Clinical History

The patient is a 50 year-old male with melanoma, being evaluated for metastatic disease.

Technique

The patient was injected intravenously with 15.9mCi of 18-Fluorine FDG. Subsequently, PET/CT images were acquired in coronal, sagittal and axial planes. The patient's blood glucose was 97 mg/dl at the time of injection. Correlation is made to a CT of the abdomen and pelvis with contrast.

Findings

1. There is normal physiologic uptake of FDG seen within the brain, oropharynx, larynx, heart, kidneys and bladder.
2. There is a focal area of increased activity in the subcarinal region with a maximum SUV of 19.81. There is a smaller focus of increased activity within the right hilum with a maximum SUV of 3.17. These findings are compatible with nodal metastases.
3. There is a small soft tissue pulmonary nodule within the right lower lobe which demonstrates a maximum SUV of 5.96. This is best seen on image overlay #356. Several other small soft tissue nodules are identified however most of these do not demonstrate increased activity.
4. There is a mixed interstitial and alveolar infiltrate within both upper lobes as well as the medial aspect of the right middle lobe. There are bilateral pleural effusions, greater on the right.
5. The liver is enlarged and demonstrates diffuse increased activity throughout both the right and left lobes. SUV values within the liver measure up to 18.45. This corresponds to the multiple hepatic metastases noted on CT.
6. There is a focal area of increased activity in the region of the pancreatic head, just anterior to the IVC. This measures up to 18.5 SUV, and corresponds to the soft tissue mass in this region on CT. Within or just superior to the body of the pancreas, there is an additional focal area of increased activity measuring up to 21.17 SUV. Within the tail of the pancreas, there is an area of increased activity with SUV values up to 20.72, which corresponds to the pancreatic tail mass seen on the CT images.
7. Additional focal area of increased activity is seen just anterior to the aorta and inferior to the head of the pancreas which demonstrates maximum SUV values of 6.96. This is best demonstrated on image overlay #595.
8. There are multiple foci of increased activity within the spine, ribs, and sternum as well as the scapula and clavicles bilaterally. There are also multiple focal areas of increased uptake within the pelvis and proximal femurs. A focal area of increased uptake is also seen within the left occipital condyle, which demonstrates a maximum SUV of 11.06. A lesion within the right sacrum demonstrates a maximum SUV of 18.3 on image overlay #713. A lesion within the L2 vertebral body demonstrates a maximum SUV of 12.1 on image overlay #569. There is also a tiny focus of increased activity within the left proximal tibia with a maximum SUV of 2.3. 9. There is mild abdominal and moderate pelvic ascites.

Impressions

1. WIDESPREAD OSSEOUS, THORACIC, AND ABDOMINAL METASTASES, COMPATIBLE WITH METASTATIC MELANOMA.
2. BILATERAL UPPER LOBE PULMONARY INFILTRATES, WHICH MAY BE DUE TO DRUG TOXICITY OR ATYPICAL INFECTION. THERE ALSO BILATERAL PLEURAL EFFUSIONS, GREATER ON THE RIGHT.

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