Posted on Feb 21, 2021
Whether it be a neck MRI or a brain scan, the images provide very important information that, when combined with your symptoms, helps piece together what’s going on in the body. But imaging reports can be confusing and difficult to understand, leaving many patients feeling confused and wondering - does this test tell me what is wrong with me?
Dr. Gaetano Pastena, a leading neuroradiologist and assistant professor at Albany Medical Center, provides second opinions through DocPanel to help ensure patients receive an accurate diagnosis. As part of the second opinion, patients can ask specific questions about their scans to help them better understand their results. Here, Dr. Pastena discusses the three most common questions patients ask about their neck and brain scans.
The most common question patients ask, in my experience, is “Was anything missed?”. Even an experienced radiologist pressed for time can miss subtle findings with the volume of images that studies have today. A second opinion ensures that a second radiologist is double-checking everything to ensure no findings were missed on the initial interpretation that might affect the diagnosis.
In addition, a subspecialist might pick up on subtle findings or patterns that a generalist might miss. While all radiologists are doctors in our field, a majority of radiologists are “generalists,” meaning they interpret all types of radiology scans on all or most parts of the body. A “subspecialist” radiologist has received extra training in the imaging of a certain part of the body, such as breast, brain/spine, or cardiac. Subspecialty radiologists will often spend a year concentrating only on those exams and learning from teachers at an academic hospital. These subspecialty radiologists go on to spend a large portion or all of their time reading exams exclusively within their discipline often at a higher complexity, such as post-surgical, advanced disease, or significant trauma. For example, as a neuroradiologist, I read almost exclusively exams of the brain, face/neck, and spine and therefore can spend much more time devoted to learning the intricacies of these areas and interacting with my clinical colleagues in neurology, otolaryngology, and neurosurgery that treat these diseases.
Since a subspecialist sees many more of these types of exams, they have more experience with subtle findings that a generalist or someone working very quickly could skip over. They also will generally have a better idea of the entire clinical picture related to neurologic diseases based on their participation with clinical teams.
The second most common question patients will ask me goes hand-in-hand with the first and is, “Were the findings interpreted correctly?”. This goes back to the subspecialist knowledge base and the fact that many disease processes, especially as seen on neck and brain scans, can appear similar. Subtle differences in patterns along with additional findings can lead to a more accurate diagnosis.
A neuroradiologist will usually have had more experience with and seen more cases of rare and unusual diseases as well as common disease patterns and therefore will be able to tell them apart faster. Also, radiology often involves a “differential diagnosis” which is a list of possible diseases or conditions that could be causing the findings and symptoms. A neuroradiologist may be able to add additional considerations to the differential list that the original interpretation may have not considered.
An example for brain scans would be multiple sclerosis (MS), which is a fairly common diagnosis and produces white matter spots. Many other less-common pathologies. however. can also produce white matter spots. So other findings can help lead to additional considerations. MS can also mimic and be mistaken for a tumor when it is focal in a condition called “tumefactive demyelination”. The differentiation is important, as it can be treated medically and not surgically. An example in a neck MRI would be tumor staging where subtle findings, such as the spread of the tumor outside a lymph node or outside the site of origin, can radically change the treatment needed.
Lastly, patients will ask “Do you have any recommendations for further workup/imaging?”. A subspecialist such as a neuroradiologist will often serve in a more complex tertiary care hospital and work very closely in settings such as tumor boards, clinical conferences, and in general, everyday consultations with clinical colleagues in fields such as neurology, neurosurgery, otolaryngology, oncology/radiation oncology, and internal medicine just to name a few. This type of interaction gives subspecialists additional experience in how the total patient is managed outside of just their imaging. Patients can benefit from this when we are able to recommend testing or a subspecialist that may not have previously been considered.
An example would be someone coming in with a brain CT that has only some vague findings. A neuroradiologist might be able to help with diagnosis off the CT, or may be able to recommend further testing such as an MRI with specific sequences, a nuclear medicine scan, or a certain specialist to look into based on the CT scan. This direction can save time and get to a diagnosis and treatment quicker.