Radiological Manifestations of Metastatic Melanoma
|
|
- Alyson Griffith
- 6 years ago
- Views:
Transcription
1 Radiological Manifestations of Metastatic Melanoma Lia Hojman, Universidad de Chile Year VII
2 Our patient: Clinical Presentation A 24 year old male. Former smoker. 8 months ago, he suffered a burn in his right hip while working. Then he noticed the area wasn t healing well and that a big, pigmented and raised mole appeared in the area where he noticed a mole a few years prior to the accident. 2
3 Our Patient: Melanoma local Management The biopsy showed a nodular melanoma with positive margins. He underwent a wide excision and inguinal + femoral lymphadenectomy. 3 3
4 Now that seen the local management of our patient s malignant melanoma, let s review some important aspects of melanoma 4 4
5 Risk Factors for Malignant Melanoma Risk factors: More than 100 moles in the entire body Familial history of melanoma Personal history of melanoma More than 4 atypical nevi Armstrong A, et al. Pathologic Characteristics of Melanoma in: UpToDate, Armstrong A. (Ed), UpToDate, Waltham, MA,
6 Features of Suspicious Moles ABCDE of Moles: A for Assymetry B for irregular Borders C for Color variegation D fordiameter> 6 mm E for enlargement/ evolution 6 6
7 Let s check our patient s follow up studies 7 7
8 Our Patient: Right lower lobe nodule Right lower lobe pulmonary nodule, 1 cm in diameter Axial, C, Chest CT 8 PACS, BIDMC 8
9 Our Patient: Left lower lobe nodules Tiny submilimiter nodules in the lower segment of the left lower lobe Axial, C, Chest CT 9 PACS, BIDMC 9
10 Our Patient: Left lower lobe nodules Tiny submilimiter nodules in the lower segment of the left lower lobe Axial, C, Chest CT 10 PACS, BIDMC 10
11 Our Patient: Gastrohepatic lymph node mass Large conglomerate lymph node mass identified within the gastrohepatic ligaments Axial, C+, Abdominal CT 11 PACS, BIDMC 11
12 Our Patient: Hepatic Metastases There are metastasis in the liver. The largest measures 5.0 x 4.5 cm in segment II of the liver. And in the segment VII measuring 1.4 x 1.5 cm. Axial, C+, Abdominal CT 12 PACS, BIDMC 12
13 Our Patient: Hepatic Metastases There are metastasis in the liver. The largest measures 5.0 x 4.5 cm in segment II of the liver. And in the segment VII measuring 1.4 x 1.5 cm. He also was found to have metastasis in segments IVa and III. Axial, C+, Abdominal CT 13 PACS, BIDMC 13
14 Finding s Summary In the follow up CTs we found: Pulmonary Metastases Conglomerate lymph node mass in gastrohepatic ligament Liver Metastases 14 14
15 Metastasic Sites Where does melanoma spread to? Kumar R, et al. Clinical applications of fluorodeoxyglucose--positron emission tomography in 15 the management of malignant melanoma. Curr Opin Oncol Mar;17(2):
16 Our patient: Further work up He underwent a Head MRI to see if there was also brain lesions
17 Our Patient: Frontal Lobe nodule There is an approximately 1 cm enhancing mass within the right frontal lobe, which may lie within the cortex or could be sulcal, concerning for a metastatic lesion. Axial MR, T1 Flair PACS, BIDMC 17 17
18 Our Patient: Frontal Lobe nodule There is surrounding vasogenic edema within the right frontal lobe, though without mass effect or shift of midline. Axial MR, FLAIR sequence PACS, BIDMC 18 18
19 Our Patient: Temporal Lobe nodule Within the inferior left temporal lobe there is an enhancing lesion measuring approximately 3 mm without significant surrounding edema. Axial MR, Flair sequence PACS, BIDMC 19 19
20 Head MRI Findings Summary There is a 1 cm enhancing mass within the right frontal lobe, with surrounding vasogenic edema, concerning for metastatic lesion. In the left temporal node, a second enhancing lesion can be seen, without surrounding edema
21 Our patient: Further work up To further characterize the lesions, a PET CT was performed. Butbeforeweseeourpatient spet CT, we are going to learn how a PET CT is done
22 PET CT: The Pasteur Effect Glucose Glucose Aerobiosis O 2 Energy Energy In aerobiosis, glucose is transported into cells to be used in energy production. This is called Glycolysis In anaerobic conditions, the energy production process is less effective so there is enhanced uptake. This is called the Pasteur effect O 2 Anaerobiosis Stark P, et al. Computed Tomography and Positron Emission Tomographic 22 Scanning in: UpToDate, Stark P. (Ed), UpToDate, Waltham, MA,
