0:01

In this case we have an 81-year-old male

0:04

with remote history of follicular lymphoma that was treated

0:09

at the time with chemotherapy

0:12

and uh, stem cell transplant that presents

0:15

with new neck adenopathy.

0:20

This pet was performed for uh, restaging this patient.

0:24

Looking at the mip, we can identify that there are

0:30

multiple areas of very intense tracer uptake in the right

0:34

neck, axi and probably within the chest.

0:40

And we're gonna discuss the

0:43

specific findings on this patient.

0:46

There's multiple novel stations

0:49

that are involved in the right side of the neck

0:51

that correspondent to the palpable adenopathy.

0:55

And the decree of uptake is it's quite intense.

1:00

I mean, if I put a scale of zero to five, it's hard for me

1:04

to identify the lymph nodes.

1:05

I have to decrease the scale to be able to separate them.

1:09

That tells you that the intensity is really high.

1:12

Now, if I put volumes of interest

1:14

and I evaluate the SUV max

1:17

in this particular software, I get a cross

1:22

where the maximum intensity is found,

1:25

which would be in this region.

1:28

This SUV max is 32.5. That's extremely high.

1:32

So now we know that there is extremely FDG AVID

1:37

AADE adenopathy in the right side of the neck that extends

1:40

to the supraclavicular region

1:43

and even infraclavicular

1:46

and axillary region on the right.

1:49

In addition, we see

1:50

that there are intensely the GI lymph nodes

1:53

that are a smaller in the superior mediastinum.

1:57

There was nothing in the lamp parenchyma this case

2:02

and moving to the abdomen there were no abnormal findings.

2:06

So we're gonna look at the spleen in this case.

2:09

I would say visually the apick of the spleen is equal

2:12

to the liver and the size of the spleen is normal.

2:15

So I don't suspect

2:17

that there is a splenic involvement in this case.

2:21

We performed at essentially vertex to toes

2:26

protocol, but we can see that there's no other areas of

2:30

uptake that would be concerning.

2:32

The only uptake that I see in the hip

2:34

is probably insertional.

2:36

As you can see here, it is associated

2:39

to the greater TR hunter of the right femur.

2:43

This patient had a history of follicular lymphoma.

2:46

We don't have the prior imaging,

2:47

but as we now look at the CT for additional findings,

2:52

we don't see any other areas of lymph nodes

2:56

that may have not been FG avid.

2:58

So this patient's disease was limited to

3:03

above the diaphragm.

3:05

There's a little bit of an uptake related

3:08

to the left IAC crest

3:10

and a little bit on the soft tissues here

3:13

with some stranding as you can see on the ct.

3:15

And this was the result of a bone marrow biopsy that was,

3:20

um, benign finding.

3:23

So in a patient with a history of lower grade lymphoma, such

3:27

as follicular lymphoma with new presentation

3:32

of adenopathy, with this level of FDG uptake,

3:37

one should raise the concern of transformation

3:42

and this was biopsy confirmed

3:45

and this patient transformed from the follicular

3:48

to diffuse large ReCell lymphoma.

3:50

There are not a specific SUV max values to

3:56

accurately diagnose transformation,

4:00

but we raise the concern generally speaking

4:04

above an SUV max of 15.