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  • PET scan without contrast

    We just recently moved to a new state, and therefor have a new Oncologist.
    Hubby is 1 year post chemo and due for a scan but this doc wants no contrast (oral or IV) and he has always had both oral and IV contrast in the past for all scans. Am I just worried or will a CT scan show any tumors without the contrast?
    Husband's history:
    7/17/08 ER with pain, found mass -antibiotics
    7/28/08 Repeat u/s
    7/30/08 blood work showed HCG 27, AFP 3
    switched docs!
    8/5/08 CT scan showed mets to lymph nodes (8.5cm)
    8/11/08 LIO, 100% Embryonal - stage II-C
    9/5/08 MRI showed no brain or bone involvement
    9/8/08 - 12/08 4xEP (baby girl born 9/25 )
    complications: chemo related anemia requiring 3 blood transfusions & Neulasta for low white blood cell counts.
    As of 02/2010 All free and clear!!!

  • #2
    I'm far from being real knowledgeable on this but I do know a regular CT scan will show enlarged lymph nodes and tumors as it did for my son. The contrast that is given for a PET scan makes any live cancer show up. The exception being Teratoma which will have no uptake as it is like regular live tissue as I understand it. Someone correct me if I be wrong.
    sigpic
    15 Dec 08 Son Vincent diagnosed with TC
    20 Dec 08 RT I/O, 85% EC,15% Teratoma
    3XBEP Feb to April 09
    18 Aug 09 ct scan,massive tumor in lymph nodes
    23 Sept 09 RPLND, 80% Immature Teratoma, 20% Mature Teratoma
    21 Dec 09 scan shows neck, abdomen and groin node enlargements
    21 Dec 09 Amended path report, Metastatic Primitive Neuroectodermal Tumor as well as Metastatic Teratoma
    29 Dec 09 starts 6X VAC/IE
    7 March pet scan shows new disease, chemo stopped
    Hospice 5/11/10
    Passed away 5/15/10

    Comment


    • #3
      Jay had with and without IV contrast always. The last few times he had without IV contrast on his CTscans because they couldn't find a vein and his creatinine level was too high. They were able to compare because of the prior ct's. Your doctor may be concerned about exposure to the IV contrast, have you asked him why he doesn't want to do IV contrast? Never heard of not drinking the stuff beforehand though.
      Diagnosed Mixed Germ Cell tumor Carcinoma and classic seminoma StageIIC 6*8cmbulky June 26-08
      Left I/O June 26-08 4*BEP July-08-Sept-08
      Mets to Abdomin/chest,
      Stage III, , 6*8 cm Jul 08
      Markers normalized Nov08, residual tumor 3*2cm in abd. 13mm in chest. Spinal Stenosis,Neuropathy RPLND feb 09
      Found all three: Cancer, teratoma and scar tissue
      10/09 B-HCG up to 39.90, recurrent TC, 2*VIP 12/09, TI started 05/11/2010, stem cell infusion 5/18/2010 day of rebirth
      08/10 all clear

      Comment


      • #4
        Contrast is definitely necessary for the types of structures radiologists need to see. Since CTs are X-ray-based, bone structures are spotted easily. The oral stuff (Gastrografin or barium) will coat your GI tract, which can be used as a reference. You can see very few lymphovascular structures without IV contrast, though. As far as a PET is concerned (since this is the title of your thread), I will tell you that you cannot do a PET without a positron source such as the 18-FDG contrast. The agent itself is the basis for getting a PET in the first place.
        "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
        11.22.06 -Dx the day before Thanksgiving
        12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

        Comment


        • #5
          Thanks everyone. Hmmm, I will have to call the imaging center and doc on Monday. In the past (before we moved) he has always had a PET scan but not real sure if this is a CT or PET scan but sounds like contrast (both oral and IV) should be used either way. Thanks again!
          Husband's history:
          7/17/08 ER with pain, found mass -antibiotics
          7/28/08 Repeat u/s
          7/30/08 blood work showed HCG 27, AFP 3
          switched docs!
          8/5/08 CT scan showed mets to lymph nodes (8.5cm)
          8/11/08 LIO, 100% Embryonal - stage II-C
          9/5/08 MRI showed no brain or bone involvement
          9/8/08 - 12/08 4xEP (baby girl born 9/25 )
          complications: chemo related anemia requiring 3 blood transfusions & Neulasta for low white blood cell counts.
          As of 02/2010 All free and clear!!!