23 PET CT: The Warburg Effect Glucose Glucose Normal Cell O 2 Tumor Cell In tumor, there is enhanced glycolysis even in aerobic conditions. This is called the Warburg effect. O 2 Stark P, et al. Computed Tomography and Positron Emission Tomographic Scanning in: UpToDate, 23 Stark P. (Ed), UpToDate, Waltham, MA,
24 PET CT: Changing Glucose for FDG Glucose FDG Physiologic Process Energy When we do a PET, we use a glucose analog, FDG, that can t be metabolized, so it stays in the cell. When it decays, emits protons that are sensed by the detectors. The more uptake, the darker it looks. Stark P, et al. Computed Tomography and Positron Emission Tomographic 24 Scanning in: UpToDate, Stark P. (Ed), UpToDate, Waltham, MA,
25 PET CT: The CT contribution Unfortunately, the PET by itself doesn t give enough anatomical information, but when is combined with a non contrast CT, we can see the anatomic position of a high FDG uptake focus. Axial, FDG, Chest PET PACS, BIDMC This test is normally used to look for metastases. Stark P, et al. Computed Tomography and PET Scanning in: UpToDate, Stark P. (Ed), UpToDate, Waltham, MA,
26 PET CT: The CT contribution Unfortunately, the PET by itself doesn t give enough anatomical information, but when is combined with a non contrast CT, we can see the anatomic position of a high FDG uptake focus. Axial, FDG, Chest PET PACS, BIDMC Axial, FDG, Chest PET PACS, BIDMC Axial, C, Chest CT This test is normally used to look for metastases. 26 Stark P, et al. Computed Tomography and PET Scanning in: UpToDate, Stark P. (Ed), UpToDate, Waltham, MA,
27 PET CT: It s not perfect Sources of error: False positive High uptake due to active infections. High uptake due to brown fat. False negative Tumors with low metabolic activity Too small tumors (less than 7 mm in diameter) Hyperglicemia: Glucose and FDG compete for the same receptors. Stark P, et al. Computed Tomography and PET Scanning in: UpToDate, Stark P. (Ed), UpToDate, Waltham, MA,
28 Follow up PET So now that we understand how it works, let s see what we find 28 28
29 Our Patient: Subcarinal lymph node conglomerate PACS, BIDMC Axial, FDG, Chest PET Axial, C, CT Axial, FDG, Chest PET Axial, FDG, Chest CT CHEST: A 2.2 cm subcarinal lymph node conglomerate to the right of midline, with increased uptake with SUV max of 6.6. The previously seen right lower lobe nodule near the diaphragm measures 1.5 cm and demonstrates minimal avidity with SUV max
30 Our Patient: Liver Mets and Lymph node conglomerate PACS, BIDMC Axial, FDG, Chest PET Axial, C, CT Axial, FDG, Chest PET Axial, FDG, Chest CT Extensive diffuse FDG avidity is seen in the liver,predominantly in the left lobe. Also involving the periportal tissue, IVC and aorta, corresponding to regions of known liver metastases and lymph node conglomerates
31 Our Patient: Vertebral C5 early metastasis PACS, BIDMC Axial, FDG, Chest PET Axial, C, CT Axial, FDG, Chest PET Axial, FDG, Chest CT A focus of FDG tracer uptake is seen in the vertebral body of C5 with SUV max 3.6. It has no correlation in CT Concerning for early metastasis
32 PET CT Findings Summary Focus of FDG tracer uptake was seen in Subcarinal lymph node conglomerate The liver, predominantly in the left lobe. The vertebral body of C
33 PET CT Findings Summary Focus of FDG tracer uptake was seen in Subcarinal lymph node conglomerate The liver, predominantly in the left lobe. The vertebral body of C5 Next, we will review some basic facts on bone metastases 33 33
34 Bone Metastasis Metastasis are the most common variety of bone tumor Always consider them in an older patient. The most common primary tumors are Greenspan, Adam. Differential diagnosis of tumor and tumor like lesions of bones and joints. First Edition. New York, 34 NY. Editorial Lippincott Raven;
35 Bone Metastasis: Most common primary tumors Thyroid Breast Lung Kidney Prostate Uterus Also gastric cancer, colon, urinary, melanoma 35 Greenspan, Adam. Differential diagnosis of tumor and tumor like lesions of bones and joints. First Edition. New York, 35 NY. Editorial Lippincott Raven;
36 Bone Metastasis: Favorite Localizations Axial skeleton Proximal parts of limbs Greenspan, Adam. Differential diagnosis of tumor and tumor like lesions of bones and joints. First Edition. New York, 36 NY. Editorial Lippincott Raven;
