1. < MAC & Bronchiectasis

CT Scans vs Sputum Cultures, which is more important?

Posted by mch (Marycarol) @mch, May 31, 2023

I've seen lots of comments focused on sputum culture results as a determinant of whether treatment is successful or not.  I understand the relevance of these cultures, but I'm wondering about the relative importance of CT Scans.  Seems like the sputum culture results can be somewhat erratic, including false positive and false negative potential, and highly dependent on successful sputum production which introduces considerable variability in the quality of the sample.  Can't help but question the reliability of lab results.  I tested positive for MAC based on bronchoscopy, but my pulmonologist seems much more concerned with my CT scan and almost downplays the value of sputum cultures.  I did have 2 small (less than 2cm) cavities on my initial scan so that might be why he's focusing on the scans rather than cultures going forward.  I would appreciate hearing from anyone who's had cavities and what your experience has been with treatment (Big 3 and/or Arikayce) improving (or not) your CT scans.  Thank you.

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Rick | @rstel7272 | Jul 25, 2023
In reply to @harrynsc "Rick, Interesting. What city are you in? I'm in San Jose, CA. A single chest x-ray..." + (show)
@harrynsc

Rick,

Interesting. What city are you in? I'm in San Jose, CA.

A single chest x-ray exposes the patient to about 0.1 mSv. This is about the same amount of radiation people are exposed to naturally over the course of about 10 days.

A CT scan of the abdomen (belly) and pelvis exposes a person to about 10 mSv.

A PET/CT exposes you to about 25 mSv of radiation. This is equal to about 8 years of average background radiation exposure.

So you have had a lot of radiation!! Some doctors, such as my pulmonologist,
is hesitant to order too many scans. I have an appointment tomorrow,
and I will ask him about what additional information a CT gives over an
XRay.

I do have COPD and Emphysema, so maybe that makes a difference.

Harry

Radiation info from cancer.org website.

Jump to this post

I am 65 and live in Northern Colorado. I had one PET a 15 months ago (Negative, yea) and a VQ a year ago. I have a lot going on: Copd, Emphysema, MAC, cavitation, scar tissue, alpha-1, maybe some pulmonary hypertension, and now aspergillis. All but the aspergillus were diagnosed before most of the CT's. But hey, I played golf, fished and worked last week so I am not doing too bad.

REPLY
shar1120 | @shar1120 | Jul 25, 2023
In reply to @rstel7272 "I've had NTM's for 5 years, had about 20 CT's, not one x-ray other than just..." + (show)
@rstel7272

I've had NTM's for 5 years, had about 20 CT's, not one x-ray other than just after a surgical lung biopsy. And I've seen a lot of different pulminologists/id's, not one has ordered an x-ray.

Jump to this post

Same here. CT shows soft tissue that an X-ray can’t see

REPLY
harrynsc | @harrynsc | Jul 25, 2023
In reply to @harrynsc "Rick, Interesting. What city are you in? I'm in San Jose, CA. A single chest x-ray..." + (show)
@harrynsc

Rick,

Interesting. What city are you in? I'm in San Jose, CA.

A single chest x-ray exposes the patient to about 0.1 mSv. This is about the same amount of radiation people are exposed to naturally over the course of about 10 days.

A CT scan of the abdomen (belly) and pelvis exposes a person to about 10 mSv.

A PET/CT exposes you to about 25 mSv of radiation. This is equal to about 8 years of average background radiation exposure.

So you have had a lot of radiation!! Some doctors, such as my pulmonologist,
is hesitant to order too many scans. I have an appointment tomorrow,
and I will ask him about what additional information a CT gives over an
XRay.

I do have COPD and Emphysema, so maybe that makes a difference.

Harry

Radiation info from cancer.org website.

Jump to this post

Saw my pulmonologist today. He said you do see more with
a CT, but because of the high radiation, he doesn't order
them every three months. If things appear to be stable, he
will order the next one in six months, or depending on
what is going on, may order an XRay in three months for
a quick check.
Harry

REPLY
1 reply
ncgirl | @ncgirl | Aug 3, 2023

Well - my ct has been unchanged throughout my journey: im very grateful for the cultures as I don’t know I’d have ever received proper diagnosis without them as I kept getting very, very ill with respiratory symptoms & no one seemed to be able to tell me why until cultures. With this disease I don’t think any one test is the holy grail, it’s really looking at all the pieces, including your symptoms. Let us know how it goes

REPLY
Rick | @rstel7272 | Aug 4, 2023
In reply to @harrynsc "Saw my pulmonologist today. He said you do see more with a CT, but because of..." + (show)
@harrynsc

Saw my pulmonologist today. He said you do see more with
a CT, but because of the high radiation, he doesn't order
them every three months. If things appear to be stable, he
will order the next one in six months, or depending on
what is going on, may order an XRay in three months for
a quick check.
Harry

Jump to this post

I do love the term "stable", I wish I heard it more often.

REPLY
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