Clinical History
This is a 47 year-old female with non small cell lung carcinoma undergoing
evaluation for the presence of mediastinal, hilar, or additional metastatic
foci. Comparison is made with an outside CT scan of the chest which demonstrates a large spiculated mass measuring 4.5cm x 3.5cm in the left upper lobe as well as a smaller mass in the mid to lateral aspect of the right upper lobe measuring 2.2cm x 1.5cm.
Technique
The patient was administered an IV injection of 8.87 mCi of F18 labeled
Fluorodeoxyglucose and approximately 45 minutes later the patient underwent
whole body imaging. Multiple bed projections were utilized with
reconstructions of the whole body study in addition to standard coronal,
axial, and sagittal planes.
Findings
1. There is a large area of markedly increased uptake identified in the
left apical region corresponding to the spiculated mass identified on the
CT scan. There is also a second area of markedly increased uptake noted in
the right upper lobe which appears slightly smaller than the previously
mentioned lesion.
2. There is no evidence of focal areas of increased uptake identified
in the mediastinum or hilar regions bilaterally.
3. There is no evidence of abnormally increased uptake identified
throughout the remainder of the imaged portions of the body including the
neck, axillary regions, abdomen and pelvis to suggest the presence of
metastatic foci to these regions.
4. Note is made of normal uptake within the myocardium, liver, spleen,
kidneys with excretion into the urinary bladder, and bowel.
Impressions
INTENSE UPTAKE IDENTIFIED IN BOTH THE LEFT APICAL AND RIGHT UPPER LOBE LESION COMPATIBLE WITH CARCINOMA. HOWEVER, NO ADDITIONAL FOCI OF ABNORMALLY INCREASED
ACTIVITY ARE IDENTIFIED TO SUGGEST THE PRESENCES OF METASTATIC DISEASE
EITHER THE HILAR REGIONS OR MEDIASTINUM OR ELSEWHERE WITHIN THE BODY.
Follow-up PET Scan
The patient returned 8 months later for evaluation of response to therapy. Her outside CT scan shows a minimal decrease in size of the two lesions and the large tumor still has a spiculated appearance. The left upper lobe lesion is now approximately 4cm x 3cm and the mass in the mid to lateral aspect of the right upper lobe is now 1.8cm x 1.5cm.
Technique
Forty-five minutes following the uneventful intravenous injection of 9.04 millicuries of fluorine-18 FDG, imaging was performed in the axial, sagittal, coronal and whole body volume projections. The region imaged extends from just inferior to the cerebellum, inferiorly to the midthigh.
Findings
Comparison is made to the prior PET study dated 12/29/99.
1. No areas of increased uptake are identified in either lung field. This represents a marked improvement as compared to the prior study which revealed large areas of increased uptake in the left pulmonary apex and right upper lobe.
2. No areas of increased uptake are identified in the mediastinum or hilar regions. Normal physiologic activity is seen in the heart, liver, kidneys, and urinary bladder.
3. No additional areas of increased activity are seen throughout the remainder of the imaged chest, abdomen, and pelvis.
Impressions
1. INTERVAL RESOLUTION OF AREAS OF INTENSE UPTAKE IN THE LEFT APEX AND RIGHT UPPER LOBE. THESE FINDINGS ARE CONSISTENT WITH A MARKED RESPONSE TO INTERVAL THERAPIES.
2. NO EVIDENCE OF RESIDUAL OR RECURRENT NEOPLASTIC DISEASE IS SEEN.
Click on the button below to view a PET Lung Scan case that is negative and the CT scan is positive
