Radiology - Help with interpreting CT

Author

Help with interpreting CT

deaddog@cotse.net

2006-01-08, 11:39 am

I just did a walk-in CT heart scan. I understand the debate on the
value of these for asymptomatic people and I suspect that my inquiry
demonstrates some of these problems.

Note that although the scan shop advertised a cardiologist and
radiologist consult, no cardiologist was on the premises. Radiologist
advised no need for cardiac consult but urged another scan in 2-3 years
(instead of 10 years for "normal" people)

So, I'm Iooking for any input/advice in light of the following CT
scores -- for example, get to a cardiologist ASAP, no need for Dr.,
just try to maintain healthy lifestyle, and/or quit being a
hypochondriac, etc.

Biggest concern is CT radiologist says calcium score is bad for my age
(90% of people better than me) THANKS++++

45 y/o white male
5''9" 175 lbs

Exercises 5-6 days/week (30-40 minutes high level (145-150 heart rate)
cardio on elliptical or bike)

Non-smoker (smoked a little in college 25 years ago, nothing since)

Cholesterol Total 158; LDL 86; HDL 53
Triglycerides 96

Family history of heart disease (Father MI + quintuple bypass in
mid-60's when otherwise very healthy weight, non-smokeretc)

Very high stress job and personal life; work 70+ hours/week

CT results on siemens 64 slice - dye injection for CT angiogram

Calcium - - score 39 with 1 lesion (LM Artery) volume 33.8 mm3; equiv
mass (mg CaHa) 7.58
Radiologist says huge amount of calciumin bad place at junction of
two arteries

CT Angiogram -- Radiologist says lesion is primarily "outside" artery
and he estimates 15% blockage

Other symptoms - probably none although very mild chest pain/tightness
in high stress (emotional) situations - very well could by psychosomatic

Andrew Kerr

2006-01-08, 11:39 am

deaddog@cotse.net wrote:
> I just did a walk-in CT heart scan. I understand the debate on the
> value of these for asymptomatic people and I suspect that my inquiry
> demonstrates some of these problems.
>
> Note that although the scan shop advertised a cardiologist and
> radiologist consult, no cardiologist was on the premises. Radiologist
> advised no need for cardiac consult but urged another scan in 2-3 years
> (instead of 10 years for "normal" people)
>
> So, I'm Iooking for any input/advice in light of the following CT
> scores -- for example, get to a cardiologist ASAP, no need for Dr.,
> just try to maintain healthy lifestyle, and/or quit being a
> hypochondriac, etc.
>
> Biggest concern is CT radiologist says calcium score is bad for my age
> (90% of people better than me) THANKS++++

You're right, your case does demonstrate the negative side of performing
diagnostic tests on an otherwise healthy, asymptomatic person.

On the one hand, you do have a family history of heart disease and
therefore have at least one risk factor. On the other hand, you are
capeable of sustaining a high workload for a long time with no cardiac
symptoms.

Now you have found out that you have a calcium lesion in your left main
artery. So now what do you do?

On thing you didn't mention, do you have diabetes? This is very
important when dealing with suspected coronary disease in an
asymptomatic person. I suspect that you don't, or else you would have
mentioned it.

There are other tests you could have that would provide you with
functional information about your heart; a Cardiolite/Thallium scan, or
an exercise echocardiogram. I think both these tests must be ordered by
a physician.

I will confess that I don't know a lot about calcium scores, as that
form of testing is not widely performed in my part of the world
(Ontario, Canada). However, I suspect that if the radiologist was truly
concerned he/she would have set up a consult with a cardiologist.

Andrew
ps: I'm not a doctor, I am a nuclear medicine technologist

Ray Laughton

2006-01-08, 11:39 am

Andrew Kerr <apkerr@yahoo.com> wrote:

>
> Now you have found out that you have a calcium lesion in your left main
> artery. So now what do you do?

Maybe they could crush it (like kidney stones) with a lithotrypser? :-/
The stress-ECG /Ergometry would be the next step IF you have angina.
7.58mg of calcium, hmmmm. I doubt that any CT is so accurate as to be
able to estimate to .01 of a mg, so this result is a bit suspect.

RL

RThud4@aol.com

2006-01-09, 5:59 pm

Based on the calcium score, it sounds as if you would have a potential
widow maker. The cardiac CTA sounds more innocuous. However, if I were
you, I would get the cardiac CTA second-opinioned by an experienced
fellowship-trained radiologist or an experienced interventional
cardiologist with extra CT training and experience. I would also
consider getting a cardiac MR, getting a folllow-up CT score and
cardiac CTA. I would also modify the stress if I were you. P.S., I am a
radiologist.