Case Studies

Indication:

Breast cancer, restaging.

Technical Factors:

The patient was injected with 16.6 mCi (F-18) FDG via a vein in the left arm and, approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the pelvis. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

There are numerous FDG-avid lesions seen throughout the axial and peripheral skeleton, as well as the chest, including multiple subcentimeter lymph nodes in the anterolateral chest wall, right greater than left, and supraclavicular regions (SUVs measuring as high as 9.0 gm/ml), with the most prominent residing in the region of the left thoracic inlet. There is also soft tissue fullness in the subcarinal region (SUV 10.8 gm/ml) and left hilum (SUV 10.4 gm/ml). Multiple hypermetabolic lesions are seen in the cervical spine (SUV 8.2 gm/ml), lumbar spine (SUV 10.0 gm/ml), left pelvic bone, ilium (SUV 14.0 gm/ml), and sacrum (SUV 7.0 gm/ml).

Impression:

Patient with history of breast cancer with findings to suggest metastatic disease, including:

  1. Chest wall, mediastinal, and left hilar adenopathy.
  2. Bone metastases.

SUVs were measured and reported so that this study may be used to monitor therapeutic response.

Indication:

Breast cancer, restaging.

Technical Factors:

The patient was injected with 17.3 mCi (F-18) FDG via a vein in the left antecubital fossa and approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the pelvis. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

Asymmetry is noted in the chest wall due to prior right mastectomy. There is a large soft tissue mass in the high anterolateral chest wall deep to the pectoralis muscle and adjacent to the upper ribs. The mass measures up to 6 cm, with SUVs as high as 10 g/mL.

Smaller lesions are noted in the hilum where a 1.5-cm lymph node (SUV 9.5 g/mL) is present and in the left hilum where a 1.7-cm lymph node is seen (10 g/mL). Subcentimeter precarinal lymph nodes are seen (6.5 g/mL).

The exam otherwise reveals normal physiologic distribution within the axial and peripheral skeleton, GI and GU tracts, and soft tissues.

Impression:

  1. Large soft tissue (likely nodal) mass in the high right anterolateral chest wall/axilla.
  2. Mediastinal and hilar adenopathy.
  3. SUVs were measured and reported so that this study may be used to monitor therapeutic response.

Indication:

Colon cancer, restaging.

Technical Factors:

The patient was injected with 16.1 mCi (F-18) FDG via a vein in the right antecubital fossa and, approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the pelvis. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

There are numerous hypermetabolic lesions seen in the liver. The most prominent is in the left lobe where an ill-defined low-density lesion is seen on CT (SUVs measuring as high as 11.0 gm/ml), and a lateral subcapsular, anterior segment, right lobe liver lesion (SUV 8.6 gm/ml).

The exam otherwise reveals normal physiologic distribution within the lungs, mediastinum, axial and peripheral skeleton, remainder of the GI and GU tracts, and soft tissues.

Impression:

  1. Liver metastases.
  2. SUVs were measured and reported so that this study may be used to monitor therapeutic response.

Indication:

Esophageal carcinoma, staging.

Technical Factors:

The patient was injected with 16.7 mCi (F-18) FDG via a vein in the right antecubital fossa and, approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the pelvis. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

There is extensive and diffuse FDG accumulation seen in the distal esophagus, extending through the gastroesophageal junction into the region of the stomach fundus (SUVs measure as high as 41.0 gm/ml), correlating with a soft tissue mass seen on CT fusion. Hypermetabolic changes extend inferiorly to the aortocaval region at the level of the kidneys (SUVs 52.0 gm/ml), and to the parapancreatic (body) region (SUVs 17.0 gm/ml).

The exam otherwise reveals normal physiologic distribution within the lungs, mediastinum, axial and peripheral skeleton, GI and GU tracts, and soft tissues.

Impression:

  1. Hypermetabolic distal esophagus extending into the gastric fundus, presumably the patient's esophageal primary.
  2. Focal/surrounding adenopathy.
  3. No distant metastases seen.

Indication:

Head and neck (vocal cord) carcinoma, staging.

Technical Factors:

The patient was injected with 14.2 mCi (F-18) FDG via a vein in the right arm and, approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the pelvis. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

There is a focal area of FDG accumulation seen in the region of the left vocal cord, where SUVs measure as high as 9.0 gm/ml. Expected changes are seen at the tracheostomy site. There are subtle, focal, FDG-avid lesions seen posterior to the airway at this level, with SUVs measuring as high as 6.0 gm/ml.

