PET/CT Scan Results

PET/CT Results from 5/1 PET/CT scan. I highlighted changes in red; bolded the final results. Discussion and other ramblings in the next post. Stay tuned!

Exam: PET - TUMOR IMAGING W/ CONCURRENT CT, SKULL BASE - MID THIGH Patient: BISHOP, VICKI Exam Date: 05/01/2020 DOB: 12/06/1956 At the Request of: Patient Age: 63 DARREN KOCS MD Patient Sex: F 2410 ROUND ROCK AVE ARA MR #: 2113432 SUITE 150 Exam Status: Routine ROUND ROCK, TX 78681 Accession #: 30634097 PET - TUMOR IMAGING W/ CONCURRENT CT, SKULL BASE - MID THIGH: 5/1/2020 SKULL BASE TO MID THIGH PET/CT - CLINICAL HISTORY: Left breast cancer, subsequent treatment strategy. RADIOPHARMACEUTICAL: 12.0 mCi F-18 FDG was administered intravenously. The blood glucose level was 105 mg/dl. TECHNIQUE: The F-18 FDG injection was followed by an uptake period of 52 minutes. CT was then performed from the skull base through the mid thighs for attenuation correction, followed by positron emission tomography (PET) imaging in the same distribution. PET images were viewed in axial, coronal, and sagittal planes, along with reformatted CT images for anatomic correlation. COMPARISON: 12/13/2020, 12/02/2019. FINDINGS: NECK: Visualized portions of the brain show normal metabolic activity. Brain parenchyma is normal in appearance. The orbits, intra and extraocular structures are normal. Visualized sinuses are well aerated, with no air fluid levels or abnormal activity. The salivary glands are symmetric, and have physiologic uptake. Focal nasopharyngeal uptake has dramatically decreased. SUV max 3.7; previously 6.4. Larynx is normal, and has physiologic uptake. The thyroid has normal parenchyma and normal physiologic uptake. CHEST: New left upper lobe nodular airspace opacity demonstrating low level uptake, likely infectious/inflammatory. * Left upper lobe nodular airspace opacity: 14 mm, SUV max 1.5. Stable apical pulmonary scarring. No abnormal uptake. No pleural effusion, pleural mass, or pneumothorax is noted. No abnormal FDG activity is seen in the pleura. Esophagus is normal, and has physiologic uptake. The heart has normal metabolic activity. No evidence of pericardial effusion. Reference background activity (mediastinal blood pool): mean SUV is 2.3. ABDOMEN AND PELVIS: Medial segment left lobe hepatic metastasis is larger, although uptake has decreased. * Medial segment left lobe hepatic metastasis: 20 x 19 mm, SUV max 10.9; previously 13 x 11 mm, SUV maximum 16.3. The pancreas is normal in appearance and has physiologic uptake, without mass or inflammatory change. The spleen demonstrates physiologic activity without splenomegaly or mass. The adrenals are normal, and have physiologic uptake. Physiologic FDG excretion is seen in the kidneys. Atrophic left kidney redemonstrated. Normal physiologic activity is seen in the bowel. No evidence of bowel obstruction. The reproductive organs are normal in appearance and activity. The bladder is normal. Reference background activity (liver): mean SUV is 2.8. LYMPH NODES: Lymph nodes in the neck, chest, abdomen and pelvis are normal in size. No abnormal radiotracer accumulation in the lymph nodes. BONES AND SURROUNDING SOFT TISSUES: Most neck lymph nodes demonstrate decreased activity. Axillary and supraclavicular adenopathy has improved. Significant misregistration of activity is present, although new foci FDG activity in the porta hepatis region appear to be related to new lymphadenopathy. * Left submandibular nodule: SUV max 8.1; prior SUV max 9.5. * Left cervical level 2A node: SUV max 9.0; prior SUV max 9.2. * Left cervical level 2B node: SUV max 2.6; prior SUV max 8.4. * Left supraclavicular adenopathy: SUV max 6.6; prior SUV max 14.4. * Right axillary node: SUV max 1.7; prior SUV max 8.5. * Left axillary node: SUV max 2.7; prior SUV max 11.3. * New porta hepatis node: SUV max 9.9. * Precaval node: SUV max 4.5. PET/CT IMPRESSION: 1. Although neck and chest adenopathy has improved, a couple of new lymph node metastasis are seen in the right upper abdomen. 2. The left lobe hepatic metastasis is larger, although uptake is lower. This could be explained by inconspicuous necrosis. 3. New nodular left upper lobe pulmonary airspace opacity demonstrating low level FDG uptake, likely infectious/inflammatory. Follow-up recommended. 4. Decreased focal uptake in the nasopharynx.