

Roxx

So I’m quite sure that CT is waay more acurate than echo as they get a 3D picture of things.

I'm with him ...

 

[pellicle]

also this on comparing angiogram to CT (angiogram is invasive through the artery and has some risks, was the gold standard (perhaps still is) but shows the advantages of CT:

https://www.ncbi.nlm.nih.gov/pubmed/1990170

As CT scanning has evolved as a reliable clinical tool, the use of angiography in the diagnosis of aortic aneurysmal disease has diminished. Fewer than 25% of patients with aortic aneurysmal disease undergo aortic angiographic evaluation at our institution.
A prospective clinical study was undertaken to assess the validity of this policy. One hundred patients with clinical or ultrasonographic evidence of aortic aneurysms were evaluated prospectively during the period July 1987 to December 1989.
All patients underwent CT scanning as an initial evaluation. Patients were selected for angiography if they fulfilled any of the following criteria: radiographic evidence of thoracoabdominal or juxtarenal aneurysms, or horseshoe kidney; or clinical suggestion of renal artery stenosis, mesenteric arterial insufficiency, aortoiliac occlusive disease, or lower extremity aneurysmal disease.
During this period 19 patients (19%) underwent both CT scanning and angiography.
The indications for angiography were thoracoabdominal aneurysms (7), juxtarenal aneurysms (2), clinical evidence of mesenteric insufficiency (1) or renal insufficiency (2), evidence of lower extremity aneurysmal disease (3), or severe aortoiliac occlusive disease (4).
Eighty-one patients (81%) underwent CT scanning as the only radiographic evaluation. No patient was adversely affected by elimination of angiographic evaluation.
T scanning revealed inflammatory aneurysms (4), retroaortic renal veins (2), and horseshoe kidney (1). This study suggests that most (81%) patients with aortic aneurysmal disease can be adequately evaluated by CT scanning, and that a very selective policy of angiographic evaluation is indicated.

 

[Roxx]

Thanks for the reply guys, and that above was very informative. I think my biggest concern is although I want to believe the CT scan results, I’m skeptical. Could all those ECHO’s have really been that inaccurate?

 

[pellicle]

, I’m skeptical. Could all those ECHO’s have really been that inaccurate?

skepticism is a good thing, as long as its not based in ignorance.

Even if you don't want to delve into the science, ask yourself this :
hy would hospitals and medical specialists continue to support a multi-million dollar, room filling piece of equipment, that has a precision aligned ring of sensors if a small thing on a trolley costing a couple of hundred thousand (at most) which is operated by a technician with a hand held transducer could be as accurate?

Its not "flat earth" or "moon landing fakery" conspiracy I can tell you that ...

 

[Rob88]

Hi Roxx,

I do CT scans for a living, CT is the more accurate test. The issue with echo is they are limited to how they can visualize the anatomy. The Aorta sits at different angles and the one performing the ultrasound tries to capture the anatomy from the top of the chest. They can't always get the perfect angle to get a true representation of the size of the aorta. With a CT scan, data is gathered from all angles of the body and the radiologist can adjust how the image is viewed to get an accurate picture. If the Aorta is sitting at an angle, they can get a direct overhead view to measure properly.

Keep in mind measurements are just someone drawing a line over a circle essentially and if the circle has thick outlines two people could draw that line at slightly different sizes. This is why there will be some variance sometimes in measurements of the same modality.

Hopefully that helps but let me know if that just brought up more questions.

Rob

 

[Roxx]

Guys thanks for all your replies..... so is a ascending aorta or descending aorta considered more the “root” ?? (I presume descending)

Trust me, I hope the CT scan is the more accurate. My skepticism is not if a CT scan is valuable, obviously it is for many applications. My skepticism is that there is like a 1cm difference in the findings (4.0-ish on Echo versus 3.0-ish on the CT scan that was just done)

if it was like a 0.2 difference, I wouldn’t question it.... but in this case it seems rather a significant difference.

 

[user 16827]

the root refers from where it leaves the aortic valve

the root aneurysm is on the ascending part before the arch

sounds like you have just won the lottery

best of luck

 

[user 16827]

https://lh6.googleusercontent.com/-m...placement3.PNG

 

[pellicle]

Hi

​​​
Trust me, I hope the CT scan is the more accurate. ...My skepticism is that there is like a 1cm difference in the findings (4.0-ish on Echo versus 3.0-ish on the CT scan that was just done)
.

It's more valuable BECAUSE it's more accurate. As rob88 has indicated (and he does them for a living).

Why are you so resistant to what everyone here says and your cardiologist and the specialist radiologist who did the ct are saying?
​​​​
Myself I'd be happy

 

[Roxx]

Hi


It's more valuable BECAUSE it's more accurate. As rob88 has indicated (and he does them for a living).

Why are you so resistant to what everyone here says and your cardiologist and the specialist radiologist who did the ct are saying?
​​​​
Myself I'd be happy

I am very very happy. You have no idea. I just don’t want to get my hopes up if not true. I mean, what are the odds my test was mixed up with another persons? Many of you seriously seem to know more about heart disorders than even some physicians I have been to. It’s why I always come here more than anywhere else for answers, as just about everyone here has been through most of the stages of this. Thanks again

 

[pellicle]

I am very very happy..... Thanks again

excellent.

BTW (I don't know if its all over your head or you go "ahhh") but the anatomy that leadville posted is good to know and understand (as is the anatomy of the arch)

The differences you mentioned are well within tolerances of measurement, and if you've ever actually LOOKED at that muddy mess of low resolution that an ultrasound gives you'd be unsurprised as to why its "a rubbery number"

I've recently posted this on the forum but I urge you to read it and understand as much as you can:

http://www.anzsvs.org.au/patient-information/aortic-aneurysm/

in particular the following points from that should suggest you were (even with the biggest reading) a long way away from joining us in post surgery (and by the way I'm doing quite fine thankyouverymuch after three surgeries in my life ... even not considering comparing to what it would be if I had not had said surgeries ... which would be dead)

I underlined a key point
[h=2]When do aortic aneurysms require treatment?[/h]
In healthy people the aorta (the main blood vessel that becomes swollen) is usually about 2.0-2.5 cms (20-25mm) in diameter although this can vary with age and whether you are a man or a woman. We know from two large studies in the USA and UK (Lederle FA et al, 2002) that aneurysms less than 5.5 cms (55mm) across can be safely watched as long as they are monitored on a regular basis. For aneurysms less than 4.4 cms across or less, a yearly ultrasound scan is sufficient to monitor aneurysm growth. For aneurysms between 4.5 and 4.9 cms across, a scan every 6 months is advised. An aneurysm greater than 5.0 cms across requires scans every 3 months although there is some variation in recommendations.

When an aneurysm reaches 5.5 cms most surgeons would consider offering surgical intervention.

 

[pellicle]

Also a worthy read:
https://en.wikipedia.org/wiki/Aorta