Esophageal Cancer - 64-year-old-man

History
64 year old man with recently diagnosed esophageal cancer for staging PET/CT.

Dosage
Radiopharmaceutical Administered F18 FDG 10.33mCi IV

PET/CT Imaging Findings
There is abnormal, markedly increased metabolic activity in the distal esophagus, corresponding with the patient's known malignancy. No nodal, hepatic, nor pulmonary metastases are seen. There is a subtle focus of mildly increased activity within the T11 vertebral body. While significantly greater than the activity in other vertebral bodies, this is not as hot as would typically be for malignancy. No abnormality is appreciated on the CT portion of the exam at this level. This is mildly suspicious for an early bone metastasis, and could be followed up with bone scan and plain films.

Discussion
There are a couple of teaching points in this case. This is a good example of what a typical FDG-avid esophageal cancer looks like. Most esophageal cancers are FDG avid, however, some of the more well-differentiated pathologic cell types may not be very FDG avid and can be missed unless the FDG uptake (or lack of FDG uptake) is correlated with the anatomical findings of esophageal mass/thickening.

Also, this patient had mild uptake in a vertebral body without a CT correlative anatomical abnormality. Given the intense FDG uptake in the primary tumor, it is unlikely that the mild uptake in the vertebral body represents metastatic disease.

Unfortunately, this patient expired secondary to post-op complications.

Courtesy of
University of Pittsburgh PET/CT Scanner