Wk 3, Case 1 - Review

EXAM: MIBG with SPECT-CT

INDICATION: Lymphadenopathy

TECHNIQUE: Nuclear medicine MIBG study with SPECT-CT was performed. After the oral administration of 125 mg of perchlorate, 3.3 mCi of I-123 MIBG was administered intravenously. Anterior and posterior whole body imaging was performed. Immediately following the SPECT imaging, noncontrast CT of the Chest, Abdomen, and Pelvis was obtained without contrast. These images were obtained for the purpose of diagnosis, anatomic correlation, and attenuation correction. The CT images were fused to the SPECT dataset.

FINDINGS:

In the chest, there is limited evaluation of the thoracic aorta due to lack of IV contrast. Left subclavian central venous catheter tip terminates at the cavoatrial junction. There are enlarged mediastinal and perihilar lymph nodes. There is a 1.3 cm right perihilar infiltrating mass with increased uptake. There is increased uptake of right paratracheal and subcarinal lymph nodes. There is a nodule adjacent to the right cardiac margin with mildly increased uptake. The heart is grossly unremarkable. Unremarkable noncontrast appearance of the pulmonary arteries.

There is bibasilar dependent atelectasis in the lungs. The trachea and mainstem bronchi are patent. There are 2 right pleural-based metastases with increased MIBG uptake. Interval resolution of bilateral pleural effusions. Negative for pneumothorax.

No aggressive appearing osseous lesions. Unremarkable appearance of the axilla and chest wall soft tissues.

In the abdomen and pelvis, noncontrast images of the liver are within the range of normal. The bile ducts are of normal caliber for patient age. In the gallbladder, there are no calcified gallstones, gallbladder wall thickening or pericholecystic fluid. Pancreas is normal in appearance. Unenhanced images of the spleen are normal in appearance.

There is a large, infiltrative partially calcified 7 x 4 cm MIBG-avid, heterogeneous mass arising from the right adrenal gland which crosses midline.

In the kidneys, there is trace hydronephrosis, most clearly seen on the right. There is mild apparent bladder wall thickening with a focus of air.

Negative for bowel obstruction. No acute findings in the stomach. The appendix is not definitively visualized, however there is no evidence of right lower quadrant inflammation or fluid to suggest acute inflammation. Negative for free intraperitoneal air. Small amount of free pelvic fluid is present. Normal appearance of the pelvic organs. Unenhanced images of the aorta and branch vessels are within normal limits for the patient age. There is retroperitoneal and left iliac lymphadenopathy. The left iliac chain lymphadenopathy measuring 1.5 cm is MIBG avid.

No acute abnormalities of the abdominal wall.

IMPRESSIONS:

Metastatic neuroblastoma arising from the right adrenal gland which crosses midline. There is involvement of the right pleura, bone, and mediastinal and iliac lymph nodes.