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TECHNIQUE: Approximately 1 hour following F-18 FDG tracer injection, F-18 FDG
PET images were acquired from the base of the skull through the proximal thighs.
Noncontrast low-dose CT imaging skull base and neck, chest, abdomen, pelvis and
proximal thighs was acquired and used for F-18 FDG PET attenuation correction
and for anatomic correlation, but is not of diagnostic image quality.
FINDINGS:
F-18 FDG PET Imaging: Reference data includes a volume of right hepatic lobe
parenchyma which contains maximum SUVs of 3.6 and mean SUVs of 2.4. Superior
vena cava mediastinal blood pool SUVs are up to 2.1.
The posterior left lung subpleural pulmonary nodule measuring 0.9 x 1.2 cm
(image 107, series 2) is mildly hypermetabolic containing SUVs up to 2.4.
The previously seen very large hypermetabolic left lower lobe lung mass is no
longer present. The unenhanced CT imaging findings are compatible with interval
left lower lobe lobectomy surgery.
There is again evidence of extensive right neck surgery and photopenia of the
cervical vertebral bone marrow compatible with prior radiation therapy.
There is a very extensive very hypermetabolic skeletal metastatic pattern, with
very hypermetabolic lesions too numerous to individually describe. They involve
sites in the cervical spine, multiple thoracic vertebrae, bilateral rib
contours, all of the lumbar vertebrae and multiple sites in the pelvis and
metabolically active lesions in both proximal femurs. Examples include:
1. An osteolytic lesion in the central and right aspect of T8 vertebral body
contains SUVs up to 12.4.
2. A slightly leftward expansile osteolytic lesion the left side of L2
vertebra, measuring about 2.3 x 2.8 cm (image 168, series 3) contains SUVs up to
9.9.
3. The extensive osteolytic lesion in the S1 sacral body and left alum (image
210, series 3) contains SUVs up to 11.0.
4. Right femoral intertrochanteric proximal metaphyseal lesion contains SUVs up
to 6.8.
No additional soft tissues including lymph nodes stations detectable
hypermetabolic lesions are identified. All other sites of F-18 FDG tracer uptake
between the skull base and thighs are explainable by expected physiologic
processes including some F-18 FDG tracer localization in the left ventricular
posterolateral wall myocardium, moderate nonfocal bowel-related F-18 FDG
localization coursing through the abdomen and pelvis and evidence of excretion
of F-18 FDG tracer by the kidneys and ureter into the urinary bladder.
Other low-dose anatomic correlation CT imaging findings:
Noisy low-dose images of the brain show areas of what appear to be vasogenic
edema in the right cerebral hemisphere, involving the inferior frontal lobe
region, the frontoparietal region and especially the inferolateral right
temporal lobe. There is reduced F-18 FDG metabolic activity in the large area of
right temporal lobe radiolucency.
No metabolically active enlarged cervical lymph nodes are identified. Extensive
right neck tissue loss and numerous surgical clips also seen in the right
thoracic inlet are again noted.
The multiple osteolytic rib and thoracic spine lesions seen previously are again
noted. No additional new pulmonary nodule. The heart size is normal. No enlarged
mediastinal or hilar lymph nodes are identified and there is no evidence of
enlarged axillary lymph nodes.
The unenhanced appearance of the liver is not remarkable. The spleen size is
within normal limits measuring 11.0 cm transaxial dimension. Neither adrenal
gland contains a mass. Unenhanced appearance of the pancreas and kidneys is
unremarkable. There are no metabolically active enlarged retroperitoneal or
pelvic lymph nodes.
There is a small hiatal hernia sac. The stomach otherwise is unremarkable. Small
bowel loops are normal caliber. The colon is not remarkable.
The urinary bladder contains a small amount of fluid. The prostate gland has
dystrophic calcifications. The seminal vesicles appear symmetric.
Extensive osteolytic lesions in multiple lumbar vertebrae and in both sides of
the pelvis are noted.
IMPRESSION:
1. Previously seen large hypermetabolic left lower lobe mass is no longer
present, evidence of interval left lower lobe resection.
2. Evidence of very extensive hypermetabolic, osteolytic skeletal metastatic
pattern.
3. The small left inferoposterior lung subpleural pulmonary nodule also is
detectably metabolically active, compatible with a soft tissue metastasis.
4. Other incidental findings are similar to that seen previously.
