0:04

So let me now go to the lung cancer patient.

0:09

You know what, I would just go directly to the findings.

0:11

I think I need to put this on a lot of emphysema changes.

0:17

And then there was this here, this

0:20

actually look in the map here.

0:21

It's nice. It shows you the primary site

0:23

and then the look looking at the me will tell you

0:25

that there's a primary lung cancer, the static hy

0:27

and medicinal lymph node just looking at the meb

0:30

and I can make it actually rotate.

0:33

Um, so obviously there is an

0:36

intensely here.

0:39

An intensely hyper metabolic speculated

0:43

right upper lobe nodule here.

0:49

That is obviously this is the primary lung cancer.

0:53

And then you see here, this is um,

0:57

obviously looks like lymphatic spread.

1:00

See how it's like there's septal thickening,

1:02

nodular septal thickening tracking all the

1:04

way to the pleura here.

1:05

That is hypermetabolic obviously, right?

1:09

This here and then when you go mely,

1:12

there are hilar lymph nodes

1:14

and which is here, you put it in um,

1:18

medicinal window, there's hilar lymph node, right?

1:21

And there is also mein node theoral, right?

1:26

Lymph node and sub lymph node.

1:30

And when, if you remember,

1:31

the TNMN one is the pulmonary inal

1:36

ipsilateral int B.

1:37

Once you go to ipsilateral, um,

1:41

mediastinal it's in two actually,

1:48

can you, can you imagine it's in two.

1:52

So this one would be an N two in lung cancer staging

1:56

contralateral medicinal,

1:58

and above the G clavicle it's N three.

2:03

So in this case we have hilar,

2:08

precarinal and SubCal lymph.

2:10

No, right, obviously.

2:14

And then once you finish that,

2:16

you'll look at the rest of the lung.

2:17

There was nothing else. Of course phys exchange scarring,

2:20

all these incidental finding, but nothing suspicious.

2:23

Hypermetabolic metabolic. There's no contralateral median.

2:27

There is no contralateral hide.

2:29

There is no sub clavicular, which is so important

2:31

with scale lymph nodes.

2:33

This is, um, clean this,

2:35

all these are important information, right?

2:39

Um,

2:46

this is, this is masticator activity,

2:49

which is a physiological ache.

2:51

Right now I go

2:55

down here, I

3:00

Just, physiologic activity in the kidneys,

3:03

adrenals were negative.

3:05

And then there was nothing else.

3:07

All, all incidental findings

3:09

that you can find in the report, nothing really important.

3:13

Uh, related to the cancer splenomegaly.

3:19

Some liver cirrhosis atherosclerotic changes, right?

3:24

But there is no, um,

3:26

distant metastatic disease in this patient, right?

3:31

So it's regional disease in this patient.

3:36

And you can see that in the Meb bun. The map is rotating. I.

Wk 1, Case 3 - Review

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video

0:04

So let me now go to the lung cancer patient.

0:09

You know what, I would just go directly to the findings.

0:11

I think I need to put this on a lot of emphysema changes.

0:17

And then there was this here, this

0:20

actually look in the map here.

0:21

It's nice. It shows you the primary site

0:23

and then the look looking at the me will tell you

0:25

that there's a primary lung cancer, the static hy

0:27

and medicinal lymph node just looking at the meb

0:30

and I can make it actually rotate.

0:33

Um, so obviously there is an

0:36

intensely here.

0:39

An intensely hyper metabolic speculated

0:43

right upper lobe nodule here.

0:49

That is obviously this is the primary lung cancer.

0:53

And then you see here, this is um,

0:57

obviously looks like lymphatic spread.

1:00

See how it's like there's septal thickening,

1:02

nodular septal thickening tracking all the

1:04

way to the pleura here.

1:05

That is hypermetabolic obviously, right?

1:09

This here and then when you go mely,

1:12

there are hilar lymph nodes

1:14

and which is here, you put it in um,

1:18

medicinal window, there's hilar lymph node, right?

1:21

And there is also mein node theoral, right?

1:26

Lymph node and sub lymph node.

1:30

And when, if you remember,

1:31

the TNMN one is the pulmonary inal

1:36

ipsilateral int B.

1:37

Once you go to ipsilateral, um,

1:41

mediastinal it's in two actually,

1:48

can you, can you imagine it's in two.

1:52

So this one would be an N two in lung cancer staging

1:56

contralateral medicinal,

1:58

and above the G clavicle it's N three.

2:03

So in this case we have hilar,

2:08

precarinal and SubCal lymph.

2:10

No, right, obviously.

2:14

And then once you finish that,

2:16

you'll look at the rest of the lung.

