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CIN:U85199DL1999PTC101010
SARITA BRAHMI, 77 YRS./F
REFERRED BY: DR. BHARAT KUMAR MARCH 22,2023
WHOLE BODY FDG PET CECT SCAN
Whole body FDG PET CT scan was
performed from the vertex to mid thigh on a GE Discovery STE
PET CT system without breath hold instruction following intravenous injection of~ 0.15 mCi/Kg of
F- fluorodeoxyglucose
through an IV line. Patient was asked to rest quietly for 60 +/- 15 minutes
in a shielded room to allow tracer to
accumulate in the body. High
resolution CT scan was
performed during this examination on a 32 slice/Sec MDCT with intravenous injection of non ionic
contrast(lohexol 40 ml) followed by PET images. Additional breath hold CT was performed for
evaluation of the lungs. The semiquantitative analysis of FDG
uptake was performed by calculating
SUV (Standardized uptake value) corrected for the administered dose and patient body weight. The
creatinine level of the patient was 0.44 mg/dl and blood sugar level was 104 mg/dl at the time of
tracer injection. No adverse reaction was observed
during the scan.
Patient is up case of carcinoma right breast (infiltrating duct carcinoma, triple
a follow
Degative), status: post 8 cycles of NACT (last on Mareh 08, 2023). FDG PET CT scan
done for treatment response evaluation and restaging. Previous (pre-treatment) FDG PET CT
scau dated November 30, 2022 is available for
comparison.
The overall biodistribution of FDG is within normal physiological limits.

Brain: Diftuse cortical atrophy noted with prominent ventricles and basal cisterns. Calcification
noted along the falx. Rest of the brain parenchyma is unremarkable with normal FDG
biodistribution. No significant focal lesion or abnormal focal FDG uptake noted.
It may kindhy be noted that all brain metastases may not be apparent on a PET CT scan and an MRI head may be
performed where clinically indicated

Head & Neck: Few non FDG avid hypodense lesions are noted in both lobes of the thyroid gland
largest in right lobe measures approximately 1.7 x 1.! cm in size. Suggested USG correlation. The
thyoid gland is otherwise unremarkable with normal homogenous attenuation on CT scan and no
abnormal FDG uptake.

Few non FDG avid subcentimeter sized right infra clavicular lymph nodes are noted.

Right Breast: Mildly FDG avid (SUV max-2.86, previous SUV max-22.1) heterogeneously
enhancing soft tissue lesion with spiculated margins is noted in the right breast measuring
approximately 3.5 x 3.1 x 2.8 cm in maximum measurable dimensions. The lesion is reaching
upto and infiltrating the overlying skin, subcutaneous tissue and nipple areola complex. Mildly
FDG avid thickening of the overlying skin noted with maximum thickness of approximatel
0.7em. The underlying chest wall structures appear unremarkable.

Few mildly FDG avid (SUV max-2.67, previous SUV max- 22.4) and non FDG avid discrete
and coalescent right level I and II axillary lymph nodes are noted, the largest in the right level
1 axillary station, measures approximately 2.2 x 1.4 cm in size.

Sir Ganga Ram Hospital Safdarjung Developement Area Defence Colony Pusa Road Gurugrarn Bali Nagar Page Nagar
Fortis Flt. Lt. Rajan Dhall Hospital PSRI Hospital Sports Injury Centre, Safdarjung Hospital Fortis Escorts, Jaipur
PositronEmission Tomography With Multi Detector CT (PET CT) Whole Body DOTANOC PETCT
Whole Body Prostate Specific Membrane Antigen PET CT (PSMA) Dual Head Spect Gamma Camera Ria Lab DEXA Bone Densitometry
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CIN:U85199DL1999PTC101010
YRS./F
SARITA BRAHMI, 77
REERRED BY: DR. BHARAT KUMAR MARCH 22,2023
Left breast and axilla appear unremarkable with no focal abnormal FDG uptake

Thorax: Poor breath hold noted. Few subcentimeter sized non FDG avid fibronodular lesions are
noted in bilateral lung fields (left more than right). No significant FDG avid hilar / mediastinal
lymphadenopathy is seen.

