Lymphoma - 61-year-old male with non-Hodgkin’s lymphoma diagnosed in May 2002 status post partial gastrectomy

History
61-year-old male with non-Hodgkin's lymphoma diagnosed in May 2002 status post partial gastrectomy. The most recent chemotherapy was February 2004. The patient is referred for restaging and possible left neck nodules.

Dosage
12.2 mCi of F-18 fluorodeoxyglucose (FDG) was administered intravenously per protocol.

Procedure
Images were acquired with the patient in the supine position (arms up) from the level of the eyes down to the mid femurs approximately 90 minutes post injection per protocol. Tomographic attenuation corrected and non attenuation corrected FDG-PET images were reviewed as a part of this PET/CT study. CT images were utilized for attenuation correction and anatomic localization.

Comparison
December 14, 2004.



PET/CT Findings
Neck: Mild symmetric tonsillar activity is nonspecific and can be physiologic. There is no focal increased FDG uptake in the cervical nodal regions. There is no focal increased activity or asymmetry in the limited images of the brain.

Chest: Unusual focal left paraspinal increased activity (maximum SUV 4.0) about the level of T6 and posterior to the aorta does not correlate with a definite lymph node on CT scan, and is more focally prominent compared with prior study. There is no focal increased FDG uptake within the bilateral lung parenchyma, or in the hilar, remaining mediastinal, or axillary nodal regions. Subtle right upper anterior chest wall activity is compatible with the patient's port.

Abdomen/Pelvis: Mild gastric activity is diffuse, nonspecific. No focal increased activity is identified in the liver, spleen, or adrenal glands. Focal increased right paraspinal activity adjacent to the L1/L2 vertebral bodies (maximum SUV 5.5) just superior to the left psoas muscle is notably more focally prominent compared with prior study. There is no focal increased activity in the paraaortic, ilian, or inguinal nodal regions.

Impression
Abnormal left thoracic paraspinal focal hypermetabolic activity and right upper lumbar paraspinal focal hypermetabolic activity as described. Given the history of lymphoma, findings are suspicious for neoplasm.

Courtesy of
University of Tennessee Medical Center
David Townsend