8/24/23 PET Scan Report (Surgery + 5 weeks)

Received a PET scan last week (8/24/23), following the July neurosurgery by 5 weeks.

I am scheduled for a brain MRI this coming Friday.

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PET/CT Whole Body (vertex to toes)    8/24/2023 9:47 AM

COMPARISON (including at least the prior year or since last change in therapy): Prior PET from: 12/20/2021.

REASON FOR THE STUDY: Restaging.

CLINICAL HISTORY: 58 years old Male with metastatic melanoma, left forehead primary and additional primary in the left neck.  

CURRENT THERAPY AND DATE INITIATED: Ipilimumab/nivolumab

TECHNIQUE: Patient's fasting time was > 6 hours. Following the radiopharmaceutical, a low dose, non-contrast, nondiagnostic CT was obtained for attenuation correction purposes. This was followed by an emission PET scan started 51 minutes after FDG injection.  PET images were corrected for attenuation using the CT transmission data. PET/CT was acquired from vertex to toes. A rotating 3D MIP, as well as axial, coronal, and sagittal PET images with and without attenuation correction was interpreted. Acquired and fused PET/CT images were reviewed alongside the PET images. Patient's random blood glucose at the time of FDG injection was 95 mg/dL.

CONTRAST MEDIA AND RADIOPHARMACEUTICALS: 18F-fluorodeoxyglucose (FDG) - 8 millicurie - Intravenous

RADIATION DOSE INDICATORS: Exposure Events: 3 , CTDIvol Min: 0.1 mGy, CTDIvol Max: 5.1 mGy, DLP: 999 mGy.cm

FINDINGS:

Reference standardized uptake values:

Current exam: Cerebellar SUVmax is 8.7. 

Prior cerebellar SUV max: 10.5

 

Oncologic findings:

Index lesions: None

Lymph nodes: Scattered hypermetabolic but nonenlarged bilateral cervical and axillary lymph nodes, for example left occipital node measuring 0.5 cm in short axis (series 2, image 63).

Lungs: No metastases.

Abdominal and pelvic organs: No metastases.

Bones: No metastases.

Other: No metastases.

Non-oncologic findings:

Brain: Prior right temporal and left parieto-occipital craniotomies with expected photopenia of the left parieto-occipital resection cavity. Please see recent prior brain MRI from 8/1/2023 for intracranial findings.

Neck: Focal low-level hypermetabolism in a partially calcified subcentimeter right thyroid nodule.

Chest: Multiple small nodules throughout both lungs, some solid and some groundglass, which are new from 3/30/2023, for example hypermetabolic 0.8 cm left lower lobe solid nodule (series 4, image 146). Status post right upper and lower lobe wedge resections. Otherwise unremarkable.

Abdomen/Pelvis: Right renal cyst. Otherwise unremarkable.

Musculoskeletal: Plate and screw fixation hardware in the right clavicle. Otherwise unremarkable.

 

IMPRESSION: 

1.  Scattered hypermetabolic but nonenlarged bilateral cervical and axillary lymph nodes, favored reactive. Symmetry of findings would be unusual for metastatic disease; however, given history of left forehead/neck melanoma, recommend short interval follow-up PET/CT in 3 months to assess for stability.

2.  Multiple small nodules throughout both lungs, some solid and some groundglass, new from 3/30/2023 and likely infectious or inflammatory in etiology. Attention on follow-up.

3.  Focal low-level hypermetabolism in a partially calcified subcentimeter right thyroid nodule, which can be further evaluated with dedicated thyroid ultrasound as clinically indicated.

4.  Please see recent prior brain MRI from 8/1/2023 for intracranial findings.