Abdomen: The liver shows mildly diffuse hypoattenuation, suggestive of fatty infiltration.
evidence of any FDG avid focal parenchymal lesion. No significant dilatation of IHBR iss
Major hepatic vascular channels do not show any significant abnormality.
The gll bladder is unremarkable (USG is the modality of choice to rule ou GB stones).
The spleen is unremarkable and demonstrates normal physiological FDG uptake. No focal lesion is
seen.

The pancreas appears unremarkable with no abnormal FDG uptake.

Left adrenal gland appears bulky with no evidence of any abnormal FDG uptake. Right adrenal
gland is unremarkable with no evidence of any abnormal FDG uptake.
Both kidneys demonstrate lobulated contour ? Scarred. Bilateral kidneys are otherwise
unremarkable with no evidence of any abnormal FDG uptake.
The stomach and distended small bowel and large bowel loops areunremarkable.
No significant FDG avid abdominal or pelvic lymphadenopathy isseen.
No significant loculated/ free fluid is seen in the abdomen or pelvis.
The urinary bladder is partially distended and is unremarkable.

The uterus and bilateral adnexae appear unremarkable.

Skeleton: Degenerative changes are noted in the spine. Diffuse osteopenia noted in the bones under
survey with no evidence of any abnormal FDG uptake.

OPINION: In this follow up of carcinoma right breast, post 8 cycles of NACT status, PET
case
soft tissue
CT sean findings are suggestive of mildly FDG avid heterogeneously enhancing
subcutaneous
lesion with spiculated margins in the right breast infiltrating the overlying skin,
with few mildly FDG
and nipple areola complex, likely residual primary mitotic pathology
fibronodular lesions in bilateral
avid right level I axillary lymph nodes and few non FDG avid
lungs, likely metastatic.
Suggested : Histopathological correlation.
Note is made of few non FDG avid hypodense lesion in both lobes of the thyroid gland.
Suggested: USG correlation.

Page 2 of 3
Pusa Road GurugraH Bali Nagar
Sir Ganga Ram Hospital Safdarjung Developement Area Defence Colony Fortis Escorts, Jaipur
Fortis Flt. Lt. Rajan Dhall Hospital PSRI Hospital Sports Injury Centre, Safdarjung Hospital
DOTANOC PET CT
Positron Emission Tomography With Multi
Detector CT (PET CT) Whole Body
Ria Lab DEXA Bone Densitometry
h o l a Rody Prostate Snesific Membrane Antigen PET CT (PSMA) Dual Head Spect Gamma Camera
 info@mahajanimaging.com NABH
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CIN: U85199DL1999PTC101010o

SARITA BRAHMI, 77 YRs./F

REFERRED BY: DR. BHARAT KUMAR MARCH 22, 2023
As compared to the previous (pre-treatment) FDG PET CT scan dated November
.The intensely FDG avid right breast lesions show 30, 2022;
and FDG avidity significant reduction in size, extent
The FDG avid right axillary lymph nodes show
and FDG avidity
significant reduction in size, number
The FDG avid bilateral lung lesions show
significant reduction in size, number and
absence of FDG avidity
The FDG avid infraclavicular lymph node shows near complete resolution
The FDG avid right internal mammary lymph nodes show near complete resolution
No new lesion seen

Please correlate clinically.

(Please note: °FDG PET CT scan cannot differentiate between mitotic and infective pathology
Histopathology is suggested for confirmatory diagnosis).

unan auna
Dr. Ritu Verma Dr.Eth>S Belho *Dr. Kumar Gaurav Dr. Sunil Gadde
Resident Resident
Sr.Consutant & HOD Sr.Consultant
(Please carry report dhd CD on younextvisit for comparison).
(In case of any typographical error please inform immediately and get it corrected within 7 days).

Bali NagarPage Nagar

Ram Hospital Safdarjung Developement Area Defence Colony Pusa Road Gurugrarh
Sir Ganga Sports Injury Centre, Safdarjung
Hospital.Fortis Escorts, Jaipur
Fortis Flt. Lt. Rajan Dhall Hospital PSRI Hospital

Positron Emission Tomography With Multi Detector CT (PET CT) Whole Body DOTANOC PET CT
T (nSMA) Dunl H o a d Snect Gamma Camera Ria Lab DEXA Bone Densitometry