Wk 3, 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 recently diagnosed with IgG kappa multiple myeloma, 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 -- at --.
Incubation interval: -- minutes.
Oral contrast: --.
Positioning: --.
PET/CT scanner: ---.
PET/CT acquisition: Vertex-to-feet.
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 (mSUV) and all CT linear measurements are performed on axial images.


Head and Neck:
Intensely hypermetabolic lytic lesion involving both the inner and outer tables of the left parietal bone/vertex with a large soft tissue component showing dural extension measuring 2.9 x 2.4 cm with maximum SUV 9.0.
No suspicious hypermetabolic cervical lymphadenopathy.
The thyroid is unremarkable.


Chest:
No suspicious hypermetabolic lesions within the chest.
Physiologic FDG avidity involving the left ventricular myocardium.
There is no pericardial effusion.
There are no suspicious hypermetabolic or pathologically enlarged mediastinal, hilar or axillary lymph nodes.
No suspicious hypermetabolic pulmonary masses, nodules or airspace consolidations.
Multiple calcified lung granulomas.
Right IJ Port-A-Cath with tip in the cavoatrial junction.
Calcified mediastinal and perihilar granulomas.
Small right pleural effusion, likely reactive.


Abdomen:
No suspicious hypermetabolic lesions within the abdomen and pelvis.
Physiologic FDG avidity in the liver, spleen, adrenal glands and pancreas. The spleen is normal in size, measuring 12.7 cm in maximum craniocaudal dimension.
Tubular, physiologic FDG avidity throughout normal caliber loops of small bowel. There is no ascites.
There are no suspicious hypermetabolic or pathologically enlarged mesenteric, retroperitoneal, pelvic or inguinal lymph nodes.
Symmetric, physiologic excretion of the radiotracer from both kidneys.


Musculoskeletal:
Diffuse intensely hypermetabolic lytic lesions, many of them with soft tissue components, involving the axial and appendicular skeleton. Index lesions are:

Intense focal FDG activity fusing to a permeative lesion of the right 5th rib anteriorly with associated hypermetabolic subpleural soft tissue thickening, maximum SUV 12.4.
Intensely hypermetabolic lytic lesion involving the left pedicle and the left the transverse process of T9: maximum SUV 12.4.
Intensely hypermetabolic right iliac crest lytic lesion: maximum SUV 7.5.

Impression:
1. Diffuse intensely hypermetabolic lytic lesions, many of which have soft tissue components, involving the axial and appendicular skeleton, including a left vertical parietal lesion with soft tissue component on both sides of the calvarium, consistent with biopsy proven multiple myeloma.
2. No evidence of hypermetabolic extramedullary disease.