NAME: KISHWAR JAHAN AGE / SEX: 53 YRS / F

REF PHY: DR.SHYAM AGRAWAL MD DM PATIENT ID: NCH-2023-204

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

WHOLE BODY PET-CT SCAN

Clinical history: Patient is a case of Left renal mass under evaluation. 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 nodular lesions are noted in both lung fields, few of them showing internal
cavitations, largest one in left lower lobe measuring about 7.3 x 8.7 cm, SUVmax: 24.6.

Left mild pleural effusion noted with subsegmental collapse of basal segments of left lower lobe.

Mildly FDG avid left prevascular lymph node is noted, measuring about 2.7 x 1.9 cm, SUVmax: 26.2.

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 heterogeneously enhancing exophytic lesion is noted arising from left kidney, measuring
about 10.8 x 8.9 cm, SUVmax: 17.2 and solid areas.

FDG avid lymph nodes are noted in left retrocrural, left para-aortic, left perirenal regions, largest node
in left para-aortic region measuring about 2.3 x 1.9 cm, SUVmax: 24.8.

FDG avid nodal deposit is noted in left adrenal gland, measuring about 2.2 x 2 cm, SUVmax: 17.1.

The liver is normal in size and shape No focal intrahepatic lesion is noted. The intrahepatic biliary radicles are not
dilated. The portal vein is normal. No abnormal FDG uptake is noted in the liver parenchyma.

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 left renal mass under evaluation. PET/CT scan shows:
 Heterogeneously enhancing, hypermetabolic Exophytic mass lesion arising from left kidney -
likely site of primary tumour
 Hypermetabolic metastatic mediastinal, retroperitoneal and left perinephric lymphadenopathy
 Hypermetabolic metastatic bilateral pulmonary and left adrenal deposits, as described above
 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