Pet Images. My Big Day!

Ok, so some of you know that I have been questioning for a couple months me being on the MOPP chemo regimen because I can’t be on ABVD because of bad PFTs (pulmonary function tests).  I have also been really concerned because I have not have a PET/CT since May 12th.  Well, today was the big day!  I had a PET.  Since I have a second opinion on Tuesday, they asked me to have them put it on disk.  And of course, since I had the disk I had to take a look.  Now, I have never seen a PET before, and I think what I THINK I am looking at looks effing awesome, but I can’t be sure.  The first image is my PET 5/12 and the second is today’s.  After the 1st PET I also listed the report that accompanied the scan.  The report isn’t ready yet for today’s scan.  Anyhow… So here they are:

PROCEDURE: PET/CT SCAN

CLINICAL HISTORY: Hodgkin disease.

TECHNIQUE: PET/CT scan was performed following intravenous injection of 7 mCi of F-18 FDG following at least four hours of fasting. Low-dose CT scan with contrast was performed prior to PET scanning from the skull bases to the mid-thighs, and the images were then fused and viewed in multiple projections on a workstation.

COMPARISON: Correlation is made with a prior CT scan which was performed at X-Ray Associates dated 04/08/08.

FINDINGS:

NECK:

There is a lymph node in the right lower neck, supraclavicular region, which measures 1.9 x 1.6 cm, just lateral to the right thyroid lobe, and this accumulates FDG activity, maximum SUV 8.3.

CHEST:

There are multiple sites of abnormal activity. There is a large mediastinal mass, which occupies primarily the anterior mediastinum, but also extends to involve the middle and the posterior mediastinum, and this is very FDG-avid, maximum SUV 12.0.

There are also multiple large pulmonary masses and nodules, and these also accumulate intense activity, with most of the SUV activity levels in the 8-10 SUV range.

There is an enlarged right cardiophrenic lymph node, measuring approximately 4.0 cm x 1.8 cm, maximum SUV 9.2.

There is also moderate adenopathy in the region of the internal mammary lymph node chain bilaterally, the most obvious measuring approximately 2.0 cm x 1.6 on image #26, maximum SUV 6.8.

Enlarged lymph node in the right anterior chest wall measures 2.8 x 1.7 cm, just posterior to the right pectoralis minor muscle, maximum SUV 11.3.

There is a closely adjacent 1.0 cm x 1.0-cm lymph node in the right axilla, with borderline activity (maximum SUV 2.4).

No definite abnormal activity in the left axilla.

ABDOMEN:

No definite abnormal activity.

PELVIS:

There are small lymph nodes in the region of the right groin, with a 1.0 cm x 0.9 cm lymph node in the right inguinal region, which has borderline activity with maximum SUV of 2.5. There is also a 1.3 cm x 0.9 cm lymph node just medial to the right external iliac artery, image #104, with moderate activity of maximum SUV 3.0.

IMPRESSION:

Multiple sites of abnormal activity, with the bulk of intense activity being in the mediastinum and in the lungs bilaterally, as well as adenopathy involving the right supraclavicular region, right anterior chest wall, right cardiophrenic angle, and internal mammary lymph node chains.

Small residual lymph node noted in the right pelvis and inguinal region, with relatively mild activity.

PROCEDURE: CT SCAN OF THE NECK, CHEST, ABDOMEN, AND PELVIS WITH CONTRAST

TECHNIQUE: CT scan of the neck, chest, abdomen, and pelvis was performed following intravenous and oral contrast.

COMPARISON: Made to a prior scan which included the chest, abdomen, and pelvis performed at X-Ray Associates dated 04/08/08.

FINDINGS:

NECK:

There is a mildly prominent lymph node in the right posterior triangle, image #23 measuring 0.9 cm x 0.6 cm. Although there were some minimal activity associated with this lymph node, with a maximum SUV of 2.1, it is below the threshold of 2.5

More inferiorly, there is a lymph node in the right supraclavicular region, lateral to the right thyroid lobe, which has decreased in size, now measuring 1.9 cm x 1.6 cm, where previously, it had measured 2.8 cm x 2.0 cm. This is intensely active by PET.

CHEST CT:

There is a large mediastinal mass, which involves the anterior and middle mediastinum, with soft tissue density extending into the posterior mediastinum. This mass is somewhat difficult to measure, but on image #46, where the bulk of the tumor is, it measures approximately 7.3 cm x 14.1 cm in AP and transverse dimensions, which represents a modest decrease in size when compared to measurements at the same level where it was 14.8 cm x 7.8 cm.

Large bilateral pulmonary masses are also present, ranging in size from a few millimeters to the largest at the left lower lobe measuring 5.6 cm x 6.0 cm. These were also intensely positive by PET. Overall, there has been a modest decrease in size of these pulmonary masses. (Largest in the left lower lobe on the prior CT scan of 04/08/08, 0.6 x 6.3 cm).

There is a right cardiophrenic lymph node, maximum diameter 4.0 cm x 1.8 cm, which is unchanged.

Internal mammary adenopathy also does not appear significantly changed, largest lymph node in the left internal mammary lymph node chain measures 2.0 cm x 1.6 cm. This is also positive by PET.

Enlarged lymph node in the right anterior chest wall posterior to the pectoralis minor muscle, measures 2.8 cm x 1.7 cm, and was FDG positive. This does not appear significantly changed.

Largest lymph node in the right axilla measures 10 mm, and was mildly FDG positive.

Posterior mediastinal soft tissue is difficult to measure, but does appear to overall, have decreased slightly in size from prior exam.

There are small bilateral pleural effusions, and these do not appear to have changed significantly.

ABDOMINAL CT:

Spleen is mildly enlarged. This is unchanged.

A tiny 2-mm lesion in the anterior aspect of the medial left hepatic lobe is unchanged and probably represents a tiny cyst.

Ill-defined low attenuation just anterior to the right portal vein on image #49 has a similar appearance to the prior exam and did not accumulate FDG, may represent a small focus of fatty infiltration.

Pancreas, kidneys, and adrenal glands as well as the gallbladder and bile ducts are all normal.

No ascites. No retroperitoneal or mesenteric adenopathy.

The bowel appears normal.

PELVIS:

I believe that the enlarged lymph node in the right inguinal region has been removed since the prior exam, as there is some soft tissue density here suggesting postoperative change.

There is a 1.0 cm x 1.0 cm lymph node remaining in the right inguinal region, which was mildly FDG positive. Additionally, somewhat more posterior to this at the external iliac lymph node chain, is a slightly larger lymph node measuring 1.3 cm x 0.9 cm, which also was mild to moderately FDG positive.

Otherwise, no pelvic masses or additional sites of adenopathy.

IMPRESSION:

When compared to the prior exam, there has been a modest decrease in size of the very large mediastinal mass and mediastinal adenopathy, as well as modest decrease in size of multiple bilateral pulmonary masses and nodules.

Adenopathy involving the right supraclavicular region, right anterior chest wall, internal mammary lymph node chains, and right cardiophrenic angle are also noted and stable.

Small bilateral pleural effusion.

Small residual lymph nodes in the right inguinal region/external iliac lymph node chain, decreased.

Radiologist: Linda Casey, MD

LC/vhe/cc

D: 05/14/2008
T: 05/14/2008
Job #: 14533

Well?  What do you think?!?!?!?