          Comment


          • #6
            Originally posted by momof4 View Post
            Thanks everyone. Hmmm, I will have to call the imaging center and doc on Monday. In the past (before we moved) he has always had a PET scan but not real sure if this is a CT or PET scan but sounds like contrast (both oral and IV) should be used either way. Thanks again!
            A PET scan alone is not useful because you need a frame of reference in order to interpret the results. That's why a PET scan is always done together with either a CT scan or an MRI.
            "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
            11.22.06 -Dx the day before Thanksgiving
            12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

            Comment


            • #7
              According to the Oncologist it is a CT scan, not a PET scan and he refuses to use any contrast (oral or IV). He got a little short with me when I was persistent and explained that since Shane is a new patient and this is our fist scan with him he would have nothing to compare to, etc without using contrast. His response was this..."I don't understand why you are requesting unnecessary harm to your husbands kidneys. Contrast is not necessary for every scan...why do the harm?" When I persisted he said he would not do it with contrast.
              I was a little dumb founded and unsure how to respond. He is suppose to be the expert but Shane and I aren't comfortable with his reasoning. This is not the surveillance we are used to. I still worry since this should be the one year "all clear"...shouldn't we do it right? Or are we over reacting?
              Husband's history:
              7/17/08 ER with pain, found mass -antibiotics
              7/28/08 Repeat u/s
              7/30/08 blood work showed HCG 27, AFP 3
              switched docs!
              8/5/08 CT scan showed mets to lymph nodes (8.5cm)
              8/11/08 LIO, 100% Embryonal - stage II-C
              9/5/08 MRI showed no brain or bone involvement
              9/8/08 - 12/08 4xEP (baby girl born 9/25 )
              complications: chemo related anemia requiring 3 blood transfusions & Neulasta for low white blood cell counts.
              As of 02/2010 All free and clear!!!

              Comment


              • #8
                Does Shane have kidney issues? Before a CT scan is done, bloodwork is necessary (BUN and creatinine) to check whether kidney function is normal. If those results are abnormal, then contrast is not used. Similarly, if Shane is taking metformin (Glucophage), then there are certain contrast agents that are incompatible.

                CTs can be done without contrast, but in the absence of contrast, all you are really getting is an expensive X-ray. The only time I have had a CT without contrast was to determine the location of a pulmonary nodule. In that case, the contrast was unnecessary because I already had a baseline chest CT from a few years back. The report did note that the absence of IV contrast precluded the analysis of mediastinal lymphovascular structures.
                "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
                11.22.06 -Dx the day before Thanksgiving
                12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

                Comment


                • #9
                  Thanks Fed! No, Shane has no kidney problems at all and is not on any medication besides Testim. He just had blood work done and everything looked great, including his tumor markers
                  Looks like our best bet is to postpone the scan another month in the search of another oncologist, that's the beauty of having a PPO I guess. It seems like this would be the better option so we can see those lymph nodes...since if there is anything, that is where it would be.
                  Husband's history:
                  7/17/08 ER with pain, found mass -antibiotics
                  7/28/08 Repeat u/s
                  7/30/08 blood work showed HCG 27, AFP 3
                  switched docs!
                  8/5/08 CT scan showed mets to lymph nodes (8.5cm)
                  8/11/08 LIO, 100% Embryonal - stage II-C
                  9/5/08 MRI showed no brain or bone involvement
                  9/8/08 - 12/08 4xEP (baby girl born 9/25 )
                  complications: chemo related anemia requiring 3 blood transfusions & Neulasta for low white blood cell counts.
                  As of 02/2010 All free and clear!!!

