Wk 2, Case 2 - Review

Please note: Items with dashed lines (--) are information withheld as it is not relevant for you to arrive at the correct findings and impression for the report and/or it was withheld for privacy information. The items were left in to show you the typical information documented in a PET report.

Patient History:
---year-old female with history nodular sclerosing Hodgkin lymphoma, status post 2 cycles of ABVD, presenting for mid-treatment response assessment.

Technique:
Preparation: Last oral intake (except water)-------.
Diabetic: --.
Blood glucose at time of FDG administration: --mg/dL.
Radiopharmaceutical: ---- mCi of F-18 FDG administered IV at --- at ---.
Incubation interval: -- minutes.
Oral contrast: ---.
Positioning: Arms down.
PET/CT scanner: --------.
PET/CT acquisition: Vertex-to-feet.
Standardized uptake value (SUV): Corrected for -----.
TOTAL DLP (Dose Length Product): ----- mGy.cm.

Comparison/Correlation:
--

Findings:
Technical quality: ----.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target.
Mean SUV Aorta: ---, compared to ----.
Mean SUV liver: ---, compared to ----.

Head and Neck:
Complete metabolic resolution with interval decrease in size of previously seen left cervical adenopathy. Examples are:

12 x 5 mm left supraclavicular lymph node showing mild FDG uptake similar to blood pool level maximum SUV 1.5, compared to 14 x 13 mm maximum SUV 5.2 in prior scan.
22 x 11 mm left medial supraclavicular lymph node showing no FDG uptake above blood pool level, compared to 35 x 18 mm maximum SUV of 4.5 and prior scan.
Chest:
Complete metabolic resolution with interval significant decrease in number and size of previously seen hypermetabolic anterior mediastinal, left axillary, and bilateral subpectoral lymphadenopathy with little to no significant residual metabolic activity. Examples are:

1 cm left subpectoral lymph node which previously measured 1.5 cm
1 x 2 cm left supraclavicular conglomerate with maximum SUV 2.1, previously 1.5 x 2.3 cm with maximum SUV 5.2
No suspicious pulmonary nodules or masses.
No mediastinal, hilar, or axillary adenopathy.
Normal caliber of the thoracic aorta.


Abdomen and Pelvis:
No suspicious hypermetabolic lesions in the abdomen or pelvis.
Spleen is average in size showing diffuse FDG uptake similar to liver parenchymal level.
Solid Abdominal Organs:
No focal hypermetabolic activity in the liver significantly greater than the heterogeneous physiologic uptake. Unremarkable noncontrast appearance of the liver.
Normal gallbladder.
No hydronephrosis.
No suspicious adrenal masses.
No suspicious pancreatic findings.
GI Tract/Mesentery/Peritoneum: Physiologic bowel activity, without suspicious focal FDG uptake. The large and small bowel appear normal in caliber. No suspicious peritoneal/mesenteric findings.
Lymph Nodes: No pathologically enlarged or hypermetabolic lymph nodes in the abdomen or pelvis.
Pelvic Viscera: Unremarkable.
Vasculature: Normal caliber of the abdominal aorta.
Free Fluid: No ascites or drainable fluid collection.


Skeleton and Soft Tissues:
No suspicious hypermetabolic activity within the skeleton and soft tissues.
Diffusely increased hypermetabolic activity involving the axial skeleton and proximal appendicular skeleton compatible with bone marrow activation secondary to G-CSF therapy.
No aggressive osseous or suspicious soft tissue lesions.
Injection site activity.

Impression:
Overall findings suggest complete metabolic response,Deauville 2:

1. Complete metabolic resolution of previously seen metabolically active nodal disease above diaphragm with no significant residual metabolic activity.
2. No suspicious metabolically active nodal disease below the diaphragm.
3. No evidence of new metabolically active extra-nodal involvement.