37 Bone Metastasis: Favorite Localizations Axial skeleton Proximal parts of limbs Greenspan, Adam. Differential diagnosis of tumor and tumor like lesions of bones and joints. First Edition. New York, 37 NY. Editorial Lippincott Raven;
38 Bone Metastases: Lytic vs Blastic Lytic lesions represent ~ 75% : Blastic lesions represent ~ 15% : Kidney Lung Breast GI tract Thyroid Prostate Seminoma Breast Cervix Ovary Mixed Lesions: Represent 15%. Most common are Breast and Lung Greenspan, Adam. Differential diagnosis of tumor and tumor like lesions of bones and joints. First Edition. New York, 38 NY. Editorial Lippincott Raven;
39 Companion Patient 1: An example of lytic metastasis of Renal Carcinoma Courtesy of Dr. Corrie Yablon 39 Axillary projection, Shoulder Plain Film PACS, BIDMC 39
40 Companion Patient 1: An example of lytic metastasis of Renal Carcinoma Expansile lytic ovoid destructive lesion at the periphery of the proximal humerus. Destroying and scalloping the underlying bone with an associated soft tissue mass. Courtesy of Dr. Corrie Yablon Axillary projection, Shoulder Plain Film 40 PACS, BIDMC 40
41 Companion Patient 2: An example of mixed metastases of Breast Cancer Sagittal, C, Spinal CT PACS, BIDMC Courtesy of Dr. Corrie Yablon 41 41
42 Companion Patient 2: An example of mixed metastases of Breast Cancer Blastic Lesion in body of T12 Sagittal, C, Spinal CT PACS, BIDMC Courtesy of Dr. Corrie Yablon 42 42
43 Our Patient: Treatment choices and Prognosis Poor prognosis: Melanoma stage IV with brain metastases. Plan: Brain Metastaes: Stereotactic Surgery Quimiotherapic treatment: Temozolomide Alkylating agent Bonds to Guanine in DNA DNA damage Cell death Ipilimumab remains as an alternative Monoclonal antibody Targeted against CTL4, antigen that works as an inhibitor of T cell actvity. Ipilimumab blocks the inhibitor, resulting in T cell stimulation T cells recognize and attack the tumor
44 Summary of the presentation In this presentation, we have reviewed: History of a patient with metastasic melanoma Risk factors for melanoma ABCDE of moles Metastasic melanoma on a Chest CT Metastasic melanoma on an Abdominal CT Frequent locations of melanoma metastases Metastasic melanoma on Head MRI How a PET CT works Pasteur effect Warburg effect 44 44
45 Ipilimumab Lia Hojman, VII Summary of the presentation 2 How a PET CT works FDG and its difference with glucose The CT contribution Sources of error False Positive False Negative Metastasic Melanoma on PET CT Bone Metastases General Aspects Most common Primary Tumors Favorite localizations Lytic vs Blastic Lesions Stage IV Melanoma Treatment: Temozolomide
46 Acknowledgments Corrie Yablon, MD Emily Hanson, Student Coordinator Seth Berkowitz, MD Claudio Karsulovic, MS4 Jim Brophy, PACS 46 46
47 References Dancey AL, et al. A review of diagnostic imaging in melanoma. J Plast Reconstr Aesthet Surg Nov;61(11): Greenspan, Adam. Differential diagnosis of tumor and tumor like lesions of bones and joints. First Edition. New York, NY. Editorial Lippincott Raven; 1998 El Maraghi RH, et al. PET vs sentinel lymph node biopsy for staging melanoma: a patient intervention, comparison, outcome analysis. J Am Coll Radiol Aug;5(8): Vandewoude M, et al. (18)FDG PET scan in staging of primary malignant melanoma of the esophagus: a case report. Acta Gastroenterol Belg Jan Mar;69(1):12 4. Kumar R, et al. Clinical applications of fluorodeoxyglucose positron emission tomography in the management of malignant melanoma. Curr Opin Oncol Mar;17(2): Stone M, et al. Evaluation and Treatment of regional Lymph nodes in Melanoma in: UpToDate, Stone M. (Ed), UpToDate, Waltham, MA, Armstrong A, et al. Pathologic Characteristics of Melanoma in: UpToDate, Armstrong A. (Ed), UpToDate, Waltham, MA, Stark P, et al. Computed Tomography and Positron Emission Tomographic Scanning in: UpToDate, Stark P. (Ed), UpToDate, Waltham, MA,
An Introduction to PET Imaging in Oncology
January 2002 An Introduction to PET Imaging in Oncology Janet McLaren, Harvard Medical School Year III Basics of PET Principle of Physiologic Imaging: Allows in vivo visualization of structures by their
More informationperformed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.
Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician
More informationLos Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010
Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010 Self Assessment Module on Nuclear Medicine and PET/CT Case Review FDG PET/CT IN LYMPHOMA AND MELANOMA Submitted
More informationNew Visions in PET: Surgical Decision Making and PET/CT
New Visions in PET: Surgical Decision Making and PET/CT Stanley J. Goldsmith, MD Director, Nuclear Medicine Professor, Radiology & Medicine New York Presbyterian Hospital- Weill Cornell Medical Center
More informationThe Role of PET / CT in Lung Cancer Staging
July 2004 The Role of PET / CT in Lung Cancer Staging Vlad Vinarsky, Harvard Medical School Year IV Patient AM HPI: 81 yo F p/w hemoptysis x 1 month LLL lesion on CXR, not responsive to Abx 35 pack-year
More informationProf. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.
Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,
More informationIndex. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic
More informationRadiology Pathology Conference
Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationClinical indications for positron emission tomography
Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will
More informationImaging in Metastatic Melanoma. Nilanthi Gunawardane Gillian Lieberman, MD March 2008
Imaging in Metastatic Melanoma Nilanthi Gunawardane Gillian Lieberman, MD March 2008 Malignant Melanoma Neoplasm of pigment-forming cells, melanocytes,, and nevus cells Types of melanoma Superficial spreading
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More informationPositron Emission Tomography in Lung Cancer
May 19, 2003 Positron Emission Tomography in Lung Cancer Andrew Wang, HMS III Patient DD 53 y/o gentleman presented with worsening dyspnea on exertion for the past two months 30 pack-year smoking Hx and
More informationDr Sneha Shah Tata Memorial Hospital, Mumbai.
Dr Sneha Shah Tata Memorial Hospital, Mumbai. Topics covered Lymphomas including Burkitts Pediatric solid tumors (non CNS) Musculoskeletal Ewings & osteosarcoma. Neuroblastomas Nasopharyngeal carcinomas
More informationLung. 10/24/13 Chest X-ray: 2.9 cm mass like density in the inferior lingular segment worrisome for neoplasm. Malignancy cannot be excluded.
Lung Case Scenario 1 A 54 year white male presents with a recent abnormal CT of the chest. The patient has a history of melanoma, kidney, and prostate cancers. 10/24/13 Chest X-ray: 2.9 cm mass like density
More informationImaging of the cisterna chyli on PET-CT in patients with known malignancy: Report of two cases
Imaging of the cisterna chyli on PET-CT in patients with known malignancy: Report of two cases Natalie Burns, B.S., Jason Barksdale, M.D., Linh Ho, M.D., and Patrick M. Colletti, M.D. Citation: Burns N,
More informationRadiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh
Radiological staging of lung cancer Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Bronchogenic Carcinoma Accounts for 14% of new cancer diagnoses in 2012. Estimated to kill ~150,000
More information1 Introduction. 2 Materials and methods. LI Na 1 LI Yaming 1,* YANG Chunming 2 LI Xuena 1 YIN Yafu 1 ZHOU Jiumao 1
Nuclear Science and Techniques 20 (2009) 354 358 18 F-FDG PET/CT in diagnosis of skeletal metastases LI Na 1 LI Yaming 1,* YANG Chunming 2 LI Xuena 1 YIN Yafu 1 ZHOU Jiumao 1 1 Department of Nuclear Medicine,
More informationUpdate on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD
Update on RECIST and Staging of Common Pediatric Tumors Ethan A. Smith, MD Section of Pediatric Radiology C.S. Mott Children s Hospital University of Michigan ethans@med.umich.edu Disclosures No relevant
More informationUse of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer
November 2010 Use of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer Laura Myers, Harvard Medical School, Year III Clinical Presentation 79yo woman with cough productive of green
More informationAppendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer
Appendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer Locoregional (N stage) disease was redefined in the seventh edition of the AJCC Cancer Staging Manual as any periesophageal lymph
More informationPOSITRON EMISSION TOMOGRAPHY (PET)
Status Active Medical and Behavioral Health Policy Section: Radiology Policy Number: V-27 Effective Date: 08/27/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should
More informationPET/CT F-18 FDG. Objectives. Basics of PET/CT Imaging. Objectives. Basic PET imaging
