Wk 5, Case 1 - 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 with T4bNab medullary thyroid cancer status post bronchoscopy with tracheal biopsy and tracheal balloon dilatation presenting for initial staging and treatment planning.

Technique:
Preparation: Not on Somatostatin Analogue Therapy.
Radiopharmaceutical: ------ mCi of Ga-68 dotatate (NETSPOT), a somatostatin analogue (SSA), administered intravenously at ------ at ---- PM
Incubation interval: ---- minutes.
Oral contrast: Not applicable.
Positioning: Arms by sides.
PET/CT scanner: Siemens Biograph 40 mCT.
PET/CT acquisition: Vertex-to-mid-thighs.
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.

Comparison/Correlation:
--

Findings:
Technical quality: Diagnostic.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target (mSUV).

Reference: Mean SUV liver ---.

Head and Neck:
Heterogenous DOTA-avid infiltrative thyroid mass involving both thyroid lobes with encasement/involvement of the subglottic larynx, and upper trachea and associated moderately narrowing/stenosis, and extension inferiorly towards the superior mediastinum, and superiorly at the level of the thyroid cartilage, is compatible with biopsy proven primary medullary thyroid cancer, maximum SUV of 6.2, measures 56 x 49 mm.
Multiple intensely DOTA-avid left level IIB, III, IV and IVA lymph nodes, consistent with metastatic disease. Additional smaller left cervical lymph nodes with no significant activity are also seen. For reference purposes:

The dominant left level IIb/III lymph node demonstrates maximum SUV of 7.2, measures 15 mm in short axis.
Mild diffuse cerebral volume loss.
Paranasal sinuses and mastoid air cells are clear.


Chest:
No suspicious DOTA-avid foci in the chest.
Intrathoracic central airways are patent.
Calcified superior segment left lower lobe pulmonary granuloma.
No suspicious pulmonary nodule.
Mild cardiomegaly with dilated right and left ventricles.
Aorta is normal in caliber and course.
Main pulmonary artery is normal in caliber.


Abdomen and Pelvis:
No suspicious DOTA-avid foci in the abdomen or pelvis.
Physiologic activity in the spleen, adrenal glands, kidneys and the urinary bladder.
Unenhanced liver, gallbladder, adrenal glands, pancreas appear unremarkable.
Calcified splenic granulomata.
Nonobstructive left punctate nephrolithiasis.
Calcifications in the prostate gland.
No evidence of bowel obstruction.


Skeleton and Soft Tissues:
No suspicious DOTA-avid foci in the visualized osseous structures.
Reversal of the cervical spine lordosis centered at C3-4.
Advanced multilevel degenerative change in the spine, worse in the cervical and lumbar spine.

Impression:
1. Large DOTA-avid infiltrative thyroid mass with encasement/involvement of the larynx, and upper trachea with associated tracheal narrowing is compatible with biopsy proven medullary thyroid cancer.
2. Multiple DOTA-avid metastatic left cervical lymph nodes.
3. No evidence of DOTA-avid distant metastatic disease.