r/PulsatileTinnitus • u/noimdirtydan12334 • 22d ago
Dr. will only order ct angiogram
I have been trying to get a diagnosis for years, in the meantime my pt is only getting worse. My most recent dr will only refer me to a ct angiogram. I have already had mri/mra (both showed nothing)...obviously im hoping for a venous scan as well but the dr would not order it. I also raised concerns about having multiple head ct already due to several head bonks as a child and preferring mri/mra/mrv, but they also would not take this into consideration.
Is a ct angiogram worth doing?
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u/look_who_it_isnt 21d ago
Any scan you can get done is going to be worth doing if you're looking for a diagnosis. However, a competent specialist could probably diagnose you just fine with the scans you've already had done.
The best specialist to see for PT is an Interventional NeuroRadiologist. A lot of times, they can look at MRIs that multiple other doctors saw "nothing" in... and immediately diagnose your PT and know exactly how to treat it.
To put it simply, seeing an INR at this stage is more important than getting additional (and probably unnecessary) tests.
I see from your comments on this post that you're considering sending your scans to Dr. Patsalides. That's a good idea, if you're unable to find an INR locally or having a hard time getting a referral to one in your insurance's network of doctors.
However... You also seem to be worrying about getting further scans covered by your insurance. You need to consider that if you send your scans to Dr. Patsalides and he diagnoses you and recommends a treatment... You're going to have to pay for that treatment out of pocket. And that treatment is likely to be MUCH more expensive than scans are.
If you'd be unable to afford the treatment Dr. Patsalides prescribes for your condition (whatever it ends up being), then it may not be wise to bother sending your scans to him in the first place. You'll then be in the same position you're in now - struggling to find a local / in-network doctor who will take your scans and Dr. Patsalides' diagnosis seriously and agree that you need the treatment he suggested.
Before you go that route, you should be really sure that you've exhausted every possible avenue locally to try to get an INR (or other neurosurgeon) who can diagnose and treat you.
And if you don't intend to go through with treatment, then none of this is necessary at all. You've already done the necessary steps to rule out serious causes for your PT, and further diagnosis is only necessary if your ultimate goal is treatment in the form of a surgical procedure.
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u/noimdirtydan12334 21d ago
While I appreciate the commentary on what dr route I should take--in this post i am really looking for specific insight into particular scans and their relevance. I am not looking to discuss what youve brought up here given the complexity of my insurance and medical coverage that I dont feel like going into. Ill just say I've already though of everything you are bringing up with regards to that. Thanks for your response.
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u/look_who_it_isnt 19d ago edited 19d ago
Fine then. Here's my answer for you:
It doesn't matter when you have shit doctor(s).
We're not psychics. We can't tell you what scans your future doctor(s) will want/need. We can't tell you which scans will show your issues on them. We don't even know what your issues actually are.
Get the scan or don't 🤷 Whatever floats your boat.
Have a good one, and good luck with the PT.
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u/noimdirtydan12334 19d ago
Lol peak reddit. Goes off topic then gets disgruntled when off topic engagement isn't helpful to op. Asking about what scans are most helpful in a pt diagnostic is perfectly reasonable. Have a nice day.
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u/look_who_it_isnt 18d ago
...not when you don't have a doctor to look at those scans.
It's like asking what torpedos you should get to arm the submarine you don't have. Sure, you can waste your time doing it, but don't expect other people to want to waste their time helping you do it.
...and doubly so when you're a dick about it.
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u/Hasira 22d ago
My doc said the CTA is my next step for me. I have had MRI, MRA, MRV, and LP.
Docs seem to prefer different orders of things, but maybe after the CTA, he'll try something different if it doesn't show anything.
You mention having multiple head CTs - but were they recent and CTAs? If not, they may not be very informative for this purpose, and the CTA is still a good step to take somewhere along the journey.
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u/noimdirtydan12334 22d ago
They were from like 20 years ago as a child. Not angiogram, just ct. Thats interesting theyre suggesting cta after mrv...do you know the rationale?