                  Comment


                  • #10
                    The idea that he got upset and is refusing to do the CT scan with contrast would have me heading out the door for another doctor as well. When I have my CT Scans they always do the creatinine and I believe the BUN test as well just to make sure there hasn't been any changes to my kidney function since the last time. I have a minor allergic reaction to the IV contrast(hives) and they still give me the contrast.

                    Good luck on a new doctor!
                    Scott
                    Pure mature Teratoma
                    Stage 1
                    Surveillance
                    5/12/09-Diagnosed with TC
                    5/14/09 Left I/O
                    5/20/09 All Clear
                    8/27/09 All Clear
                    11/19/2009 All Clear
                    2/25/2010 All Clear
                    5/6/2010 All Clear- 1 year milestone
                    9/16/2010 All Clear
                    1/20/2011 All Clear
                    5/26/2011 All Clear- 2 year milestone
                    12/8/2011 All Clear-2.5 years
                    6/21/2012 All Clear-3 years.

                    Comment


                    • #11
                      PET scan and CT scan - different types of scan

                      Hi.
                      I'm reading this post and ( according to my knowlege ) You are mixing two types of scanners.
                      I had both of themy in my life and i can describe how it was for me :
                      1) PET scan ( Positron emission tomography ) is type of scanner that is using as a source of radiation special radioactive fluide that is give as IV 1 hour before scan. In this time this fluide is absorbe by even a single cancer cell . Durring this time You can't move to much becouse Your mussle also will absorbe this fluide. Scan takes about 20-30 min and after You need to drink a lot of water or avoid contact with small children and pregnent women for 24 hours.
                      2) CT scan ( Computed tomography ) - soure of radiation is in the machine . You have it WITHOUTH contrast , with IV contrast , with oral contrast , or with both type - it depend what part of Your body is going to be check and how advance machine You will use for scan I had all types of them. I had even CT scan that require oral contrast not only before scan but also day before .Scanner takes about 3 min up to 25 min . If You get IV contrast it is given DURING scan when You are inside machine .

                      In total i had 3 x PET scan and about 25 CT scans during last 8 years , most of them in Poland , few in France .
                      I hope it will help, sorry for language mistakes )
                      Thanks.
                      Krzysiek
                      ps: there is also third type of scanner : MR - (Magnetic resonance) or MRI (magnetic resonance imaging) - no contrast - what is special in this type of scanner is that is very LOUD - like someone is shooting from AK47 near You )
                      TC - You think it's the end, but it's just the beginning.

                      Comment


                      • #12
                        Thanks everyone! I now know the difference between the scans. My confusing title was due to the fact that I was not sure which scan was ordered by the doc. Shane has had both in the past but never has he had anything ordered without contrast....well, except for his MRI in the beginning.
                        as of 2/16 his BUN was 19 mg/dL (normal range is 7-25) and his creatinine is was 1.05 mg/dL (normal range is 0.79-1.33). Everything normal there.
                        From everyones experiences here it just confirmed our hesitation of no contrast.
                        This morning I faxed all Shane's records to UCSD's Moore Cancer Center here in San Diego and am waiting for a call back to schedule an appointment. New doc time!
                        Husband's history:
                        7/17/08 ER with pain, found mass -antibiotics
                        7/28/08 Repeat u/s
                        7/30/08 blood work showed HCG 27, AFP 3
                        switched docs!
                        8/5/08 CT scan showed mets to lymph nodes (8.5cm)
                        8/11/08 LIO, 100% Embryonal - stage II-C
                        9/5/08 MRI showed no brain or bone involvement
                        9/8/08 - 12/08 4xEP (baby girl born 9/25 )
                        complications: chemo related anemia requiring 3 blood transfusions & Neulasta for low white blood cell counts.
                        As of 02/2010 All free and clear!!!

                        Comment

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