The exam otherwise reveals normal physiologic distribution within the lungs, mediastinum, axial and peripheral skeleton, GI and GU tracts, and soft tissues.

Impression:

  1. Findings in the region of the left vocal cord are suspicious for recurrence.
  2. If clinically warranted, consider MRI to further characterize.

Indication:

Lung nodule.

Technical Factors:

The patient was injected with 14.9 mCi (F-18) FDG via a vein in the right antecubital fossa and, approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the pelvis. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

A 3.5 cm stellate mass is seen in the posterior subpleural, posterior segment, left upper lobe (SUVs measure as high as 11.0 gm/ml). A subcentimeter, anterior mediastinal, lymph node is present (SUV 7.4 gm/ml). Multiple enlarged AP window lymph nodes, measuring up to 2.4 cm (SUVs measuring as high as 6.3 gm/ml) are present, and there is an approximately 2.4 cm left hilar mass (SUV 8.6 gm/ml).

It should be noted that there is diffuse FDG accumulation seen in the soft tissues, most notably in the upper extremities (SUVs measuring as high as 3.0 gm/ml).

Impression:

  1. Hypermetabolic left upper lobe mass suggests malignancy.
  2. Mediastinal and left hilar adenopathy.
  3. No distant metastases seen.
  4. Soft tissue changes suggesting dermatomyositis secondary to paraneoplastic syndrome.
  5. SUVs were measured and reported so that this study may be used to monitor therapeutic response.

Indication:

Lymphoma, restaging.

Technical Factors:

The patient was injected with 16.1 mCi (F-18) FDG via a vein in the right antecubital fossa and, approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the pelvis. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

There are numerous, new, hypermetabolic, lymph nodes, including a subcentimeter right jugulodigastric node (SUV 10.0 gm/ml), a 1.0 cm right posterior cervical chain lymph node (SUV 13.0 gm/ml), right supraclavicular lymph node (SUV 9.5 gm/ml), subcentimeter left subclavicular lymph node (SUV 7.1 gm/ml), a 1.9 cm high left anterolateral chest wall/axillary lymph node (SUV 9.2 gm/ml), multiple right hilar lymph nodes (SUV 10.0 gm/ml), left infrahilar lymph nodes (SUV 6.5 gm/ml), a 1.9 cm left parabronchial lymph node (SUV 16.0 gm/ml), a 4.0 cm nodal mass in the region of the head of the pancreas (SUV 23.0 gm/ml), multiple aortocaval lymph nodes measuring up to 2.0 cm (SUVs measuring as high as 12.0 gm/ml), left para-aortic lymph node (SUVs measuring as high as 9.7 gm/ml), and lymph nodes extending down the iliac and inguinal lymph node chains, with the largest in the right inguinal region, measuring approximately 2.1 cm (SUV 9.6 gm/ml).

Two hypermetabolic lesions are seen in the right proximal humerus and in the sacrum.

Impression:

  1. Findings suggest recurrence in the neck, chest, abdomen, and pelvis.
  2. SUVs and sizes were measured and reported so that this study may be used to monitor therapeutic response.

Indication:

Melanoma, restaging.

Technical Factors:

The patient was injected with 16.8 mCi (F-18) FDG via a vein in the right antecubital fossa and, approximately one hour later, was placed on the GE Discovery LS PET-CT scanner. PET-CT data was acquired from the top of the skull through the bottom of the feet. Attenuation corrected coronal, sagittal, and transaxial images were reviewed. Standardized uptake values (SUV) were measured, as appropriate.

Findings:

There are multiple new and larger hypermetabolic lesions seen throughout the liver. The previously seen and described mottled/destructive posterior left fourth rib, previously having SUVs measuring as high as 6.0 gm/ml, is now seen with a slightly more expansile, but notably more surrounding sclerotic bone; however, SUVs measure as high as 7.0 gm/ml. There is little change noted in the hypermetabolic lesion in the C6 vertebral body.

Impression:

  1. Findings suggest little response to therapy, with some progression of disease.
  2. SUVs were measured and reported so that this study may be used to monitor and further therapeutic response.