Please help me with my PET scan results

Jomorisin

Please note these results came in today, this Christmas morning. Of course no doctor is around and my follow-up is Monday, 12/27. I am already aware of the lymphoma diagnosis in right axillary lymph node and mesenteric mass. Sticking with the cancer related items, I believe that everything I thought I knew going into the test represents the extent of the spread. However, the following line troubles me:

“Physiologic uptake is noted in the liver, spleen, pancreas, adrenals, kidneys and stomach which are unremarkable CT.“

This is the 2nd “unremarkable” CT I have had in 3 months (other than for the mesenteric mass). I know some level of uptake occurs in the organs “normally” but this freaked me out, particularly as no SUV score is stated. The lymph nodes and mesenteric mass have stated SUVs. What does this ambiguous line potentially means?

I appreciate any clarification. I hope you are all well or on the way to wellness. Thank you

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Study Result

Impression

IMPRESSION:

1. FDG avid right axillary, right retropectoral and mesenteric lymph nodes, consistent with biopsy-proven lymphoma. Deauville score 5

2. No hepatosplenomegaly.

Deauville Criteria

Deauville 1: No FDG uptake

Deauville 2: FDG uptake < or = mediastinal blood pool

Deauville 3: FDG uptake > mediastinal blood pool and < or = normal liver parenchyma

Deauville 4: FDG uptake greater than normal liver parenchyma

Deauville 5: FDG uptake significantly greater than normal liver parenchyma or new FDG-avid lesions

Deauville X: FDG uptake not related to lymphoma.

Narrative

AGENT:

13 mCi F18-FDG, IV via the left wrist vein.

HISTORY:

55-year-old male with large B cell lymphoma involving the right axillary lymph nodes diagnosed in 12/2021. PET scan for initial staging.

EXAM CATEGORY:

Initial treatment strategy.

TECHNIQUE:

58 minutes following injection of the radiopharmaceutical, PET/CT imaging was performed from the skull base to mid thigh. Fasting serum glucose was 66 mg/dL prior to injection. Oral contrast was given per protocol. All SUV values reported represent maximum SUV (SUV max) unless otherwise specified. 

This study was interpreted using a lean body mass corrected SUV technique. Please note this may result in lower SUV values compared to a body-weight corrected technique. If there is a prior PET/CT for comparison, please see this current report for lean body mass corrected SUV values for the current study and the prior study.

Reference liver uptake SUV mean 2.1. SUV max 2.7

COMPARISON:

11/29/2021 CT abdomen pelvis

FINDINGS:

Head and neck:

There is no suspicious FDG uptake in the head and neck.

No significant head and neck lymphadenopathy on CT.

Chest:

FDG avid enlarged right axillary and retropectoral lymph nodes, consistent with biopsy-proven lymphoma, for example:

* Image 49, SUV 8.3, 2.6 x 1.9 cm

* Image 51, SUV 9.8, 3.9 x 3.2 cm.

* Right retropectoral lymph node image 53, SUV 1.8, 1.3 x 1.1 cm.

On CT, there is no supraclavicular, hilar, mediastinal or left axillary lymphadenopathy. The heart and great vessels are unremarkable. No pleural or pericardial effusion. Non-FDG avid 3 mm right middle lobe pulmonary nodule, lung image 47.

Abdomen and pelvis:

There is a 6.1 x 5.9 x 6.8 cm FDG avid mesenteric mass in the left mid abdomen image 106, SUV 11.0, consistent with lymphoma.

There is a 1.6 x 1.1 cm non-FDG avid mesenteric lymph node inferior and posterior to the above lesion, image 114. Several non-FDG avid subcentimeter mesenteric lymph nodes are present. No evidence of FDG avid retrocrural, retroperitoneal, pelvic or inguinal lymphadenopathy.

Physiologic uptake is noted in the liver, spleen, pancreas, adrenals, kidneys and stomach which are unremarkable CT.

No acute bowel-related abnormality. No hepatosplenomegaly. Atherosclerotic vascular calcification, sigmoid diverticulosis and enlarged prostate 5.6 cm in transverse dimension, are visualized.

Musculoskeletal and extremities:

There are no suspicious FDG-avid osseous lesions.

No aggressive osseous lesions are seen on CT.

Please note KEY IMAGES for this PET/CT study are visible in iSite by scrolling to the far right of the collection of image preview thumbnails.

Diagnostic confidence level used in this report:

Consistent with/compatible with or no modifier - greater than 98%

Most likely - greater than 90%

Likely/probably - greater than 75%

Possibly 50%

Less likely - less than 25%

Unlikely - less than 5%