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So the first case we have today is gonna be the modality,

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thyroid, um, cancer patient.

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Uh, these, uh, the thyroid cancer, as you guys know,

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is a neuroendocrine tumor

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or neuro um, so neuro um, endocrine cells.

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So, um, dotatate is um, um, usually done.

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You can, we can also do F DG PET as well.

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Um, so I wanted to show you um, example

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of a Dotatate PET CT done for thyroid cancer patient.

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And this is, as you see here,

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as I we did see in prior sessions,

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you have to adjust the intensity.

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This is the map. You have to adjust the intensity to be able

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to see these cancers.

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When I'm up here, again, I'm not gonna go

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through my search pattern, I'm gonna directly go

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to the findings.

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When I'm the neck, I'll increase the intensity

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to look at the thyroid first.

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Look at this, it's enlarged.

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Um, nitrogenous in the CT here.

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Thyroid usually is hyper dense because the odine content.

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But look how there is a large infiltrative ill-defined mass

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replacing most of the thyroid gland.

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And this mass in most part is intensely uh, dotatate Avid

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or SSA avid heterogeneously, intensely avid.

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And there's extension outside of the thyroid.

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Obviously you can see here how it's extending

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outside the thyroid gland infiltrating aju structures.

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That traia you can,

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you can't see like really assuming you guys to see, um,

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there's no uh, flings with the trachea esophagus here.

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Very large infiltrated mass in the thyroid gland, right?

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Aggressive mass here.

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And there's of course some necrosis here,

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which is photonic in the pet damage, right?

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And then when you go up here, it's always,

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there's the static, uh, left cervical lymph nodes,

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multiple metastatic left cervical lymph nodes,

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obviously lymphatic SCA lymph nodes.

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Right? Now of course you,

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we will describe it in the report location, like

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what are the levels of metastatic lymph nodes.

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Um, and then, and be careful

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because of course you know the parotid plant is the

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physiologic side for the dotatate.

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So don't confuse that with metastatic disease, right?

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And um,

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just like looking here in the mastoid here,

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there is some activity in the mastoid.

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Let me see here, what's going on.

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This like something in the mastoid

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or something in the rain.

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Just took me a second. Dunno if we did notice that.

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It's very subtle, very mild activity. Sometimes it's

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Also the, the sinuses, the venous sinuses.

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Let's see on the map,

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see there's little, some ality here and I can go back

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and look at the case and see if we saw something

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and if the patient has correlative images

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that showed something there.

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In this here

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there's a little bit widening.

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Yeah, I don't think we recommended in that, right?

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Yeah, I'll look at that and maybe follow up if you

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send you a follow-up email.

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Subtle like focal activity here, again,

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you don't see it till you

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really increase the intensity high.

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If you look at the regular like intensity,

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it's like it'll skip through and it, it might be nothing.

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It's really the level of activity is um, blood pool level.

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So it might be nothing, it's not metastatic or anything.

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And if it's anything it's gonna be like maybe um, mening

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or most probably a

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mening if anything.

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Or one of these like benign

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lesions in the brain if something.

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Or at most it's gonna be maybe inflammation.

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I don't see evidence of mastitis right now

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but I have to investigate it more.

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I'll look at that and I will give you a follow up guys.

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So let's go back to our case.

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So there is here, like we said, primary thyroid,

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me thyroid cancer with metastatic cervical lymph nodes.

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And then um, when I go down

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there was I think nothing in the lungs, not SS a avid

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or even non um, S ss a avid

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and you have to adjust the intensity when you go down here

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into the liver to be able

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to see like real any liver static lesions.

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Lemme change the intensity here

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and don't forget also to decrease the intensity

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to look at the spleen nicely.

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'cause when it's really very intense,

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you can't see really anything in the spleen.

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There's nothing in the spleen. The kidneys are fine.

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Then we go back to the tendency to look forward

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to the neo lymph nodes and there is nothing, right?

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So looking at the MIP again, what

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you can see is the medullary thyroid

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can infiltrated, sorry,

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the infiltrated moderate thyroid cancer

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and metastatic lymph nodes that you can

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See in this. So

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regional lymph nodes and primary thyroid cancer.

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Uh, that's all you can see in this patient.

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And there was no, um, bone mets.

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So keep in mind that modality,

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thyroid cancer is a neuroendocrine in the

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neuroendocrine tumor categories.

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And um, dotatate is very valuable

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and, um, helpful in this patient,

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these patient population, right?

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There's reactive inflammatory lymph

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nodes in the inguinal region.

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There's nothing here too. This is degenerative.

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And as you know, um, we know that also what some, one

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of the pitfalls of dotatate is that the same as a bg.

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See here there's some activity, mild activity

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because, um, osteoblastic,

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so breast receptor receptors.

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So when there's some active, uh, changes for example

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or healing fractures, they will show some to the activity,

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don't get confused

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and think that there's something going on.

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This is just when it's obviously degenerative changes,

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it's ion, there's no problem with that.

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And activity is usually mild, can be moderate,

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not more than that, right?

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So that is it for this patient. There's nothing extra.