Clinical History

The patient is a 57-year-ole male with known liver metastases secondary to colon carcinoma. This examinations is performed to evalutate the extent of metastatic disease.

Technique

The patient received an IV injection of 30 millicuries of Tc-99m Anti Carcinoembryonic antigen (CEA). Approximately 3 hours later, whole body imaging was carried out. This was followed by SPECT imaging.

Findings

There is evidence of significant retention in the major vessels, heart, lungs and vasculature of the head. Note is also made of activity in the urinary bladder, kidneys, liver, spleen and external genetalia. There are considered to be areas of physiological localization. The liver demonstrates a major deficiency in in uptake in the dome of the liver. This corresponds with the large hypovascular and probably necrotic mass in the dome of the right lobe of the liver. Note is also made of some minor activity in the vertebral column which is probably a remnant of yesterday's tc-99m MDP bone scan.

The SPECT scan again shows physiological uptake in the kidneys and bladder and in the inferior aspects of the liver, which entered the field of view. There is increased activity in the descending colon as well as the ascending colon. This activity could be physiological at 3 hours post- injection.

Following Mag Citrate bowel cleansing, the patient returned the following day and SPECT imaging of the pelvis and lower abdomen, liver and upper abdomen were again obtained. The faint activity in the descending colon, seen on the previous day, has now been excreted, but there is definite retention in the RLQ extending superiorly to the lower aspect of the liver. This is almost certainly ascending colon and the presence of this activity 24 hours following injection and bowel cleansing is not considered normal.The possibility of synchronous lesions must be considered. In addition, there is intense physiological activity in the kidney, especially the superior aspect of the left kidney. This may be a reflection of previous renal disease, but a colonic metastasis to kidney could be considered. Correlation with recent CT would be very helpful. In the SPECT images of the liver and upper abdomen at transverse 68, sagittal 84, and coronal 62, there is focal uptake which is clearly outside the renal parenchyma and is in rather good location to be left adrenal or an abnormal lymph node very close to the left adrenal. Most likely, this is a metastasis to the left adrenal. Since there is a great deal of experience in CT and sonography in this region, correlation with those two modalities is suggested.

Impressions

1. No definite evidence of lymph node involvement.

2. Abnormal CEA uptake in the right colon.

3. Possible left adrenal metastasis and possibly left renal metastasis from colon cancer. Correlation with anatomical modalities would be most helpful.

4. The large metastases seen on CT are also identified. In addition, there is a possibility of multiple other focal liver mesastases, perhaps as many as an additional 7 to 10 seen in the liver CEA SPECT reconstruction. It is possible that these smaller focal regions may be inherent in the SPECT reconstruction method.

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