Correlative Imaging:
48 year old female with history of neuroendocrine tumor of the pancreas status-post distal pancreatectomy, splenectomy, hepatic trisegmentectomy in 2000. Subsequently was treated with Sandostatin systemically. Liver metastases were treated with radiolabeled Sirspheres, chemoembolization (TACE), and radiofrequency ablations (RFA). The patient exhibited slowly progressive disease over time. The following nuclear medicine studies demonstrate this progressive disease:
Tc-99m MDP Bone Scan:
Impression:
Multiple areas of increased uptake in the ribs, mid-thoracic spine, lower sternum, and right distal femur, consistent with skeletal metastases. Attention is to be paid to the right femoral lesion as this could be potential site for pathological fracture.
Octreoscan:
4-hr images:
SPECT/CT Fusion at 4 hrs:
24-hr images:
Impression:
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August 2011 Tc-99m MDP case
History:
55 year old female with stage IV breast cancer who is status post chemotherapy. Tc-99m MDP spot views of the ribs are provided along with a coronal image from her CT scan.
Impression:
Tc-99m MDP images show soft tissue accumulation in the liver consistent with metastatic disease.
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May 2011 F-18 FDG PET case
History:
46 year-old Hispanic male presenting with odynophagia and dyspnea. Chest x-ray performed showed large left lower lung lobe abnormality which was confirmed on chest CT. Initial FNA biopsy of mass was suspicious for small cell lung cancer. F-18 FDG PET was performed, and fused with an outside hospital CT chest. Incidentally, outside hospital bone scan was negative for osseous metastases.
Impression:
Abnormal F-18 FDG PET study demonstrating hypermetabolic area within the left posterior mediastinal/infrahilar mass which extends into the adjacent distal esophagus and is consistent with malignancy (T4 disease).
There is no evidence for distant metastatic disease.
Follow-up:
EGD (esophagoduodenoscopy) was performed subsequently, which revealed: "large, focal, semi-circumferential ulcerative fungating mass from 30 to 36 cm in the distal esophagus; stomach and duodenum were normal." Biopsy revealed small cell carcinoma, presumably from a lung primary. Patient was considered a limited-stage small cell lunc cancer and is planned to be treated with combined chemoradiation therapy.
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April 2011 Whole-body Iodine-131 case
History:
53 year-old female with papillary thyroid cancer (1.7 x 1.3 x. 1.3 cm, well-differentiated, multifocal, no capsular/lymphovascular/extrathyroidal invasion, negative surgical margins, +0/3 lymph nodes; pT1b N0 Mx) status-post thyroidectomy. She presented to the department for Iodine-131 diagnostic whole-body imaging in anticipation of radio-ablative iodine therapy. The patient was on hormone withdrawal for 4 weeks, then had 72-hour whole body images acquired after I-131 administration.
Pictures - First Set = Pre-therapy Scan (designated as follows):
 72-hour anterior and posterior whole-body images |
 Approximate 72-hour right and lateral images of the abdomen and pelvis |
 The patient was asked to drink water and ambulate. She then returned to the department for additional imaging approximately 8 hours after the initial whole-body images were acquired. This is anterior/posterior spot images of the abdomen and pelvis |
 SPECT images of the abdomen/pelvis |
Findings (Pre-therapy Scan):
Whole-body anterior/posterior images, as well as lateral spot views of the abdomen were acquired 72-hours after administration of Iodine-131.
There is the expected residual uptake in the post-surgical thyroid bed. However, suspiciuos focal uptake is seen in the right lower quadrant of the abdomen slightly above and to the right of the bladder. Lateral images demonstrate that the activity is in line with the anterior aspect of the bladder.
The patient was asked to drink water and ambulate. She was then brought back approximately 8 hours alter for additional static anterior/posterior views and SPECT imaging of the abdomen/pelvis.
Images demonstrate that the previously seen focal uptake has moved higher up in the abdomen, possibly to the level of the hepatic flexure, and there is evidence for uptake adjacent to the focal uptake in a pattern consistent with colonic morphology (see SPECT). Interval movement of the uptake and conformatoin to GI (gastrointestinal) morphology confirms that this was physiologic GI uptake rather than a metastatic focus.
Impression:
Whole-body I-131 scan demonstrating evidence for expected residual uptake in the neck only. There is no evidence for distant metastatic disease. 72-hour uptake was calculated at 0.7%.
Follow-up 1: The patient was treated with 100 mCi I-131.
48-hour anterior and posterior whole-body images (after therapy)
Findings:
There is the expected residual uptake in the post-surgical thyroid bed. Physiologic diffuse GI uptake, including in the stomach, duodenum, and the entire colon is noted. Physiologic activity is also noted in the bladder. There is, once again, no evidence for distant metastatic disease.
Impression:
The post-therapy I-131 scan demonstrates evidence for expected residual uptake in the neck only. There is no evidence for distant metastatic disease.
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April 2011 PET/CT Case Study
A 62 year-old female presented with a right hip mass with a past medical history of left breast cancer treated 7 years ago. She underwent F-18 NaF PET/CT bone scan (left), F-18 FDG PET/CT (right).
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Clinical Information:
A 62 year old female is presented with a carcinoid tumor of the rectum. Recent biopsy of the rectal mass demonstrated a carcinoid tumor. Status post tubal ligation and salpingo-oophorectomy. Initial treatment strategy.
Procedure:
The patient’s blood glucose was 111 upon reporting to the department. 14.7 mCi of F-18 FDG were administered intravenously, and a 62 minute uptake interval occurred. CT and PET imaging was obtained concurrently from the skull base through the proximal thighs. Axial, sagittal, coronal and three-dimensional reconstructions are reviewed.
Impression:
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Archived Case Studies:
October 2011 Breast Cancer Study
September 2011 Tc-99m MDP Bone Scan
August 2011 Tc-99m MDP case
May 2011 F-18 FDG PET case
April 2011 PET/CT Case Study
HIDA, Bile Duct Obstruction
PET-CT Cardiac Mets
F-18 NaF Bone Scan comparison to F18 FDG PET-CT
