Wk 4, Case 4 - 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:
Recently diagnosed primary well differentiated NET within the head of pancreas, initial evaluation

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: ---.
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.

Head and Neck:
Focal intense DOTA activity fusing to the left para-sellar region with maximum SUV 7.4 image 39, likely representing a meningioma.
No other suspicious DOTA avid lesions within the head and neck.
No suspicious DOTA avid cervical lymphadenopathy.
Partial opacification of left maxillary sinus consistent with sinus disease.

Chest:
No suspicious DOTA-avid lesions within the chest.
No suspicious DOTA-avid mediastinal or hilar adenopathy.
No suspicious pulmonary nodules.
No enlarged mediastinal, or axillary adenopathy.
No focal consolidation or pleural effusion.
The heart size is normal with no pericardial effusion.
The thoracic aorta and coronary arteries are atherosclerotic.

Abdomen and Pelvis:
Large, intensely SSA avid, centrally necrotic mass in the uncinate process of the pancreas measuring 4.4 x 5.2 cm with maximum SUV of 119.4, compatible with known primary malignancy.
No suspicious DOTA-avid adenopathy in the abdomen or pelvis.
The unenhanced liver, spleen, pancreas and adrenal glands appear unremarkable.
No hydronephrosis.
Status post cholecystectomy.
Tiny hiatal hernia.
Small calcifications in both kidneys could represent nonobstructing tiny calculi, vascular calcifications or combination of both.
A 3.0 cm exophytic photopenic hyperdense left renal cyst.
No ascites is identified.
No evidence of bowel obstruction.
Skeleton and Soft Tissues:
No suspicious DOTA-avid osseous lesions.
No suspicious lytic or blastic osseous lesions.
Advanced degenerative change throughout the spine.
Median sternotomy wires.


Impression:
1. Intensely DOTA-avid pancreatic head mass with central necrosis is compatible with primary NET.
2. No evidence of DOTA-avid regional or distant metastatic disease.
3. Focal intense DOTA activity fusing to the left para-sellar region, likely representing a meningioma, can be further evaluated with MRI brain.