Clinical History
The patient is a 60 year-old male with multiple myeloma, 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 111 mg/dl at the time of injection. Correlation is made to a CT of the abdomen and pelvis with contrast.
Findings
There is normal physiologic uptake of FDG seen within the brain, heart, kidneys, bladder and bowel.
Multiple abnormal areas of increased metabolic activity are identified scattered throughout the entire body. A left Level II lymph node has a maximum SUV of 6.16 at table position 191. A right supraclavicular lymph node has a maximum SUV of 7.98 on image 249. A more inferior right supraclavicular lymph node has a maximum SUV of 7.49 on image 282. A left supraclavicular lymph node has a maximum SUV of 7.04 on image 253.
Increased activity is seen in the proximal humeri bilaterally. The right demonstrates a maximum SUV of 17.58 on image 321. The left demonstrates a maximum SUV of 16.48 on image 328.
A soft tissue mass with increased metabolic activity involving the left axilla, chest wall, and lower left rib demonstrate a maximum SUV of 14.21 on image 380. A left scapular lesion has a maximum SUV of 6.76 on image 282.
Prevascular lymphadenopathy on image 344 has a maximum SUV of 10.99. A right subdiaphragmatic nodule has a maximal SUV of 10.63 on image 514. A left perimesenteric mass at the level the right kidney has a maximum SUV of 11.53 on image 590. A left peritoneal nodule on image 737 has a maximum SUV of 7.15. A left paraspinal mass has a maximum SUV of 6.5 by on image 599. A dominant left omental mass on image 648 has a maximum SUV of 13.34. A right lower quadrant peritoneal nodule has a maximum SUV is 7.38 on image 727.
The L1 vertebra has increased activity with a maximum SUV of 11.50 on image 590. Right iliac bone uptake has a maximum SUV 14.50 on image 766. Left iliac wing activity has a maximal SUV of 7.53 on image 753. Left pubic symphysis activity demonstrates a maximum SUV of 8.31 on image 894. Patchy increased marrow uptake is seen in the bilateral femurs. The right demonstrates a maximum SUV is 7.91 on image 791. The left has a maximum SUV of 15.27 on image 739.
The right gluteal subcutaneous nodule has a maximum SUV of 8.57 on image 760. A right intramuscular proximal thigh mass has a maximum SUV is 13.24 on image 994.
Impressions
EXTENSIVE METABOLICALLY ACTIVE OSSEOUS LESIONS, LYMPHADENOPATHY, AND PLASMACYTOMAS, AS DESCRIBED.