Peter Attia· MD
patients kind of know that it's the most detailed exam you can get and as well there's no radiation so we actually had the patient and it's kind of like yes there's this I don't you know what this is going on here so we set them off to a facility that does nothing but women's imaging and they too didn't know what it was and so they stuck a needle in it and it actually came back as uh trying something fibrous zach was actually trapped scar tissue and at that point when we'd spoken to a woman afterwards were like did you ever have trauma like why would you have scar to that area it's like oh yeah I was in a bad car accident and that was it it was a seat belt scar those are two pretty interesting false negatives right both breasts men women I would have always maybe guessed or been most concerned about the false positives that occur deeper in the body I always tell patients the call I'm always most afraid of getting is the little shadow in the pancreas where you just don't know is this in add no carcinoma of the pancreas which of course is something that if you're lucky you can resect it and if you're even luckier you can survive it and I guess that's the only shot you're gonna have at surviving pancreatic cancer as an incidental finding really don't think anybody that presents with pancreatic cancer is going to survive it at least not as an adenocarcinoma but then you worry about well what if it's something that turns out not to be cancer and you hear these horror stories there's a very famous one I believe at Stanford several years ago where a woman went to a sort of drive-by CT clinic got a CT scan showed something in the pancreas she ended up going to get a biopsy and I believe it was an ERCP I did biopsy one complication led to another led to another she died of sepsis and by the way it turned out she didn't have pancreatic cancer I don't know that firsthand so that might be a bit of a wives tale stretch but certainly that's a very popular story in the Bay Area but it's the cautionary tale right definitely it is and that's kind of where the real value of actually having MRI as opposed to CT comes in in the fact that when we're looking at organs particularly the pancreas or any of the visceral solid organs we're looking about seven different filters looking at at different ways top to bottom front to back to really be able to see what's going on and that's where what we call contrast density becomes really important in the fact that when we're actually looking at the pancreas in particular we can actually pick out the pancreatic duct as well as in bile duct and be able to see that just standing out against the rest of the organ and one of the first most common things that pancreatic cancer likes to do is to actually start to walk that duct and so that's why when the ERC peas are done they're actually looking for her cells of pancreatic cancer and an ERCP is basically when they go down into through the mouth and the esophagus and they actually go and take a trace of fluid from the pancreatic bile duct so one of the other things that kind of amazes me when we go through these images here is when we've talked a little bit about the hardware they'll actually I kind of want to come back and ask more hardware questions but it's almost like you've created your own software now as well I had never seen this is it commercially available to have that rotating diffusion-weighted image math is that a commercially available piece of software or did you guys make that we actually built that as a display tool and that's actually effectively taking a page of the nuclear medicine positron emission tomography or PET CT handbook and the reason why we actually put together is because it actually allows you and effectively a pretty efficient viewing to be able to see what's going on through the entire body it's almost like making a transparent person and we're basically any of the black spots that stand out would be the hard spots or the firm areas and the one that we've just looked at earlier I remember you saying that if I understood you correctly one of the advantages of using a quote-unquote low-power magnet like you're using is you don't have any of the gaps in the spine you've got this everything that you showed on that rotating diffusion-weighted image you have the dark brain obviously full of firm fluid and then you have this dark beautiful tail coming out of it which is the spinal fluid but it was perfectly smooth right and that's actually one of the important things because magnets actually have a lot of homogeneity problems we call them and the fact that you want it to be perfect so at the field in between the top and the bottom and the left and the right are identical and as soon as you put a person in there that comes in various sizes and shapes they actually distort that magnetic field and this sweet spot for the magnetic field is perfectly in the center and so when we put all these protocols and built all these things we actually built it for different body shapes and we can actually go and tune it for all these body shapes so that the goal is that no matter what when we're doing these rotating images that it looks like a normal person not a segmented piece of a person yeah it's when you say that she took a playbook out of the pet/ct that's