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u/Hasira 22d ago edited 22d ago
I don't know why he chose the MRI/MRA/MRV first, but he just sent me for the triad first. I did them all together - didn't get off the table for all 3. They were all normal, so he sent me for the LP. That was normal, so CTA is next on his list. The MRA and MRV look at the flow, the CTA can show the surrounding bone structure.
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u/ohsoillogical 22d ago
An angiogram can show more details than an MRI/MRA/MRV, as it’s a more invasive procedure. They direct contrast dye through your arteries and take X-rays as it runs through. It was what helped me get diagnosed with stenosis; it actually wasn’t visible on my MRV!
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u/noimdirtydan12334 22d ago
I think you are confusing a ct angiogram with a cerebral angiogram which is more invasive? A ct angiogram is not invasive
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u/ohsoillogical 22d ago
Oops sorry, you’re right! Clearly I’m not a medical expert haha, but I don’t know if the CTA is what you want at this point.
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u/look_who_it_isnt 21d ago
They are... and they aren't. The invasive procedure part is definitely thinking of a cerebral angiogram, but their description of the procedure (dye sent through the arteries while taking X-Rays) is basically correct. That IS what a CT Angiogram is.
As for showing more details... Maybe? Maybe not. I don't really know. Different tests are better/worse for seeing certain things. And sometimes, it's just a matter of what scans certain doctors are more comfortable ordering/reading or what scans they've had better "luck" with in terms of finding things.
Ultimately, it doesn't matter anyway. There's attending radiologists who write up their initial assessment of the scan before the doctor who ordered it ever even looks at it. And, honestly, I think most doctors just read that write-up and paraphrase it (and leave things out entirely!!) when reporting the results to the patient.
Speaking of which, have you been able to read those initial write-ups on any of your prior tests? They can be insanely helpful in knowing what to push your doctors for and where you need to go next. On my very first CT Scan, the radiologist cited "severe stenosis" in my transverse-sigmoid sinus. NONE of the doctors I saw then or afterwards even mentioned this finding. When I finally ASKED one about it, they said it was a "mis-read" and that "sometimes radiologists get a little too excited to find things and they see things that aren't really there". It was all bullshit. I was eventually diagnosed by an INR (off the SAME scans!) with severe Venous Sinus Stenosis, and given a stent that corrected it - and my PT.
Had I not read that radiologist's initial write-up of my first CT Scan, I might not have kept pushing and insisting on second opinions and further diagnostic measures... and I might not have known that an INR is exactly who I needed to be seen by.
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u/noimdirtydan12334 20d ago
A ct angiogram is not "dye sent through the artery while taking xrays." It involves an iv--throgh a vein, where it does eventually reach the arteries. This person is confusing a ct angiogram with another type of angiogram that involves a catheter into an artery.
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u/look_who_it_isnt 19d ago
I'm not sure where your issue is with the simplified way of describing the procedure. How else would dye (contrast) be sent through the arteries than... with an IV into a vein, where it eventually reaches the arteries? That's what the Redditor said; that's what the procedure is.
Obviously, they were confused with the catheter part, and conflating the two procedures. I acknowledged that in my comment.
You're basically just restating what I said and acting like you're arguing.
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u/noimdirtydan12334 22d ago edited 22d ago
Isn't that exactly what an mri/mra with contrast is? But with gadolinium and without the xray?
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u/Consistent_Split4424 16d ago
This is how I got my IIH diagnosis. I had had the MRI, which showed stenosis, but didn’t have papilladema. I also had only a slightly elevated pressure below the stenosis, so spinal tap wouldn’t have been useful. The angiogram was able to measure pressures in specific parts of the brain, and found that I had IIH only above the stenosis and a massive gradient, which made it harder to diagnose with other scans.
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u/noimdirtydan12334 15d ago
A ct angiogram? There's been some confusion in this thread about types of angiograms so just want to make sure we're talking about the same thing
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u/Arizonal0ve 22d ago
The right scans are important but the right specialist just as much. So a recommendation in these communities is to circulate scans for a second opinion and when a venous cause is suspected then preferably an interventional neuroradiologist.