0:01

We just review the baseline PET CT for this patient

0:04

with a history of treated follicular lymphoma

0:09

and suspected transformation.

0:11

This was confirmed on a biopsy

0:15

on the middle row.

0:16

I'm showing the interim PET ct

0:19

and on the top row I'm showing the end of treatment pet.

0:24

So let's go through the findings.

0:27

Remember that there was bulky disease

0:30

in the right side of the neck.

0:32

And let's see how this has changed

0:36

all these very large lymph nodes.

0:39

In for instance, these level two B have

0:44

reduced markedly in size and are not longer at G avid.

0:48

The only area of persistent metabolism

0:53

was found in this small lymph node.

0:58

When there is bulky disease on prior, it is hard to,

1:03

you know, compare this one and the prior,

1:07

but this extensive disease in the right side of the neck

1:11

and supraclavicular region has markedly improved.

1:14

So the residual lymph node measures now

1:19

1.1 centimeter with SUV max

1:24

2.7 where

1:26

before disease in the areas of higher uptake was

1:30

32.5.

1:33

Remainder of the disease in the upper mein

1:38

has completely resolved both morphologically

1:41

and metabolically.

1:43

There remain some mildly FDG AVID permanent rate,

1:48

axillary lymph nodes,

1:50

but markedly improved from prior in this case.

1:53

And as we can see on the MIP, there were no areas

1:56

of new disease.

1:59

So in this case, if we wanted to provide a double score,

2:04

it would be based on the areas where there continues

2:07

to be uptake, which is in, in this lymph nodes in the base

2:11

of the neck and supraclavicular region.

2:14

So now applying the devil score,

2:16

because this is visual, sometimes it's hard

2:19

to compare a structure that is in the neck to the liver

2:22

of the mediastinum, but MEP helps you

2:24

and if not, I would do a coronal view.

2:27

Probably the degree

2:28

of uptake you can see is greater than the blood pull

2:32

and it's probably equal to the liver.

2:38

So when we look at the classification of deve score,

2:42

DIL three is described

2:45

as an uptake greater than the mediastinum, but equal

2:48

or less than the liver.

2:50

And a DIL four,

2:53

it's moderately increased compared to the liver.

2:57

In this case, I would say

2:58

That because visually I see it similar to the liver,

3:04

I would provide a double score of three

3:09

and when sometimes it's not clear,

3:11

you can say three slash four

3:14

and reevaluate at the end of treatment.

3:18

At the end of treatment, this patient

3:21

had a complete response.

3:23

We look at these lymph nodes

3:26

that still had some activity in the interim, PET

3:29

have decreased in size and are very mildly of VG Avid.

3:35

Same goes with the axillary lymph nodes, decreased in size

3:39

with some avidity,

3:41

but this avidity is

3:44

less than the mein.

3:47

So in this case we still have some lymph nodes

3:51

that can be measured, but the uptake is

3:55

within normal limits.

3:57

So therefore we would categorize these as a devo two.