NAME: ASHA CHACHODIYA AGE / SEX: 55 YRS / F

REF PHY: DR.SHYAM AGRAWAL MD DM PATIENT ID: NCH-2023-0207

TEST NAME: WHOLE BODY F 18 FDG PET-CT SCAN DATE: 29- APR- 2023

WHOLE BODY PET-CT SCAN

Clinical history: Patient is a known case of Ca Left Breast. Current PET-CT is being done for further evaluation
and disease status.

Procedure: Whole body FDG PET scan was acquired from vertex to mid thigh in a whole-body PET-CT scanner
(GE Discovery), one hour after intravenous injection of 370 MBq of 18F-FDG. High resolution, contrast CT scan
was also obtained of the same area. Oral contrast was administered for bowel opacification, over 90 min, before
the scan. Images were reconstructed using Q Clear algorithm and slices were reformatted into transaxial, coronal
and sagittal views. Semi-quantitative estimation of FDG uptake was performed by calculating SUV max value,
corrected for dose administered and lean body mass (g/ml).

Findings:
Physiological biodistribution :- noted in the parapharyngeal region, left ventricle, liver, spleen, kidneys and urinary
bladder

Brain:
Normal physiological tracer distribution noted in the brain parenchyma. No focal abnormal uptake noted in the
brain.

Note: All brain lesions may not be apparent on a PET/CT scan and a MRI can be performed where clinically indicated.

Head and neck:

Normal physiologic uptake noted in the nasopharynx, oropharynx, hypopharynx and larynx. Parotid and bilateral
submandibular glands demonstrate normal metabolic activity.

The thyroid gland shows homogenous pattern on CT. No abnormal FDG uptake is seen in the thyroid.

No significant cervical / supraclavicular lymphadenopathy noted.

Thorax:

Multiple FDG avid soft tissue density lesions are noted in lower quadrant of left breast. There is associated mild
thickening of overlying skin. Underlying chest wall muscles appear free. The largest lesion in lower outer
quadrant measures about 3.3 x 2.3 cm, SUVmax: 8.0.

FDG avid left axillary level I, II lymph nodes are noted, largest one measuring about 0.9 x 1.2 cm, SUVmax: 5.6.

Few FDG avid soft tissue density lesions are noted in upper inner quadrant of right breast, largest one
measuring about 1.8 x 1.8 cm, SUVmax: 14.8.
No evidence of thickening of overlying skin or involvement of underlying chest wall muscles is noted.
Few low-grade FDG avid right axillary lymph nodes are noted, showing preserved fatty hilum, largest measuring
about 1.8 x 1.1 cm, SUVmax: 0.9 - appear reactive.

Mildly FDG avid patchy infiltrates in basal segment of right lower lobe, SUVmax: 2.1 appear infective

The heart and the mediastinal vascular structures are well opacified with I/V contrast. The trachea and main bronchi
appear normal.

Abdomen and pelvis:

FDG avid hypodense lesion is noted in segment II of liver, measuring about 1.5 x 2 cm, SUVmax: 13.2.

The gall bladder is well distended with no abnormal FDG uptake.

The pancreas and spleen appear normal on CT with no abnormal FDG uptake.

Bilateral adrenal glands appear normal in size with no abnormal FDG uptake. Both the kidneys appear normal in
size, shape and attenuation. No scan evidence of calculus or hydronephrosis is noted.

The stomach, opacified small bowel and rest large bowel loops appear normal in caliber and fold pattern.

No significant abdominal, retroperitoneal lymphadenopathy noted.

Urinary bladder is well distended with no abnormal FDG uptake.

Musculoskeletal system:

The visualized portion of the musculoskeletal system shows normal physiological tracer distribution.
IMPRESSION:
In a known case of Ca Left Breast PET/CT scan shows:
 Hypermetabolic multiple soft tissue density lesions in lower quadrant of left breast - suggestive
of multicentric primary
 Hypermetabolic multiple soft tissue density lesion seen upper inner quadrant of right breast -
suggestive of multicentric primary
 Hypermetabolic metastatic left axillary level I, II
 Hypermetabolic metastatic hypodense lesion in segment II of liver
 No focal abnormal FDG avid lesion in rest of the body.

Dr ROMA Dr L P KASHYAP
MD Nuclear Medicine Senior Consultant
AIIMS, DELHI Nuclear medicine & PET-CT