0:00

So for our final case of this section,

0:04

we're looking at a patient who has had a prostatectomy.

0:08

And in our practice,

0:09

unfortunately this patient didn't have an early dynamic,

0:11

but often in our practice they will.

0:13

Um, sometimes it's just a matter of timing on the day

0:16

and just to kind of show,

0:18

illustrate a bit of a practice point.

0:20

So I'm gonna make it a little bit paler.

0:24

So this is kind of, you know, reading on like, you know,

0:26

zero to 10, zero to 15

0:28

and rotating on that mib even though kind

0:30

of we can see really well through the liver and spleen.

0:33

We are not seeing the abnormality.

0:36

So I'm going to put it back onto where I like to read it

0:39

and this is why I like to read things a little bit more

0:41

toasty, a little bit more noisy

0:42

because if you look closely down at the bladder,

0:46

there's something going on here.

0:48

The patient has that kind of, you know,

0:50

the bladder's kind of funneled down.

0:52

The patient has had a prostatectomy

0:53

so it's fallen into the prostatectomy bed,

0:55

but there's something going on here.

0:58

Not too much else as we might check out what that.is.

1:02

But this patient only had a very small

1:03

biochemical recurrence.

1:04

The PSA would've been less than one, but it's just going up.

1:07

There's something going on.

1:09

So we're coming down, down, down, down, down.

1:14

I scroll like we need to work out what this little.is.

1:17

So there's our bladder coming down front all the way

1:20

to the anastomosis

1:22

and right at the anastomosis is that dot right there.

1:27

So here we'll bring it side by side with our low dose ct

1:33

and another great demonstration of how that radio urine

1:38

tagging with the intravenous contrast is really useful.

1:41

So I'm just gonna flatten that out a little bit

1:42

so we can see inside the bladder.

1:44

So you can even see the trabeculation is quite nice,

1:46

but coming down we wanna confirm

1:48

that there is no urine down here, just that white dot

1:51

and all we can see here.

1:52

So that's going to be the urine within that physiological,

1:55

um, anastomosis and the upper urethra,

1:59

but there is nothing there.

2:01

So this spot is local recurrence, post prostatectomy.

2:05

So there's that side of disease

2:06

and we've able been able to find it so early

2:09

and in a nodule that, you know,

2:11

you probably would have a bit of trouble finding on ct.

2:15

A few other things to note on this scan as well.

2:18

You might say, oh Sally, that is this a presacral lymph

2:21

node, but actually I think it's a ganglia.

2:23

So we're here anterior to the sacral foramen.

2:25

Um, there's one on the other side that has minimal uptake,

2:27

so I'm gonna call that as a sacral ganglia.

2:29

If I kind of scroll up

2:30

and down on it, I might be able to follow it

2:32

and it's symmetrical.

2:34

And then coming up through the retroperitoneum,

2:37

I would've checked my pelvis going up and down.

2:38

There's another couple of ganglia right there.

2:41

This patient's got quite a number of them,

2:43

so coming up celiacs

2:45

and then I'd be going really well through the entirety

2:48

of the study, scrolling up

2:50

and down, interrogating the lungs to make sure

2:52

that there are no nodules looking

2:53

through the bones on the gray scale imaging as well

2:56

as the fused imaging and low

2:58

Dose CT to really, um, look for sites of recurrence

3:02

and turning down the liver and spleen to look through.

3:04

Um, but in this case it was just a single site

3:07

of recurrent disease at that post prostatectomy bed.

3:10

And this really just does highlight the importance

3:12

of accounting for your physiological uptake

3:14

and then looking outside of it.