Wk 5, 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:
--year-old male with history of metastatic castration-sensitive adenocarcinoma of prostate, status post radical prostatectomy followed by postoperative/salvage radiotherapy completed, presenting with biochemical recurrence for subsequent treatment planning.

PSA levels:
Most recent 59.18 ng/mL, compared to 14.64 ng/mL/

Technique:
Radiopharmaceutical: ----- mCi of F-18 piflufolastat (PSMA, Pylarify) administered IV at -----at -----.
Incubation interval: ---- minutes.
Oral contrast: -----.
Positioning: Arms by sides.
PET/CT scanner: ----------.
PET/CT acquisition: Vertex-to-mid-thighs.
Standardized uptake value (SUV): Corrected for body weight only.
CT: non-breath-hold, without intravenous contrast.
TOTAL DLP (Dose Length Product): -------- mGy cm.

Comparison/Correlation:
No comparison. No correlative imaging.

Findings:
Technical quality: Adequate.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target.
CT linear measurements performed on axial images.


Head and Neck:
Two intensely PSMA avid left supraclavicular lymph nodes, the larger one measures 19 x 14 mm maximum SUV 13.45.
No other suspicious PSMA avid lesions.


Chest:
- Multiple PSMA-avid posterior lower mediastinal lymph nodes within the prevertebral and para-esophageal regions. Index nodes are:

- 16 x 14 mm left para-esophageal lymph node maximum SUV 52.1
7 x 6 mm left paratracheal lymph node maximum 15.4

Multiple scattered small sub-centimeter pulmonary and pleural based nodules, many of which are partially calcified, showing no significant PSMA uptake above background level, favors granulomatous inflammatory etiology. Attention on follow up exams recommended.
No pleural effusion, pericardial effusion or pneumothorax.
Aortic and coronary calcifications.


Abdomen and Pelvis:
Multiple intensely PSMA-avid enlarged metastatic retroperitoneal lymph nodes. Index nodes are:

- 26 x 28 mm portacaval lymph node maximum SUV 46.8
- 30 x 27 mm pancreaticoduodenal maximum SUV of 43.7
- 32 x 23 mm left para-aortic nodal conglomerate with maximum SUV 46.1

Surgical changes from radical prostatectomy with no evidence of PSMA-avid recurrent disease.
Mild to moderate right hydronephrosis with dilated upper two third of the right ureter down to the level of aortic bifurcation appears to be caused by crossing right common iliac artery.
Unremarkable liver, gallbladder, spleen, pancreas, left kidney and adrenals.
Calcified atherosclerotic changes.
Urinary bladder neck funneling.
No ascites.


Skeleton and Soft Tissues:
No suspicious PSMA avid osseous or soft tissue lesions.
No aggressive lytic or sclerotic lesions.
Multilevel degenerative changes.
Contamination within a hygiene pad.

Impression:
1. Intensely PSMA-avid metastatic left supraclavicular, mediastinal and retroperitoneal adenopathy.
2. Surgical changes from radical prostatectomy with no evidence of PSMA-avid recurrent disease.
3. Multiple scattered small sub-centimeter pulmonary and pleural based nodules, many of which are partially calcified, showing no significant PSMA uptake above background level, favors benign/granulomatous inflammatory etiology. Attention on follow up exams recommended.
4. Mild to moderate right hydronephrosis with dilated upper two third of the right ureter down to the level of aortic bifurcation, with obstruction appears to be caused by crossing right common iliac artery.