Wk 2, Case 3 - Review

Clinical Indication:
Recently diagnosed right tonsillar invasive squamous cell carcinoma P 16 positive. Presenting for staging and initial treatment planning.

Technique:
Preparation: Last oral intake (except water) on --at --.
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 raised
PET/CT scanner: ---.
PET/CT acquisition: Vertex-to-midthigh.
PET reconstruction method: ---
Standardized uptake value (SUV): Corrected for body weight only.
CT: Low-dose, non-breath-hold, without intravenous contrast.
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 and all CT linear measurements are performed on axial.
Reference: mean SUV liver: ----

Head and Neck:
Intensely hypermetabolic right tonsillar mass without significant contralateral extension, poorly delineated on non-contrast images with maximum SUV 16.2, extend superiorly close to the soft palate.
No evidence of significant base of tongue invasion.
Intensely hypermetabolic right level II and III cervical adenopathy, including partially necrotic lymph nodes, consistent with biopsy proven metastatic squamous cell carcinoma. Index nodes are:

Right level II cystic or necrotic nodal mass measuring approximately 4.2 x 3.6 cm with maximum SUV 13.5.
7 mm right level III lymph node with suspicious FDG uptake for size, maximum SUV 2.7.
Sub-centimeter contralateral left lymph nodes without significant FDG uptake, likely reactive.


Chest:
No suspicious hypermetabolic lesions in the chest.
No suspicious pulmonary nodules or masses.
No suspicious focal consolidation. Benign calcified granulomas.
No FDG avid mediastinal or hilar lymph nodes.
No pleural or pericardial effusion.
Sequela of prior granulomatous disease.
No suspicious esophageal activity.
Normal caliber of the thoracic aorta.
Three-vessel coronary artery atherosclerotic calcification.


Abdomen and Pelvis:
No suspicious hypermetabolic activity in the abdomen or pelvis.
Solid Abdominal Organs:
No suspicious focal hypermetabolic activity in the liver significantly greater than the heterogeneous physiologic uptake.
Unremarkable non-contrast appearance of the liver.
Cholelithiasis.
No hydronephrosis.
FDG non-avid exophytic hypodense left renal lesion incompletely evaluated on this study. Nonspecific perinephric stranding.
Unremarkable spleen.
No suspicious adrenal masses.
No suspicious pancreatic findings.
GI Tract/Mesentery/Peritoneum:
Postsurgical changes from bariatric surgery.
Physiologic bowel activity, without suspicious focal FDG uptake. The large and small bowel appear normal in caliber.
Colonic diverticulosis.
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 in the visualized osseous structures.
No aggressive osseous lesions.
Degenerative changes throughout the spine.
Straightening of the cervical, thoracic, and lumbar spine. Anterior bridging osteophytes throughout the thoracic spine.
Bone-on-bone endplate changes and vacuum phenomena at all 3-L4 and L4-L5.
No suspicious FDG avid soft tissue nodules.
No axillary or inguinal adenopathy.

Impression:
1. Intensely hypermetabolic right tonsillar mass consistent with biopsy proven squamous cell carcinoma. No evidence of significant contralateral extension.
2. Intensely hypermetabolic right level II and III lymph metastatic adenopathy, including lymph nodes with central necrosis or cystic transformation.
3. No evidence of metabolically active distant metastatic disease.

Clinical Indication:
Head/neck cancer, assess treatment response. 57-year-old male with history of Stage I (cT2, cN1, cM0, p16+) status post right partial tonsillectomy (September 21, 2021) and adjuvant chemoradiation completed 3 months prior

Technique:
Preparation: Last oral intake (except water) on --at --.
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: --.
PET/CT scanner: ---.
PET/CT acquisition: Vertex-to-mid-thighs.
PET reconstruction method: ---
Standardized uptake value (SUV): Corrected for body weight only.
CT: Low-dose, non-breath-hold, without intravenous contrast.
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.
CT linear measurements performed on axial images.
Reference: mean SUV liver: ----; previously: ----.

Head and Neck:
No suspicious hypermetabolic activity in the head or neck.
Postsurgical treatment changes of post right partial tonsillectomy and chemoradiation. No suspicious FDG uptake within the surgical bed.
Interval complete metabolic resolution with significant decrease in size of the previously seen intensely hypermetabolic necrotic right cervical level IIA lymph node, which measures 20 x 8 mm, compared to 50 x 35 mm.
Complete resolution of previously seen hypermetabolic level III lymph nodes.
Ventricles and sulci are normal in size.
No acute large cortical infarct, intracranial hemorrhage or large mass on this noncontrast study.
No significant soft tissue swelling is present.
No calvarial destructive lesion or fractures.
Bilateral maxillary sinus retention cysts.
Mastoid air cells are clear.


Chest:
No suspicious hypermetabolic activity in the chest.
Central airways are patent.
Heart normal in size. Mitral annulus calcification.
Three-vessel calcified coronary sclerosis.
Aorta is normal in caliber and course. Main pulmonary aorta is normal in caliber.
Calcified left hilar lymph nodes.
No suspicious pulmonary nodules.
Small subcentimeter right fissural nodules.
Bilateral dependent atelectasis.
Patulous fluid-filled upper and mid esophagus.
Small sliding hiatal hernia.


Abdomen and Pelvis:
No suspicious hypermetabolic activity in the abdomen or pelvis.
No focal hypermetabolic activity in the liver significantly greater than the heterogeneous physiologic uptake.
Physiologic bowel activity, without suspicious focal FDG uptake.
Prior gastric bypass surgery.
Gallbladder contracted.
Normal liver, spleen, pancreas, adrenal glands, and kidneys.
Nondilated small and large bowel. Normal appendix.
Nondistended urinary bladder.


Skeleton and Soft Tissues:
No suspicious hypermetabolic activity in the visualized osseous structures.
No aggressive osseous lesions.
Reversal of the cervical spinal lordosis with apex at C5.
Mild thoracic dextroscoliosis with apex at T5.
Lumbar levoscoliosis with apex at L2.
Multilevel spondylotic disease with degenerative disc space narrowing, endplate sclerosis, vacuum phenomenon, Schmorl's nodes, and marginal osteophytosis.

Impression:
Findings consistent with complete metabolic response:

1. Posttreatment changes post right partial tonsillectomy and chemoradiation with no suspicious FDG uptake within the surgical bed.
2. Interval complete metabolic resolution with significant decrease in size of previously seen hypermetabolic metastatic right cervical level II and III lymph nodes.
3. No evidence of metabolically active distant metastatic disease.