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linical History: A 69-year-old male with metastatic adenocarcinoma of unknown origin from a left supraclavicular lymph node biopsy on July 11, 2018.
Indication: Evaluation of extent of disease for initial treatment strategy
Comparison: No other imaging study is available for comparison at the time of dictation.
Technique: F-18 fluorodeoxyglucose (FDG) 10.5 mCi was administered intravenously via the right antecubital vein. To allow for distribution and uptake of radiotracer, the patient was asked to rest quietly for approximately 60-90 minutes. PET/CT imaging was performed from the vertex down to the ankles. Serum blood glucose at the time of the injection was 106 mg/dL. CT scanning was done for attenuation correction, image registration, and diagnosis with scan parameters optimized to minimize radiation exposure to the patient. SUV measurements are reported as maximum SUV based on body weight unless otherwise specified.
Findings:
Head and Neck: Conglomeration of adenopathy is noted in bilateral lower neck with mild hypermetabolism (SUV of 2.4 in the left on image 81 and 2.0 in the right on image 86.
Slightly asymmetric cerebral tracer uptake is noted (more in the left than in the right hemisphere on image 26) but there is no anatomic correlation.
The orbits, paranasal sinuses and thyroids are unremarkable.
Chest: Adenopathies with mild hypermetabolism is noted in the PA window with SUV of 2.1 on image 114. Slightly prominent hilar tracer uptake is noted in the left (SUV of 2.2 on image 121-124) and right (SUV of 2.1 on image 128).
Nonhypermetabolic scarring along the fissures are noted in both lungs. Scattered calcified granulomas are noted in the right hilum and precarinal stations. Emphysematous changes are noted. There is a nonhypermetabolic left pleural effusion.
Abdomen and Pelvis: Mesenteric adenopathies are noted on image 181 with slightly above background level of tracer uptake and also in the retroperitoneum (for instance, 1.7 cm with SUV of 2.3 on image 209) and bilateral external iliac regions (image 240).
Scatter atherosclerotic calcification of the descending aorta and branch vessels are noted.
A nonobstructive calculi and is noted in the left kidney on image 197 while a renal cyst is seen in the right kidney on image 191. Scattered calcification is also noted in the an enlarged prostate which does not have asymmetric uptake.
The liver, spleen, gallbladder, adrenal glands and pancreas are unremarkable.
Musculoskeletal: Heterogeneous osseous uptake are noted and there is extensive mixed lytic and sclerotic changes throughout the skeleton involving the ribs, bilateral scapula, bilateral proximal humeri, bilateral pelvic bones and bilateral proximal femur with relatively low-grade tracer uptake. For instance tracer uptake in the left lesser trochanter is measure at SUV of 1.6 in the right kidneys measure at 2.4 on image 273. Tracer uptake in the left anterior iliac crest is measure at SUV of 2.6 in the left and 2.8 in the right on image 226..부탁 드립니다.
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