Clinical History

This is a 34 year-old patient with malignant fibrous histiocytoma of the liver.

Technique

The patient was administered 11 millicuries of F18 labeled FDG, and following the infusion of the radiotracer, 45 minutes later whole body imaging was performed with six bed positions and computer reconstruction of whole body images. Standard coronal, transverse, and sagittal images were reconstructed from the PET study.

Findings

Comparison is made to an outside CT scan from 3/17/99. The more current CT abdomen scan of 6/07/99 is not available for comparison, and reportedly, the patient has not had any more recent CT or MRI studies. There is an intense focus of FDG uptake identified in the posterior aspect of the liver, near the midline, measuring approximately 6.7 cm in transverse dimension by 5.4 cm in AP dimension, with mean SUV measurements in the range of 4.5 to 5.5. There is a smaller focus of abnormal FDG uptake seen in the hypertrophied left lobe of the liver, measuring 3.3 cm transverse by 2.8 cm AP, with overall less glucose uptake and mean SUV measurements of 2.5 to 3.5. There is also bilateral mild uptake of activity noted along the posterior pleural aspect of both lungs. Normal uptake and excretion of activity by both kidneys is noted. No definite abnormal focus of uptake is identified in the lungs.

Impressions

THERE IS A LARGE FOCUS OF INCREASED GLUCOSE METABOLISM IDENTIFIED IN THE POSTERIOR ASPECT OF THE LIVER, WITH A SMALLER LESION IDENTIFIED IN THE HYPERTROPHIED LEFT LOBE OF THE LIVER. THE LARGE LESION DEMONSTRATES AN ELEVATED SUV MEASUREMENT, WHICH IS TYPICALLY INDICATIVE OF MALIGNANCY. THE SMALLER LESION ALSO DEMONSTRATES AN INCREASED SUV MEASUREMENT, WITH THIS LESION ALSO BEING SUSPICIOUS FOR MALIGNANCY. HOWEVER, WITH THE LACK OF ANY RECENT CT OR MR FOR CORRELATION WITH THESE FINDINGS, A REPEAT CT AND/OR MR EXAMINATION WOULD BE USEFUL TO EVALUATE THESE SPECIFIC FINDINGS. THE ABNORMAL PLEURAL UPTAKE NOTED BILATERALLY IN THE POSTERIOR ASPECT OF THE HEMITHORACES IS MORE SUSPICIOUS FOR A PLEURITIS, WITH PLEURAL METASTATIC DISEASE CONSIDERED LESS LIKELY.

Comments