Wk 4, Case 5 - 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:
Male with well-differentiated grade 2 metastatic neuroendocrine tumor to the liver, kidney and bladder of unknown primary. Currently treated with octreotide.

Technique:
Preparation: On Somatostatin Analogue Therapy.
Radiopharmaceutical: _ mCi of Cu-64 dotatate (DETECTNET), a somatostatin analogue (SSA), administered IV at ---at ---. Incubation interval: _ minutes.
Oral contrast: ----.
Positioning: Arms raised.
PET/CT scanner: Siemens Biograph 40 mCT.
PET/CT acquisition: Vertex-to-mid-thighs.
Standardized uptake value (SUV): Corrected for ---.
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.
Reference: mean SUV liver: -----
CT linear measurements performed on axial images.


Head and Neck:
Mildly SSA-avid nonenlarged right supraclavicular lymph node measuring 5 mm, max SUV 4.7.
No other suspicious cervical adenopathy.
Unremarkable thyroid.


Chest:
Multiple intensely SSA-avid mediastinal lymph nodes. Examples are:

A right upper paratracheal lymph node measures 14 mm, max SUV 70.8
Lower paratracheal lymph node at the bifurcation measures 17 mm, max SUV 45.4

Moderate centrilobular emphysema.
No suspicious lung nodule.
Coronary artery calcifications. Cardiac stent.


Abdomen and Pelvis:
Intensely SSA avid mesenteric soft tissue mass with coarse calcification located within the right small bowel mesentery with adjacent mesenteric stranding measuring 2.6 x 2.2 cm, max SUV 32.3.
Adjacent to this mesenteric mass, there is focal intense increased uptake within a thickened loop of small bowel, likely ileal, max SUV 27.2, likely representing the primary small bowel site.
Innumerable intensely SSA-avid metastatic lesions throughout the liver. Examples are:

The largest is located within the inferior right hemiliver measuring 8.0 x 9.0 cm, max SUV 69.5
A lesion in the hepatic dome measures 2.9 x 2.6 cm, max SUV 36.5

Enlarged, intensely SSA-avid porta hepatis lymph node measuring 16mm, max SUV 40.3.
Multiple small, SSA-avid para-aortic lymph nodes. For example, a 5 mm node with max SUV 8.4.
No suspicious SSA-avid foci in the kidneys.
Unremarkable spleen, adrenal glands, and pancreas.
Bilateral nonobstructive nephrolithiasis. No hydronephrosis.
Subcentimeter hyperdensity arising from the left interpolar region, too small to characterize.
Diffuse colonic diverticulosis without evidence of acute inflammation. Remainder of the small bowel is normal in caliber.
Diffuse bladder wall thickening and small diverticula.
Mildly enlarged prostate with coarse calcifications.


Skeleton and Soft Tissues:
No SSA-avid lesions in the osseous structures.
No aggressive lytic or sclerotic lesion.
Mild soft tissue thickening of the bilateral inguinal canals, left greater than right, with mild SSA uptake, max SUV 7.0, likely inflammatory.
Degenerative changes of the spine.

Impression:
1. SSA-avid metastatic small bowel mesenteric mass with coarse calcification.
2. Adjacent focal intense SSA uptake fusing to a thickened loop of small bowel, ileal, consistent with primary neuroendocrine tumor site.
3. Intensely SSA avid metastatic porta hepatis, retroperitoneal, mediastinal, and right supraclavicular lymphadenopathy.
4. Innumerable intensely SSA-avid metastatic hepatic lesions.