2:17

There was nothing else. Of course phys exchange scarring,

2:20

all these incidental finding, but nothing suspicious.

2:23

Hypermetabolic metabolic. There's no contralateral median.

2:27

There is no contralateral hide.

2:29

There is no sub clavicular, which is so important

2:31

with scale lymph nodes.

2:33

This is, um, clean this,

2:35

all these are important information, right?

2:39

Um,

2:46

this is, this is masticator activity,

2:49

which is a physiological ache.

2:51

Right now I go

2:55

down here, I

3:00

Just, physiologic activity in the kidneys,

3:03

adrenals were negative.

3:05

And then there was nothing else.

3:07

All, all incidental findings

3:09

that you can find in the report, nothing really important.

3:13

Uh, related to the cancer splenomegaly.

3:19

Some liver cirrhosis atherosclerotic changes, right?

3:24

But there is no, um,

3:26

distant metastatic disease in this patient, right?

3:31

So it's regional disease in this patient.

3:36

And you can see that in the Meb bun. The map is rotating. I.

Report

Please note: Items with dashed lines (--) are information withheld as it is not relevant for you to arrive at the correct findings and impression for the report and/or it was withheld for privacy information. The items were left in to show you the typical information documented in a PET report.

Clinical Indication:
--year-old female recently diagnosed with small cell lung cancer presenting for initial staging and treatment planning.

Technique:
Preparation: Last oral intake (except water) on ---.

Diabetic: No.

Blood glucose at time of FDG administration: --- mg/dL.

Radiopharmaceutical: --- mCi of F-18 FDG administered IV at --- . at ---.

Incubation interval: --- minutes.
Oral contrast: ---.
Positioning: Arms raised.
PET/CT scanner: ------.
PET/CT acquisition: Vertex-to-mid-thighs.
Standardized uptake value (SUV): Corrected for -----.
CT: Low-dose, non-breath-hold, without intravenous contrast.
TOTAL DLP (Dose Length Product): --- mGy cm.

Comparison/Correlation:
No comparison. No recent correlative imaging.

Findings:
Technical quality: ------.
Measurements: Unless otherwise specified, all SUVs refer to maximum value in the target.
Reference: mean SUV liver: --.
CT linear measurements performed on axial images.

Head and Neck:
No suspicious metabolically active lesions within the head and neck.
No suspicious metabolically active or pathologically enlarged adenopathy.
Unremarkable thyroid gland.

Chest:
Intensely hypermetabolic 16 x 13 mm anterior right upper lobe nodule maximum SUV 6.8, consistent with primary small cell lung cancer.
Moderately hypermetabolic nodular septal thickening radiating from the nodule likely representing peri-lymphatic spread.
Intensely hypermetabolic metastatic right hilar, pre-carinal and subcarinal adenopathy. Index nodes are:

22 x 19 mm right hilar lymph node maximum SUV 7
23 x 12 mm pre-carinal lymph node maximum SUV 7.2
Bilateral upper lobe predominant emphysematous changes.
Bibasilar atelectasis, apical, middle lobe and lingular scarring.
Aortic and coronary calcifications.
No pleural effusion, pericardial effusion or pneumothorax.

Abdomen and Pelvis:
No suspicious metabolically active lesions within the abdomen and pelvis.
No suspicious metabolically active or pathologically enlarged retroperitoneal or pelvic adenopathy.
Liver cirrhosis with splenomegaly stigmata of portal hypertension.
Unremarkable pancreas, kidneys and adrenals.
Calcified atherosclerotic changes.
Pelvic laxity/prolapse
No ascites.

Skeleton and Soft Tissues:
No suspicious metabolically active osseous or soft tissue lesions.
No aggressive lytic or sclerotic lesions.
Multilevel degenerative changes.
Left hip prosthesis.

Impression:
1. Intensely hypermetabolic right upper lobe nodule, consistent with primary small cell lung cancer, details above.
2. Intensely hypermetabolic metastatic right hilar, precarinal and subcarinal adenopathy.
3. No convincing evidence of metabolically active distant metastatic disease.

Case Discussion

Faculty

Riham El Khouli, MD

Associate Professor of Radiology, Chief, Division of Nuclear Medicine/Molecular Imaging & Radiotheranostics

University of Kentucky

Michael F. Shriver, MD

Director of Nuclear Medicine

Proscan-NCH Imaging

Course

Start Here

Practice Cases

Week 1

Practice Cases

Week 2

Practice Cases

Week 3

Practice Cases

Week 4

Practice Cases

Week 5

Wk 1, Case 3 - Review