New CT scan indicates changes: Can radiologist reports be different?

I'm not a radiologist; my retired spouse was a great one, but neither is helpful right now to you. I try to open this link every day since I am a survivor of ARDS and because I'm alive I want to be supportive of others. This then is a little note to let you know that you have been heard and are being thought about with wishes sent for your peace of mind and your good health, Sincerely, Theresa in Upstate NY.

@akfishinmom1, these are great questions to ask your specialist. It is possible that at the time of the previous scan, these findings were unremarkable and therefore not noted. I would be interested in what you learn from your specialist. When is your next appointment?

I just had my appointment with pulmonoligist and he looked and said on the 2nd Ct scan the radiologist used the first scan and resized the nodule and then compared it to my second one. So based on that he said the subsolid portion grew less than a millimeter but the overall groundglass portion grew from 2.2 to 2.4 cm. The first radiologist measured the whole nodule at 18mm not 2.2. That’s a big difference. Very confusing. Also said there was no abnormal upper lymph nodes shown in partial imaging. But the pretrachael lymph node on the second scan showed as 8.8 on the short axis. Very concerning. These scans were done ar different facilities and the first one was for a calcium CT scan and second for lung scan.

It can be so confusing. Thank goodness medical specialists are trained to interpret the differences in reporting that can happen between facilities and order new tests when necessary. I'm sorry to hear that a pretracheal lymph node is showing evidence of concern. What is the next step? Will it be biopsied or further tested?

I have a PET CT scan in early September. It is the 5.5 mm sub solid portion the radiologist is concerned about for low grade malignancy. What sent my anxiety into overdrive was when the pulmonologist mentioned if the lymph node was involved it was stage 3 lung cancer.

@akfishinmom1- Hello, it's nice to meet you. I am a lung cancer survivor and the Mentor for the lung cancer group. I have run into this problem and I have to say that it shouldn't be a problem. I am treated at the second top hospital in the US and my Lung Surgeon and Oncologist now wait until after the radiologist's report to make a finding and send me the actual report. No matter how clear the CT scan is, radiologists are trained to see and measure everything little thing that they are looking for that no matter how minuscule they are. Even if doctors sometimes brag that they are great at reading CT scans, unless they are in front of the screen and are trained to read scans they aren't as good as radiologists.

My Oncologist actually goes to the radiologist who reads my scans and looks at his screen and discusses things with him/her!

Scans also depend on the size of the slice (tissue slice that is captured) that the machine is programmed for at your hospital. The thickness of the tissue represented in each image slice can vary depending on the CT machine used, but usually ranges from 1-10 millimeters.
https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct
If I were you, I would ask for an explanation of the differences in measurements. Also, the ground glass area can be made up of different types of tissues. Your specialist should explain this to you in a manner that you fully understand.

Computed tomography machines are set at different levels in different hospitals, and you had two different types of tests. Also, Lymph nodes can be swollen and not a danger. I have a couple of them.

I don't blame you for being confused. Is your specialist open to explaining things to you?

I did ask him about the difference in sizes and he looked thru the slides and showed me how he went back and sized the nodule based on his machine to the current scan I had. He also found a 10mm Pure groundglass nodule that the other radiologist did not report just like the swollen lymph node.No mention of the type of tissue the subsolid nodule looked like. Didn’t know to ask about that. I guess because the first scan was for a calcium CT score and not lung screening the radiologist didn’t feel the need to report on every little thing. Right now our hospitals are so overwhelmed with covid cases I can’t even get a pulmonary function test that he ordered. I guess the Pet/CT will show more. Thanks for your imput. I appreciate it.

DEPENDS ON COMPETENCY OF PHYSICIAN. I have been a hospital CEO for 40 years

Can a radiologist determine if a subsolid nodule is low grade malignancy from a CT scan? The radiologist measured the solid portion at 5.5 mm and said it was concerning for low grade malignancy. He recommended a 3 month follow up Ct scan or Pet/Ct. is it possible for them to determine low grade from a CT scan?

It sure does.