Abdominal Cancer - 1

A. History

• A 49-year-old male with abdominal pain. A laparoscopy was negative, but a mass was found in the lung. A bronchoscopy confirmed the lung lesion was a tumor.

• A CT Scan of the abdomen was read as negative.

• A Whole Body PET Scan wound increased FDG uptake in the lung lesion, but also found a focus of increased FDG accumulation in the abdomen.

• The conventional treatment plan based on CT would have been a thoracotomy to remove the lung mass. After PET found the area of FDG uptake in the abdomen, it was also seen on a new CT Scan and confirmed by a biopsy to be cancer. The treatment was changed to chemotherapy.

Adenocarcinoma - 1

A. History

• 48-year-old female diagnosed with adenocarcinoma.

• Mammography did not define a definitive are of abnormality, and a fine needle aspiration of a suspicious area revealed non-malignant tissue.

• A Whole Body FDG PET Study found three discrete abnormalities localized in the left axilla in the area of known tumor, but no unusual focus of uptake was found in the breasts.

Brain Metastases with Unknown Primary - 1

A. History

• A 54-year-old male with sqaamus cell brain metastases of unknown primary treated with conventional therapy.

• MRI showed two new enhancing lesions in the left temporal and parietal lobes.

• A FDG PET Scan ordered to assess the possible recurrence and metastases revealed the two lesions noted in the MRI as well as a left hilar abnormality. Subsequent CT revealed a large apical left upper segment mass consistent with brochogenic carcinoma.

Breast Cancer - 1

A. History

• A 40-year-old female with breast cancer had a lumpectomy along with chemo/radiation therapy one year ago. The patient began to experience pain in the right shoulder two months ago.

• A bone scan was negative. A CT Scan was initially read as negative.

• A Whole Body PET Scan found numerous lymph node metastases in the upper chest.

• The treatment plan based on conventional diagnostic techniques would have been watchful waiting. Thee PET Scan found a number of lymph node metastases, and the patient was put back on chemo/radiation therapy. A re-read of the CT after PET still could not accurately gauge extend of disease.

Colon Cancer (Metastatic) - 1

A. History

• A 81-year-old female with elevated CEA. Rectoscopy showed a small polyp.

• X-ray and abdominal sonography were normal.

• Whole Body FDG PET Scan found tumor in the ascending colon.

• A hemi-colectomy was performed, after which tumor marker were normal. A routine follow-up whole body PET Scan found a lesion of increased FDG accumulation in the right liver-urinary area and chemotherapy was initiated.

Colon Cancer (Metastatic) - 2

A. History

• A 59-year-old female with colon cancer resected in June 1988.

• Elevated Ca-99 levels were discovered but CEA was normal. Sonography and MRI were both negative.

• Whole Body FDG PET Scan found a 3 cm lesion in the abdominal region consistent with metastatic disease.

• Without PET, the metastatic lesion would have grown much larger before being discovered. The PET findings led to the immediate initiation of chemotherapy.

Congestive Hear Failure - 1

A. History

• A 62-year-old woman 8 years post coronary bypass grafting and 6 months post anterior wall infarction.

• She presented with congestive heart failure and an ejection fraction of 22%.

• PET imaging with NH3 and FDG revealed perfusion-metabolism mismatch consistent with a viable anterior wall; coronary angiography revealed an occluded CAD graft.

• Based on the PET results, a second bypass was performed. Six months later this patient was asymptomatic and had an ejection fraction of 47%.

Epilepsy - 1

A. History

• Intractable drop seizures since the age of 18 months. MRI without abnormalities. Ictal SPECT showed a right parietal focus. Interictal scalp EEG demonstrated epileptoform activity emanating from the right parietal regions.

• Intractable epilepsy.

• FDG PET demonstrated one focal are of cortical hypometabolism in the right posterior parietal region. Ictal EEG demonstrated seizures onset on the right parietal lobe.

• The PET abnormality guided the subdural grid placement with a very good correlation. The patient was submitted to surgery and is seizure free.

Head and Neck Cancer - 1

A. Original Diagnosis

• 72-year-old patient. CT Scan shows mass in maxillary region.

• PET Scan found accumulation of FDG in the region of the right maxillary antrum, probably with a necrotic center. There is no evidence of local or regional spread.

Lung Cancer - 1

A. History

• 63-year-old male with lung cancer. A tumor was removed from the right upper lobe several months ago.

• A CT Scan showed a new lesion in the left lung.

• The Whole Body FDG PET Scan found focal FDG accumulation in the left lung lesion. In addition, several other lesions unsuspected by CT were seen in the right lung and mediastinal lymph nodes.

• The conventional treatment based on CT results would have been a thoracotomy to resect the lesion in the left lung. After the PET Scan found other areas of focal FDG uptake, the treatment was switched to chemotherapy. The lesions could still be seen on a follow-up CT Scan after chemotherapy, but a second PET study showed the FDG uptake had returned to normal, avoiding possible resection.

Lung Cancer - 1

A. PET Diagnosis

• PET Scan found a large area of intense FDG accumulation in the right middle lobe consistent with a massive malignant tumor. No other abnormalities are noted.

