Author: Cleveland Clinic Foundation

Authored date: July 2003

History

53 year old male, 58 kg (127 lb), staging

Impression

Bulky region of abnormal hypermetabolism in the posterior mediastinum, likely representing local neoplastic recurrence.
Hypermetabolic liver lesions, suspicious for metastases.
Hypermetabolic left adrenal lesion.
Several hypermetabolic osseous lesions, suspicious for metastases.

Image Findings

There is a large, bulky region of abnormal FDG uptake seen in the posterior mediastinum surrounding the esophageal stent. This hypermetabolism extends into the subcarinal space. These findings are consistent with hypermetabolic neoplastic (malignant) tissue, likely representing local tumor recurrence.

There are several foci of abnormal FDG uptake seen in the liver, including small focus in the right lobe near the diaphragm, another focus in the posterior segment of the right lobe, and a 2 cm focus in the inferior right lobe. These findings are highly suspicious for hypermetabolic hepatic metastases.

There is also abnormal FDG uptake associated with the left adrenal gland, suspicious for hypermetabolic metastasis.

Several sites of abnormal osseous FDG uptake are seen, including a lower cervical vertebra, several mid thoracic vertebrae, the L2 vertebral body, and a left lower rib laterally. Also, there is a long segment of intense FDG uptake involving the proximal right femoral diaphysis. These findings are highly suspicious for hypermetabolic osseious metastases. Whole body bone scan is recommended to better appreciate the extent of osseous involvement.

No other areas of abnormal FDG uptake are seen to suggest other sites of abnormal hypermetabolism, as can be seen with hypermetabolic primary and metastatic lesions associated with many tumor types, including, for example, esophageal cancer.

Technique

12.81 mCi 18-FDG, followed by PET imaging of the neck, chest, abdomen and pelvis. CT without contrast was performed for attenuation correction and anatomic localization purposes.

Scan Protocol

CT: 200 mAs CAREDose, 120 kV, 5 mm slices, 2.5 reconstruction increment
PET: 474 MBq FDG (12.81 mCi), AW-OSEM (4i8s), 3 min/bed