Wk 4, 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.

Clinical Indication:
--year-old female recently diagnosed with right proximal tibial high grade chondroblastic osteosarcoma, presenting for initial staging.

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 -----.
Incubation interval: --- minutes.
Oral contrast: ----.
Positioning: Arms by sides.
PET/CT scanner: Siemens Biograph 40 mCT.
PET/CT acquisition: Vertex-to-feet.
PET reconstruction method: Point Spread Function-Time of Flight (PSF-TOF), 2 iterations, 21 subsets, with and without CT-based attenuation correction.
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 mGy cm.

Comparison/Correlation:
No comparison. No recent correlative imaging.

Findings:
Technical quality: Physiologic hypermetabolic brown fat activation.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target.

Reference: mean SUV liver: ---.
CT linear measurements performed on axial images.


Head and Neck:
No suspicious hypermetabolic foci in the head and neck.
No suspicious hypermetabolic cervical adenopathy.


Chest:
No suspicious hypermetabolic pulmonary nodules.
No suspicious hypermetabolic hilar or mediastinal adenopathy.
Areas of intensely hypermetabolic brown fat activation include: bilateral neck extending into the anterior superior mediastinum, bilateral supraclavicular regions, bilateral axilla, along the posterior costovertebral junctions in the posterior thoracic spine, an area abutting the anterior inferior precardiac fat just below the left ventricular apex, the left posterior diaphragmatic crus/ adjacent fat and focus of intense uptake fusing along the right posterior diaphragmatic crus.
There is homogeneous thymic uptake, normal for age.


Abdomen and Pelvis:
No suspicious hypermetabolic foci in the abdomen or pelvis.
No suspicious hypermetabolic retroperitoneal or pelvic adenopathy.
Unremarkable noncontrast appearance of the liver.
No hydronephrosis.
Unremarkable spleen.
No suspicious adrenal masses.
No suspicious pancreatic findings.
GI Tract/Mesentery/Peritoneum:
The large and small bowel appear normal in caliber.
No suspicious peritoneal/mesenteric findings.
Pelvic Viscera: No suspicious pelvic lesions.
Vasculature: Normal caliber of the abdominal aorta.
Free Fluid: No ascites or drainable fluid collection.


Skeleton and Soft Tissues:
Intensely hypermetabolic sclerotic lesion with associated aggressive periosteal reaction in a characteristic sunburst appearance in the right proximal tibia and a soft tissue component, the most hypermetabolic activity in the anterior and medial tibial cortex and florid periosteal changes with maximum SUV of 6.1.
The extent of hypermetabolic activity approximates 11 cm in craniocaudal dimension in the proximal third of the tibia, extending cranially to the medial physis, with suspicious involvement at the posterior medial aspect of the physis.
Activity within the IV-line tubing overlying the right antecubital fossa and proximal forearm.

Impression:
1. Intensely hypermetabolic sclerotic lesion with associated aggressive periosteal reaction in a characteristic sunburst appearance in the right proximal tibia, consistent with biopsy proven osteosarcoma.
2. No convincing evidence of hypermetabolic regional or distant metastatic disease.