Stanford Hospital and Clinics      

    EXAM DATE:    28May2004

*NUCM- PET SCAN RESTAGING LYMPHOMA

WHOLE BODY PET/CT STUDY

DATE: 05/28/2040.

ICD9 CODE: 202.

COMPARISON:
Comparison is made with PET scan from 12/03/2003.

CLINICAL DATA:
37 year old woman with history of Stage 2EA nodular sclerosing Hodgkin's disease status post twelve weeks of Stanford five, followed by radiation.  Subsequent disease in the left axilla was treated with radiation.  Subsequent follow-up PET CT scan in December showed inflammatory changes in the left breast postradiation.  Follow-up PET scan is requested.

RADIOPHARMACEUTICAL: 18F-FDG, 13.6 mCi IV.

BASELINE DATA:
Height, 5 foot. 6 inches; weight, 140 pounds; finger stick glucose, 98 mg per dL.

PROCEDURE:
Approximately 60 minutes following the IV administration of the radiopharmaceutical, a noncontrast CT scan from the mid forehead through the inguinal region was obtained for use in attenuation correction followed by an emission scan of the same region.  Images were compiled and reviewed in axial, coronal and sagittal planes.

FINDINGS:
Physiologic FDG uptake is noted in the mid portions of the brain, the oropharyngeal region, vocal cord, mediastinum, myocardium, spleen, bowel, and the axial skeleton with physiologic clearance in the kidneys, ureters and bladder.  Mild to moderate FDG uptake is noted in bilateral breast tissue, slightly more on the left than the right and it most likely is physiologic uptake.  Intensely hypermetabolic focus near the right humeral head is most likely nonspecific muscle activity.

IMPRESSION:

1.    NO SCINTIGRAPHIC EVIDENCE OF MALIGNANCY.

2.    FAINT FDG UPTAKE IN BILATERAL BREASTS IS MOST LIKELY
PHYSIOLOGIC UPTAKE.  THE SLIGHTLY GREATER FDG UPTAKE IN THE LEFT BREAST VERSUS THE RIGHT IS MORE LIKELY TO RADIATION CHANGE.

3. THE FINDINGS WERE FORWARDED TO DR.  ADVANI.

END OF IMPRESSION:


    *CT PET


CT PET: 05/28/04

CLINICAL HISTORY:  Hodgkin's disease.

COMPARISON: None.

TECHNIQUE:  5 mm noncontrast images were obtained from the level of the basal cisterns through the proximal thighs.

COMPARISON:  12/03/03

FINDINGS:
No pathologically enlarged neck nodes are seen.  Within the chest, very subtle induration is present in the anterior mediastinum completely unchanged since the patient's previous study.  No new hilar mediastinal lymphadenopathy is identified.  No pleural or pericardial fluid is seen and the lungs are clear.

Within the abdomen, sensitivity to solid organ abnormalities is markedly diminished in the absence of intravenous contrast administration.  Acknowledging this, no gross abnormality of the liver, gallbladder, spleen, pancreas, adrenals or kidneys was identified.  No free fluid was identified and no pathologically enlarged lymph nodes are seen within the abdomen or pelvis.

IMPRESSION:

NO SIGNIFICANT CHANGE SINCE PREVIOUS STUDY OF DECEMBER 3, 2003.  NO NEW LYMPHADENOPATHY IDENTIFIED.

END OF IMPRESSION:

SUMMARY 2: Abnormal, previously reported.