Follow up MRI without contrast - 6 months later - advice requested

[judyl]

I had a follow up MRI without contrast with no significant change in tumor size but the radiologist only read it with the two measurements (TRV x AP) 1.4 x .6 cm, which is up by 0.1 cm. I called the MRI Center requesting another report with the third measurement as well as called the Manager of the department this past week who asked the radiologist for add it.
In the meantime, my doctor's office cancelled my upcoming appointment due to no significant change and scheduled me for another MRI and visit in one year unless I wanted to pursue treatment. I thought it was odd that they would cancel my appointment without even seeing the CD. The radiologist add the third measurement to an addendum so they are now 1.4 x .6 x .5.  My MRI from six months ago showed 1.4 x .5 x .4 so there is a slight 0.1 cm increase on two of the measurements.

I popped the CD into my computer and still couldn't figure where the AN was, let alone measure it as ANSydney had suggested. Then again, I couldn't see if with the previous MRI that included the GD contrast.  I saw it during my doctor's visit when he displayed it on his monitor.

 At this point, I am wondering if I should request the doctor see me anyway or to wait the year.  Or should I seek out another opinion?  My symptoms have not really progressed other than the fact that I cannot do certain kinds of yoga without setting off vertigo.  I am content to continue on Watch & Wait but at the same time, I don't want to miss something that I should be doing. 

[rupert]

It is assumed that your doctor is the one that ordered the MRI.   Follow ups from the radiologist would automatically be sent to your doctor. (what kind of doc by the way?). So your doctor has probably  seen the report and the CD. I think they spelled it out clearly,  you're in watch and wait and there was no change in the tumor so there's no sense wasting their time or yours unless you were interested in discussing treatment.  It's certainly your right and good advice to seek out second and possibly third opinions.

[JD808]

I’m curious as to where your tumor is located? Entirely IAC?

Second and third opinions are always a good idea if your symptoms aren’t moving to fast.

[Naisaki]

The information we have seen is considered very good.

[judyl]

My tumor is in the IAC. He did not receive the CD. Here is the reply the nurse posted from the Jefferson doctor ( (before he saw the addendum with the third measurement):

"The radiologist who issued the reading on the current scan (not the addendum report that I have not seen) indicates that the tumor is unchanged.
 
I am happy to look at the addendum MRI report and current MRI images. Of course, there is a variation in any measurement of approximately +/-0.1 millimeter. That is the limit the resolution of the scan. So, if one particular measurements defers from a previous scan by 0.1 millimeter, it may truly be unchanged."

So now the his office is asking me to mail or "drop off" the CD, after they cancelled my appointment. I'm not local to the office from home or work, and I'm reluctant to "mail" my only copy.

FYI - my measurement differed by 0.1 cm not 0.1 mm as the doctor mentioned.  Specialty is Otolaryngology/Head & Neck Surgery - Neurotology. 

[rupert]

The margin of error on measurements is usually 1-2 mm,  not .1 mm.  Just depends on what slice of image they take the measurement from.  I wouldn't be too concerned about keeping the CD. After all what good is it doing you?  If you really want to keep it just have the radiologist make another CD and have them send it to the doctor. They should do that with no problems.  Also keep in mind that the neurosurgeon might come up with even different measurements than the radiologist.  For at least 4 years on my MRI's the radiologist said it was stable and the same size however the neurosurgeon always said the tumor was smaller and receding off the brain stem. About year 6 the radiologist said the tumor was smaller. LOL.  The radiologist reports over a period of 8 years went from a page and a half down to just one paragraph with basically a synopsis.  They know the neuro is looking at the scans so they don't elaborate much.  I would also mention it's not just a matter of 2 or even 3 measurements.  The volume, shape and location is what is most important to be considered. If you haven't done so  already,  I would consult with neurosurgeons that specialize and have vast experience in treating AN's.

[judyl]

Thank you. After much back and forth and conflicting recommendations depending on which nurse spoke to the doctor and then to me, my follow up is now scheduled for 6 months with another MRI and hearing test unless I want to come in sooner to discuss treatment options.
I think they meant to state 1 mm not .1 mm, and I do understand a 1 mm difference can be due to error and the most significant measurement is the first, the transverse measurement. 
This doctor is an otolaryngologist at Jefferson specializing in neurotology including AN and Meniere's disease. I do plan to consult with another surgeon in the near future, which is one of the main reasons I did not want to give up my only CD. I attended the AN conference in Baltimore last month and very impressed with team at Johns Hopkins.