# V58.11 or V67.2 for status post chemotherapy for PET-CT Scan report?



## she803 (Jul 30, 2012)

HISTORY: Patient is an 83 year old man with a history of metastatic prostatic cancer, status post chemotherapy. Whole body PET-CT is for restaging.

TECHNIQUE: PET CT of the whole body  was performed according to our standard protocol using multiple overlapping bed positions in 2 acquisitions from mid ear to mid thigh.

The patient was requested to fast overnight and upon presentation finger stick glucose level was 72 mg/dL.  Oral contrast was administered. The patient was injected with  16.51 mCi of F18-FDG and rested in the supine position for 45 minutes.  For each acquisition, a non-diagnostic CT was performed using low MA technique (and without intravenous contrast).  These data were used to generate attenuation maps which were applied to the subsequently obtained emission scans and were also fused for localization purposes.

RESULTS:  Comparison is made to prior study of June 20, 2011. 

The study was technically adequate.  Normal physiologic uptake is seen in the brain, heart, urinary system, liver and alimentary canal.  

The images of the head and neck are unremarkable. There is no focal abnormal uptake or discrete mass in the brain. There is physiologic mucosal uptake of the tongue. There are no enlarged lymph nodes of the neck on CT. There is no abnormal uptake in the thyroid.

Mediport is noted in the right anterior wall. No lymphadenopathy is noted in the axillae.

There is no abnormal uptake or discrete nodule in the lungs. No adenopathy is noted in the mediastinum. 

There is new non-FDG avid mild to moderate pleural effusion bilaterally.

Again noted are radiation therapy seeds in a small prostate. There is a focus at the midline of the prostate, most likely representing urine activity in the prostatic urethra. 

There are a few enlarged non-FDG avid lymph nodes in the aortocaval, left periaortic and left common iliac regions, above and below the aortic bifurcation. The largest node measures about 3.0 cm. They are grossly unchanged in the size compared to prior study, but previously seen mild uptake is almost completely resolved.

The images of the liver, spleen, pancreas and adrenal glands are normal radiographically and scintigraphically. Again noted is a 3 cm exophytic cystic lesion without uptake in the midpole of the right kidney. There is physiologic linear bowel uptake. 

The current images demonstrate extensive sclerotic lesions with mild to moderate uptake in the bilateral humeri, left clavicle, bilateral ribs, multiple vertebral bodies and posterior elements, sacrum, iliac bones greater on the left, acetabulum, left ischium and bilateral proximal femora. Compared to prior study, most lesions are stable in the extent and uptake for example a lesion in the right humeral shaft with SUV 4.2. Some lesions demonstrate decreased FDG uptake, for example the uptake of the lesion in the right transverse process of the T1 decreases from previous SUV 5.2 to current SUV 2.4; the uptake of the lesion in the left-sided T9 is also decreased from previous SUV 4.2 to current SUV 2.4. But some lesions are increased in the extent for example those lesions in the T12, L2, L5 and right posterior acetabulum.

Impression:

1. Extensive sclerotic lesions with mild to moderate uptake as described above. Most lesions are stable in the extent and uptake compared to prior study of June 28, 2011. Some lesions demonstrate decreased FDG uptake, but some lesions are increased in the extent for example those lesions in the T12, L2, L5 and right posterior acetabulum.
2. A few enlarged non-FDG avid lymph nodes in the aortocaval, left periaortic and left common iliac regions, grossly unchanged in the size compared to prior study. But previously seen mild uptake is almost completely resolved.
3. Radiation therapy seeds in a small prostate. 
4. Unchanged 3 cm exophytic cystic lesion without uptake in the midpole of the right kidney. 
5. New non-FDG avid mild to moderate pleural effusion bilaterally.


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