Malignant neoplasm of prostate (CMS/HCC)
C79.51: Secondary malignant neoplasm of bone (CMS/HCC)
Multiple prior PET/CT examinations dating back to 04/27/2017 and bone scan 04/24/2017
Non-contrast PET images as well as concurrently acquired CT for attenuation correction and anatomical localization imaging were obtained from the level of the skull base to the level of the upper thighs after the patient received 13.86 mCi F18 FDG intravenously. In line with the clinical standards of practice, the patient’ s blood glucose was measured in this office prior to injection at 95 mg/dl. In addition to transverse plane images, coronal and sagittal reconstructions are created and reviewed for the CT and PET images. Oral contrast was administered prior to the exam.
No new focus of increased glucose metabolism. Stable low-grade FDG activity in the left thyroid lobe without correlate on the CT portion examination.
No cervical adenopathy by CT size criteria. Visualized intracranial contents are unremarkable. Orbits are unremarkable. Mucus retention cyst in the right maxillary sinus. Mastoid air cells are well-aerated.
Stable mildly prominent sub and pericentimeter short axis mediastinal lymph nodes are again noted. The previously described subcarinal lymph node is stable at 9 mm in short axis dimension with maximum SUV 3.3 (previously 2.7). Also, there is mild low-level FDG activity associated with an AP window lymph node measuring approximately 8 mm in short axis dimension with maximum SUV 2.9. These findings are nonspecific.
Trachea and main bronchi are patent. Mild bibasilar dependent atelectasis. Biapical pleural parenchymal scarring and bullous changes as before. No new focal consolidation, pleural effusion or pneumothorax. No axillary adenopathy. Left chest Port-A-Cath with tip in the SVC. No pericardial effusion.
Abnormal exam.
Since the prior examination has been interval enlargement in size of bilateral iliac chain lymph nodes. The left iliac chain lymph nodes also demonstrate increased FDG activity. The largest node measures 11 mm in short axis dimension (series 3, image 69) with maximum SUV 4.3. There is an adjacent more proximal node measuring 9 mm in short axis dimension (series 3, image 74) with maximum SUV 4.9.
Previously described aortocaval lymph node now measures approximately 1.2 cm in short axis dimension (previously 1.7 cm) with maximum SUV 3.1 (previously 5.2).
Liver, spleen, pancreas, adrenal glands and right kidney are unremarkable on this low-dose, noncontrast CT examination. Multiple left renal hypodensities as before. No hydronephrosis. No radiopaque gallstones. No free fluid. Small hiatal hernia. No bowel obstruction or diverticulitis. Bladder is contracted with a mild amount of perivesicular fat stranding for which correlation with urinalysis is suggested.
Abnormal exam.
Again seen are multiple scattered sclerotic lesions consistent with osseous metastatic disease in this patient with history of prostate carcinoma.
The previously described dominant lesion in the left ilium and ischium is anatomically stable with maximum SUV 6.1 (previously 6.0). Also, the previously seen sclerotic lesion in the left ischial tuberosity has slightly increased in size now measuring 2.9 x 1.9 cm (previously 2.1 x 1.5 cm) with maximum SUV 8.9 (previously 5.9).
The dominant spinal lesion is a sclerotic focus in the L1 vertebral body with maximum SUV of 6.4 (previously 5.0). There are also innumerable scattered foci of sclerosis throughout the axial and appendicular skeletons compatible with multifocal osseous metastasis as well.
Physiologic activity seen in the brain, liver, spleen, myocardium, GI and GU systems.
Findings suggesting interval progression of disease with enlargement and increasing hypermetabolic activity within multiple left iliac chain lymph nodes.
Also, there has been interval increase in size of sclerotic lesion in the left ischial tuberosity with increased maximum SUV now measuring 8.9 (previously 5.9). The dominant spinal lesion in the L1 vertebral body also demonstrates increased maximum SUV measuring 6.4 (previously 5.0).
This report was generated using speech recognition software
Signed by: Kristopher Foreman, MD
`Radiology Information

Exam Information
  Study Status : Final
  Procedure Begin Date : 4/18/18
  Procedure Begin Time : 9:18 AM
  Procedure End Date : 4/18/18
  Procedure End Time : 10:32 AM

Staff Information
  Ordering Provider : N/A

Verification Information
  Signed By :
  Kristopher L Foreman, MD on Apr 19, 2018