Wk 2, Case 4 - 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.

Clinical Indication:
---year-old male recently diagnosed with metastatic HPV positive squamous cell carcinoma to cervical lymph nodes with unknown primary. Patient presents for initial evaluation and 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: Diagnostic.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target and all CT linear measurements are performed on axial images.

Reference: mean SUV liver: ----

Head and Neck:
Intensely hypermetabolic necrotic right cervical level 2A/3 level nodal conglomerate measuring 3.4 x 3.2 cm with a maximum SUV 10.
Additional small mildly hypermetabolic 0.7 cm right level 2B lymph node with SUV max of 3.1, also worrisome for metastatic nodal involvement.
No definite hypermetabolic primary site identified.
Mild to moderate FDG activity fusing to the right maxillary second premolar cavity (maximum SUV 4.8) and left mandibular first molar tooth root, representing odontogenic disease.


Chest:
No suspicious hypermetabolic activity in the chest.
No suspicious pulmonary nodules or masses.
No suspicious mediastinal, hilar, or axillary adenopathy.
Normal caliber of the thoracic aorta.


Abdomen and Pelvis:
No suspicious hypermetabolic activity in the abdomen or pelvis.
Solid Abdominal Organs:
No focal hypermetabolic activity in the liver significantly greater than the heterogeneous physiologic uptake.
Unremarkable non-contrast appearance of the liver.
Normal gallbladder.
No hydronephrosis.
Unremarkable spleen.
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 suspicious pathologically enlarged or hypermetabolic lymph nodes in the abdomen or pelvis.
Pelvic Viscera: Unremarkable pelvic viscera.
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 lytic or sclerotic lesions.

Impression:
1. Intensely hypermetabolic right cervical level 2A/3 nodal conglomerate and a smaller mildly hypermetabolic right level 2B lymph node, consistent with biopsy proven nodal metastasis.
2. No definite metabolically active primary site identified.
3. No convincing evidence of metabolically active distant metastatic disease.