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I’m receiving conflicting diagnosis from two doctors. I

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recently had a CTA with...

I’m receiving conflicting diagnosis from two doctors. I recently had a CTA with contrast to evaluate pote rial stenosis. Nothing remarkable was found on the CTA. I next had an MRI and MRA. The MRA report suggested a possible aneurysm of 1.3mm in the left cavernous region of the Internal Carotid Artery. The neuro radiologist suggested a CTA to clarify. I provided the CTA from a different facility and he amended the report to state no anuerysm suspected. He also called me and stated that the MRA showed an artifact which he was able to rule out by viewing the CTA. He said my vessel was slightly undulating and countoured in a way that it was exaggerated on the MRA. He said this is somewhat common and the CTA is best for detecting in this area because of the bone around it. He seemed generally interested in my case and giving me the proper information.I decided to see a neurosurgeon at a top hospital for a second opinion. He viewed the MRA and stayed I have a 1.5mm aneurysm and wa sure of it. He said there is no artifact present and that the CTA is not accurate for detecting aneurysms in this area due to bone around it. Basically the opposite of what the neuro radiologist stated. He spent a few minutes passively viewing the images and was quick to get out of the room.Any advice? This is really difficult for me being such different opinions.

Submitted: 2 years ago.Category: Neurology

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10/13/2018

Neurologist: Dr. David, Board Certified MD replied 2 years ago

Dr. David, Board Certified MD

Category: Neurology

Satisfied Customers: 61,630

Experience: Experienced physician in Neurology

Verified

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

I would trust the radiologist

do you have headaches?

why did you think you had stenosis in your blood vessels of your brain?

Customer reply replied 2 years ago

Thanks for the follow up.I had an ultrasound performed and the cardiologist thought he heard turbulence in my Carotid Artery, right side. The CTA was to rule out possible stenosis.No headaches. History of ocular migraines.Can I ask your opinion on why you would trust the radiologist over the surgeon?

Neurologist: Dr. David, Board Certified MD replied 2 years ago

you are welcome

I would trust the radiologist

do you have headaches?

why did you think you had stenosis in your blood vessels of your brain?

Customer reply replied 2 years ago

Can you provide a little more detail on your opinion please?

Neurologist: Dr. David, Board Certified MD replied 2 years ago

you are young

chance for aneurysm is smal

you had both a MRA and CTA

MRs can have artifact.

the radiologist was more interested in your case.

Neurologist: Dr. Gerry, Neurosurgeon (MD) replied 2 years ago

Dr. Gerry, Neurosurgeon (MD)

Category: Neurology

Satisfied Customers: 2,598

Experience: Neurosurgery Brain and Spine Specialist Post Graduate Year 5

Verified

Hello! Im reviewing your concern. thank you for waiting.

CTA's and MRA's are both tools that can detect aneurysm. Both two modalities have almost the same specificity and sensitivity which means that both can see aneurysm in the same number of population and it also has drawbacks on not seeing it. possible causes if it is too small, if it has artifacts, if the aneurysm coalesce in the image with nearby structures. You might want to have a Digital Subtraction Angiography which is the gold standard to detect and surgically plan the aneurysm if there is any. Im hoping for your peace of mind!

Customer reply replied 2 years ago

How would you interpret both doctor’s opinions? One is suggesting MRA is producing an artifact - a curvature of my vessel. The other is suggesting the MRA is accurate.

Neurologist: Dr. Gerry, Neurosurgeon (MD) replied 2 years ago

It can happen because this two modalities both have an "interobserver and intraobserver variabilities" especially if the size of the aneurysm is too small. for further information, you might want to check on this research paper. https://www.ncbi.nlm.nih.gov/pubmed/28343249

Customer reply replied 2 years ago

I’m sorry but that doesn’t make sense or seem to answer my question. I have one doctor stating NO aneurysm and one doctor stating YES aneurysm. Both seem certain for different reasons

Neurologist: Dr. Gerry, Neurosurgeon (MD) replied 2 years ago

Usually if there are concerns regarding if there really is an aneurysm or not, which sometimes happen depending on the doctor who reads it. A DSA is warranted.

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