0:00

So in this next case we are going to pause

0:03

and talk about a very common incidental finding,

0:06

which has been becoming more

0:09

and more pronounced in as the scanner technologies improve

0:13

with increasing spatial resolution for digital PET ct.

0:17

And also with the advent of total body PET ct,

0:20

we're now seeing more than we ever did before.

0:24

And so this patient has two foci of intense uptake,

0:27

small foci in the prostate, no nodal disease,

0:29

looks like local disease.

0:30

And I believe they were coming in

0:32

for pre um, therapy planning.

0:34

So it looks like local disease. But then what do we do?

0:38

And I'm just going to make

0:40

this window a little bit more toasty.

0:41

There we go. You can see that there's these dots

0:43

through the thorax and these are common,

0:46

but you know, how do I know

0:47

that they aren't skeletal metastasis?

0:50

Really good question. And this, especially as

0:53

that we upgraded to new scanners, we were asking ourselves,

0:56

uh, is this low volume skeletal metastases

0:58

or is this something else?

1:00

Because for all money this patient should be, um,

1:03

local disease only.

1:05

There's no lymph nodes to suggest that it has escaped.

1:09

Um, and so if I'm calling metastases, I need

1:11

to be really, really sure.

1:15

And so coming up, I'm looking on our MIP to see

1:20

where these dots were.

1:23

So we'll just re-bring that up, have them up side by side.

1:27

So we're looking for something in the left upper thorax.

1:31

So let's turn on our scroll tool.

1:35

And here it is here, focal uptake.

1:38

That spot of purple in the rib.

1:41

Is there a CT chole outlet? Let's spring up.

1:44

Have a look at our lung windows.

1:46

Sorry, bone windows come up all the way up.

1:53

No, nothing nearly there.

1:55

Maybe it's a little bit of subtle sclerosis,

1:57

but it doesn't look too different from the other ribs.

1:59

So what is this?

2:02

And I think there was another one on this case as well. Yep.

2:04

Left lower. Let's have a look down.

2:06

See if we can find that other one probably just in there.

2:10

That little bit of purple just in there too.

2:12

And so we realized that as we were improving our scans,

2:15

we were starting to see these lesions.

2:17

Some they had variable uptake, some were warmer than others.

2:20

Some had a little bit of sclerosis on the ct.

2:22

We'll just pause on that top lesion there.

2:24

Um, some had nothing at all, but what are they?

2:27

Well, it turns out that small regions of fibrous dysplasia,

2:31

small conroy lesions in these patients is um,

2:34

something that we are encountering.

2:35

And so these are benign lesions.

2:37

Um, they are not metastasis

2:39

and so sometimes it can be tricky to to tell.

2:42

And in those cases, if they are really hot,

2:43

then I'll recommend progress imaging correlation with PSA.

2:46

But you don't wanna be calling these as metastasis

2:49

and you know, targeting therapy to them

2:51

because they are bystanders,

2:53

particularly in low risk patients such as these.

2:55

This was a pre therapy patient as we mentioned,

2:58

focal uptake in two spots in the left

3:00

prostate, no nodal disease.

3:02

And so these were leave alone lesions

3:04

and we just monitor them on progress imaging.

3:07

Um, but they are benign lesions of

3:09

and fo of uptake in the ribs.