Radiation Medicine Centre

Bhabha Atomic Research Centre

C/o Tata Memorial Center Annexe,
Jerbai Wadia Road, Parel, Mumbai 400012
Tel: 24134960 / 24146059; Fax: 24157098

CC NO : 11R2023/002630 Requisition No. JZZ/PT/23/003020

Name Mr. NANDLAL BARVE
Sex/Age : M/ 53 Years Category/Status : C/ Out Patient
DMG : RMC
Service Desc WB PET SCAN-FDG (RMC) Reqn Date : 14-07-2023
Provisional Diagnosis

Final Report Report Date : 09-08-2023

INDICATION: 53 year old male, with complaints of generalised progressive weakness, imbalance while
walking, sluggish activities, slurred speech-persistent; c/o cerebellar ataxia under evaluation ? tubercular
?mets. MRI brain (26/4/23): ill-defined area abnormal signal intensity in b/l cerebellar hemisphere involving
vermis and extending to the superior and middle cerebellar peduncles with areas of blooming s/o
calcifications/haemorrhages. Solid disc like enhancement along posterolateral aspect of 4th ventricle in right
cerebellar hemisphere, larger lesion in right cerebellar hemisphere measures 1.9x1.4cm in maximum
dimension. CSF examination (29/4/23): total cells: 4/cumm, polymorphs: zero, lymphocytes: 100%, rbc:
25-30/hpf. MR spectroscopy: increased choline/creatine ratio(2.1), elevated lipid lactate peak with short TE.
Referred for FDG PET/CT.

Protocol: Whole body PET scan was done 60 minutes after i.v. Injection of 5.7 mCi of 18F-FDG, using a
whole-body full-ring dedicated LYSO PET CT time of flight scanner. Images were acquired using 3D PET
protocol. Data was reconstructed using iterative (RAMLA) algorithm. Attenuation correction was done by
using high dose CT with 250 mA and 120 KV.
Regional PET scan was done 60 minutes after i.v. Injection of 4.15 m Ci of 18F-FDG, using a whole-body
full-ring dedicated PET-CT camera.

In the Neuro-Q software for brain PET evaluation, color codes are as follow-
Blue- areas which are not significantly hypometabolic;
RED-areas which are most severe and most statistically significant hypometabolic,
Purple- areas where hypometabolism may be smaller in magnitude but remains statistically significant.

FINDINGS:

Resident (Nuclear Medicine) : DR. Akansha Kumar

Nuclear Medicine (Consultant) : Dr. SUNITA N SONAVANE

Nuclear Medicine
 Radiation Medicine Centre
Bhabha Atomic Research Centre
C/o Tata Memorial Center Annexe,
Jerbai Wadia Road, Parel, Mumbai 400012
Tel: 24134960 / 24146059; Fax: 24157098

CC NO : 11R2023/002630 Requisition No. JZZ/PT/23/003020

Name Mr. NANDLAL BARVE
Sex/Age : M/ 53 Years Category/Status : C/ Out Patient
DMG : RMC
Service Desc WB PET SCAN-FDG (RMC) Reqn Date : 14-07-2023
Provisional Diagnosis

Final Report Report Date : 09-08-2023

Multiple FDG avid ill-defined hypodense lesions, some with perilesional edema noted in right cerebral
hemisphere . Also note is made of diffusely decreased FDG uptake in bilateral parieto- temporal lobes and
periventricular regions.

Focal intense FDG uptake noted adjacent to vermis/midline in right cerebellar hemisphere; SUVmax: 18.02.
Diffusely reduced FDG uptake in rest of bilateral cerebellum (right> left).

On dedicated NEURO Q quantitative analysis of brain:

Most severe and most statistically significant hypometabolic areas: left superolateral temporal cortex (SD:
-6.56), right superolateral temporal cortex (SD: -3.65), right inferior frontal cortex, SD: -3.9.
Moderate hypometabolic areas: left inferior frontal cortex (SD: -3.4) and left inferior parietal cortex, SD:
-3.45.

No definite focal /diffuse significant hypermetabolism in cerebral/ cerebellar hemispheres.

Right kidney appears small, with left kidney appearing mildly hydronephrotic, with bilateral perinephric fat
stranding noted in CT images.

Mild FDG uptake is noted in bilateral adrenal glands which appear bulky (SUVmax 3.95), largest measuring
2x2 cm (left).

No other abnormal focus of FDG uptake noted anywhere in the body.

Physiological uptake of the tracer is noted in the cerebral cortex and basal ganglia, vocal cords, myocardium,
spleen, renal pelvicalyceal systems, urinary bladder & the gut.

Resident (Nuclear Medicine) : DR. Akansha Kumar

Nuclear Medicine (Consultant) : Dr. SUNITA N SONAVANE

Nuclear Medicine
 Radiation Medicine Centre
Bhabha Atomic Research Centre
C/o Tata Memorial Center Annexe,
Jerbai Wadia Road, Parel, Mumbai 400012
Tel: 24134960 / 24146059; Fax: 24157098

CC NO : 11R2023/002630 Requisition No. JZZ/PT/23/003020

Name Mr. NANDLAL BARVE
Sex/Age : M/ 53 Years Category/Status : C/ Out Patient
DMG : RMC
Service Desc WB PET SCAN-FDG (RMC) Reqn Date : 14-07-2023
Provisional Diagnosis

Final Report Report Date : 09-08-2023

Rest of the whole-body survey is unremarkable.

IMPRESSION
Multiple heterogenous hypermetabolism in ill-defined hypodense lesions, some with perilesional edema noted
in right cerebral hemisphere. Also note is made of diffusely decreased FDG uptake in bilateral parieto-
temporal lobes and periventricular regions.

Focal intense hypermetabolism is noted adjacent to vermis/midline in right cerebellar hemisphere. Diffusely
reduced FDG uptake in rest of bilateral cerebellum (right> left).

NEURO Q quantitative analysis reveal: Most severe and most statistically significant hypometabolic areas
involving left superolateral temporal cortex, right superolateral temporal cortex, right inferior frontal cortex-
clinical correlation.

Right kidney appears small, with left kidney appearing mildly hydronephrotic, with bilateral perinephric fat
stranding noted in CT images.

Mildly metabolic bilateral bulky adrenals further clinical correlation suggested.

No definite evidence of significant locoregional adenopathy.

No definite evidence of significant distant metastases.

Scan findings favour infective benign etiology, rather than malignancy.

Resident (Nuclear Medicine) : DR. Akansha Kumar

Nuclear Medicine (Consultant) : Dr. SUNITA N SONAVANE

Nuclear Medicine
 Radiation Medicine Centre
Bhabha Atomic Research Centre
C/o Tata Memorial Center Annexe,
Jerbai Wadia Road, Parel, Mumbai 400012
Tel: 24134960 / 24146059; Fax: 24157098

CC NO : 11R2023/002630 Requisition No. JZZ/PT/23/003020

Name Mr. NANDLAL BARVE
Sex/Age : M/ 53 Years Category/Status : C/ Out Patient
DMG : RMC
Service Desc WB PET SCAN-FDG (RMC) Reqn Date : 14-07-2023
Provisional Diagnosis

Final Report Report Date : 09-08-2023

Resident (Nuclear Medicine) : DR. Akansha Kumar

Nuclear Medicine (Consultant) : Dr. SUNITA N SONAVANE

Nuclear Medicine