Clinical History
62 years old gentleman with history of sigmoid colectomy and ileostomy in August 2005 for metastatic poorly differentiated adenocarcinoma of sigmoid colon. Had chemotherapy with FOLFOX from September 2005 till May 2006. Had Cetuximab, CPT-11 and 5-FU from October 2006 till April 2007. Started on Avastin, Mitomycin and 5FU in Jul 2007 followed by oral UFT till August 2008. Had Avastin, CPT-11 and 5FU in August 2008 with partial remission followed by Avastin, CPT-11 and Oxaliplain in September 2008. On Capecitabine from September 2008 till March 2009. PET CT in March 2009 showed disease progression. Had further chemotherapy with Cetuximab, CPT-11 and Capecitabine from March 2009 till June 2009. Currently on chemotherapy (Avastin, Oxaliplatin, CPT-11 and infusion of 5-FU). Last cycle on 27th August 2009. Recent CEA of 27 ug/l (previously 36.0 ug/L). PET/CT to assess therapy response.
Findings
The current study was correlated with the report of the previous PET scan of July 2009.
The patient is status post sigmoid colectomy. No abnormal hypermetabolic FDV avid lesion is detected at the anastomotic site. There is herniation of the transverse colon and a small bowel loop through a defect in the anterior abdominal wall. No ascites or peritoneal nodules are seen.
The previously noted FDG-avid retrocaval, aortocaval and para-aortic nodes demonstrate regression in sizes and metabolic activities (e.g., SUVmax of 4.9 vs 17.8 previously for the largest retrocaval node; 1.0 cm vs 1.6 cm previously). The subcentimeter retrocrural node of low grade uptake also shows negligible activity, and is more in keeping with a resolving node. No abnormal FDG-avid focus is seen in the liver, spleen, pancreas or adrenal glands.
The previously noted moderately FDG-avid right paratracheal node and the mildly FDG-avid node adjacent to the aortic arch also show marked decline in metabolic activities (SUVmax of 2.3 vs 8.3 previously for the right paratracheal node). The other stable subcentimeter non FDG-avid right paratracheal nodes, precarinal node, aortopulmonary window nodes and left lower paratracheal node are more in keeping with reactive nodes.
No FDG-avid supraclavicular nodes are noted. The mildly FDG avid right parotid nodule with marginal increase in metabolic activity (SUVmax of 4.5 vs 3.8 previously), but is stable in size and is most likely an inflammatory intra-parotid node.
The multiple FDG-avid bilateral pulmonary nodules also demonstrate regression in metabolic activities and sizes (SUVmax of 7.7 vs 13.5 previously for the largest right upper lobe nodule; SUVmax of 6.9 vs 13.7 previously for the lingular segment nodule). No new FDG avid nodules are detected. Linear atelectasis is present in the right middle lobe. No pleural or pericardial effusion is seen.
The FDG avid sclerotic lesions at L2 and L3 show further increase in metabolic index (SUVmax of 6.5 vs 5.5 previously for L3 and SUVmax of 5.6 vs 4.3 previously for L2 lesion).
No new FDG-avid skeletal foci are noted.
Clinical Impression
The multiple FDG-avid bilateral lung metastases show decrease in metabolic activities and sizes.
The FDG-avid retroperitoneal nodal metastases also demonstrate regression in sizes and metabolic activities.
The previously noted FDG avid right paratracheal node and a node adjacent to aortic arch show low grade activity, consistent with treated / resolving disease.
The mild increase in metabolic activity in the previously detected FDG avid bone metastases may be due to flare phenomenon, particularly in the absence of any new bone metastases. Follow-up is recommended.
No new FDG avid metastatic foci are detected.
Overall findings are suggestive of good metabolic response to therapy.
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