Wk 3, Case 3 - 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 newly diagnosed with right colon cancer on colonoscopy presenting for staging and initial 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 (mSUV) and all CT linear measurements are performed on axial images.

Reference: mean SUV liver: ----

Head and Neck:
Two moderate to intensely hypermetabolic metastatic left supraclavicular lymph nodes in the following locations:

11 x 9 mm lymph node maximum SUV 6.4
7 x 4 mm lymph node maximum SUV 4.2
Unremarkable thyroid gland.
The visualized paranasal sinuses and mastoid air cells are clear.
Cervical muscle physiologic uptake.


Chest:
No suspicious metabolically active lesions within the chest.
No suspicious metabolically active or pathologically enlarged hilar or mediastinal adenopathy.
No suspicious pulmonary nodules or masses.
Scattered tiny noncalcified clustering pulmonary nodule smaller than 5 mm showing no significant FDG uptake, below PET resolution.
Sequelae of prior granulomatous insult.
No pleural effusion, pericardial effusion or pneumothorax.
Left chest wall generator dual-chamber AICD.


Abdomen and Pelvis:
Intensely hypermetabolic approximately 32 x 31 mm mass within the hepatic flexure with associated diverticulitis and surrounding fat stranding, maximum SUV 13.9, consistent with biopsy-proven adenocarcinoma.
Multiple small to borderline-enlarged hypermetabolic metastatic periaortic and mesenteric adenopathy. Index nodes are:

The dominant lymph node measures 18 x 17 mm aortocaval lymph node maximum SUV 7.8
9 x 8 mm left para-aortic lymph node maximum SUV 2.5
8 x 7 mm mesenteric node with maximum SUV 4.3
Diverticular disease most extensive within the sigmoid colon.
Calcified splenic granulomas.
Hysterectomy.
Surgical clips from prior right adrenalectomy.
Unremarkable liver, gallbladder, spleen, pancreas, kidneys and adrenals.
No ascites.


Skeleton and Soft Tissues:
No suspicious metabolically active lesions within the skeleton and soft tissues.
No aggressive lytic or sclerotic lesions.
Multilevel degenerative changes.
Thoracolumbar scoliosis.

Impression:
1. Intensely hypermetabolic hepatic flexure mass, consistent with biopsy-proven adenocarcinoma.
2. Metastatic small to borderline-enlarged hypermetabolic periaortic and mesenteric and left supraclavicular adenopathy.
3. No convincing evidence of metabolically active distant metastatic disease to visceral organs or osseous structures.