Lung Cancer - 2

A. PET Diagnosis

• PET Scan found a large area of intense FDG accumulation in the posterior segment of the right upper lobe consistent with a massive malignant tumor. In addition, there is relatively high uptake of the focus in the left upper lobe corresponding the nodule seen on CT.

Lung Cancer - 3

A. History

• A 67-year-old male with cancer in the left lower lung.

• A biopsy showed small cell lung cancer. PET was ordered to confirm malignancy and to examine brain for metastases.

• A Whole Body PET Scan found a very large lesion in the left lung extending into the posterior mediastinum. Metastases were found in the liver, and the mediastinum.

• The original plan was radiation therapy to the chest. When PET discovered the true extent of disease, the treatment plan was changed to a much more aggressive chemotherapy regimen.

Melanoma (Metastatic) - 1

A. History

• A 71-year-old male with metastatic melanoma on the left shoulder discovered 12/94.

• A CT Scan performed on 7/10/95 demonstrated a tumor of the distal femur and adjacent soft tissue with negative findings in the abdomen. A bone scan from 7/13/95 shoed an abnormal femur and four spine lesions.

• A Whole Body FDG PET Scan demonstrates numerous lesions throughout the body.

• The patient was scheduled for an amputation based on CT and bone scan results. After the PET Scan found multiple lesions, surgery was cancelled, avoiding both the cost and the trauma of an operation that would have not been effective.

Myocardial Infarction - 1

A. History

• A 32-year-old male smoker with a family history of heart disease presented at the hospital with an acute anterior wall infarction.

• PTCA was attempted but was unsuccessful. He was then evaluated for coronary revascularization.

• PET imaging with NH3 and FDG revealed a perfusion-metabolism match consistent scar or lack of viability in the anterior wall.

• Because of his age bypass surgery was performed despite the PET results. Two months after cardiac surgery the presurgical ejection fraction of 20% was unchanged and wall motion was not improved. The patient died 6 months post bypass surgery.

Myocardial Viability - 1

A. History

• A 50-year-old female with a history of heart disease waiting for possible cardiac transplant.

• Thallium Scintigraphy found a large nonreversible defect in anterior septal segment; the myocardium was judged nonviable.

• A FDG PET Scan found good viability throughout the myocardium except for a small part of the apex.

• The conventional treatment plan based on a single photon nuclear medicine study would have been to place the patient on the transplant waiting list. After PET, a coronary artery bypass graft was performed resulting in improved cardiac function. The patient had significant improvement in quality of life.

Myocardial Viability - 2

A. PET Diagnosis

• NH3 and FDG PET Scans showed a large inferior matched defect keeping with previous infarction. An are of reduced flow is seen in the lateral wall with maintained metabolism indicating that this segment is viable and may benefit from revascularization. However, the area is probably not sufficient to significantly improve the ejection fraction but may affect the unstable angina.

Myocardial Viability - 3

A. PET Diagnosis

• NH3 perfusion and FDG viability PET Scans showed a matched pattern with absent uptake in the inferior and lateral segments consistent with massive infarction. No evidence of hibernating myocardium seen in these regions. There is normal resting flow in the septum and anterior wall.

Osteosarcoma - 1

A. History

• A nine year old girl with a history of osteosarcoma in the right shoulder.

• A PET Scan prior to chemotherapy showed high metabolic rate of glucose in the right shoulder indicating aggressive tumor growth. The patient was treated with chemotherapy.

• Ten weeks following chemotherapy a follow-up PET glucose study was performed to evaluate the metabolic tumor response to therapy. PET showed a marked reduction of glucose metabolism in the tumor region.

• The patient underwent biopsy and no tumor tissue was found.

Osteosarcoma - 2

A. History

• A 19-year-old male with a history of Osteosarcoma of the right lower leg.

• A follow-up CT Scan showed a growing lesion in the lung. A leg biopsy was negative for residual tumor.

• The Whole Body PET Scan showed high levels of FDG uptake in the femur and adjacent tissue. The lung lesion, seen growing on CT, had a low FDG accumulation rate with a standard uptake value of 2.

• The original treatment plan based on CT and biopsy results would have been a thoracotomy to resect the lung lesion. After a PET Scan found high levels of glucose metabolism in the leg, another biopsy of the femur was attempted but was unsuccessful. Two weeks later, the patient's thigh exhibited swelling, and another biopsy was done. It found a malignant fibrous histiocytoma and the leg was amputated.

Paraganglioma - 1

A. History

• A 44-year-old male with known malignant paraganglioma.

• MRI showed probable recurrence in the left bifurcation of the aorta.

• The Whole Body PET Scan showed increased FDG uptake in several areas, including the aortic bifurcation region as well as the lower neck and throughout the paravertebral, cervical, thoracic and lumbar regions.

Pheochromocytoma (Malignant) - 1

A. History

• A 35-year-old male with known abdominal malignant pheochromocytoma.

• As above. PET Scan was ordered to assess extent of metastatic disease.

• The Whole Body PET Scan revealed increased FDG uptake in the left abdomen, the area of known tumor, as well as other lesions located at the C7 vertebral body, subsequently confirmed by CT.