Basics of PET/CT Imaging Kevin Robinson, DO Department of Radiology Michigan State University Objectives Basic PET imaging Evaluating the therapeutic response Evaluating the big 5 Lymphoma Breast Lung
More informationCase Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors
CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 4/30/2011 Radiology Quiz of the Week # 18 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationHEPATIC METASTASES. We can state 3 types of metastases depending on their treatment options:
HEPATIC METASTASES 1. Definition Metastasis means the spread of cancer. Cancerous cells can separate from the primary tumor and enter the bloodstream or the lymphatic system (the one that produces, stores,
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationFive Views of Transitional Cell Carcinoma: One Man s Journey
September 2006 Five Views of Transitional Cell Carcinoma: One Man s Journey Amsalu Dabela, Harvard Medical School III Outline Overview: Renal Anatomy Our Patient s Story Diagnostic Imaging Studies Appearance
More informationPET in Rectal Carcinoma
Case Report PET in Rectal Carcinoma Josefina Jofré M 1, Paulina Sierralta C 1, José Canessa G 1,2, Pamela Humeres A 3, Gabriel Castro M 4, Teresa Massardo V 1,4 1 Centro PET de Imágenes Moleculares, Hospital
More informationSubject: PET Scan With or Without CT Attenuation. Original Effective Date: 11/7/2017. Policy Number: MCR: 610. Revision Date(s): Review Date:
Subject: PET Scan With or Without CT Attenuation Policy Number: MCR: 610 Revision Date(s): MHW Original Effective Date: 11/7/2017 Review Date: DISCLAIMER This Molina Clinical Review (MCR) is intended to
More informationFDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave
FDG PET/CT STAGING OF LUNG CANCER Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER FDG PET/CT is used in all patients with lung cancer who are considered for curative treatment to exclude occult disease.
More informationLung Cancer Imaging. Terence Z. Wong, MD,PhD. Department of Radiology Duke University Medical Center Durham, NC 9/9/09
Lung Cancer Imaging Terence Z. Wong, MD,PhD Department of Radiology Duke University Medical Center Durham, NC 9/9/09 Acknowledgements Edward F. Patz, Jr., MD Jenny Hoang, MD Ellen L. Jones, MD, PhD Lung
More informationTesticular relapse of non-hodgkin Lymphoma noted on FDG-PET
Testicular relapse of non-hodgkin Lymphoma noted on FDG-PET Stephen D. Scotti 1*, Jennifer Laudadio 2 1. Department of Radiology, North Carolina Baptist Hospital, Winston-Salem, NC, USA 2. Department of
More information1/25/13 Right partial nephrectomy followed by completion right radical nephrectomy.
History and Physical Case Scenario 1 45 year old white male presents with complaints of nausea, weight loss, and back pain. A CT of the chest, abdomen and pelvis was done on 12/8/12 that revealed a 12
More informationStaging Colorectal Cancer
Staging Colorectal Cancer CT is recommended as the initial staging scan for colorectal cancer to assess local extent of the disease and to look for metastases to the liver and/or lung Further imaging for
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 11/17/2012 Radiology Quiz of the Week # 99 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationPET/CT Frequently Asked Questions
PET/CT Frequently Asked Questions General Q: Is FDG PET specific for cancer? A: No, it is a marker of metabolism. In general, any disease that causes increased metabolism can result in increased FDG uptake
More informationAdam J. Hansen, MD UHC Thoracic Surgery
Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered
More informationParaneoplastic limbic encephalitis in Hodgkin s Lymphoma. Marc Wein, HMS III Dr. Gillian Lieberman, MD September 17, 2007
Paraneoplastic limbic encephalitis in Hodgkin s Lymphoma Marc Wein, HMS III Dr. Gillian Lieberman, MD September 17, 2007 Our patient s CC: Disorientation and insomnia HPI: 27 year old man AW with no PMH
More informationImaging of bone metastases
Imaging of bone metastases Antoine Feydy Service de Radiologie B Hôpital Cochin APHP Université Paris Descartes antoine.feydy@aphp.fr MEXICO 2016 INTRODUCTION Diagnostic Imaging Imaging Modalities Strengths,
More informationThe Use of PET Scanning in Urologic Oncology
The Use of PET Scanning in Urologic Oncology Dr Nicholas C. Buchan Uro-oncology Fellow 1 2 Aims To understand the basic concepts underlying PET scanning. Understand the emerging role of PET Scanning for
More informationPET imaging of cancer metabolism is commonly performed with F18
PCRI Insights, August 2012, Vol. 15: No. 3 Carbon-11-Acetate PET/CT Imaging in Prostate Cancer Fabio Almeida, M.D. Medical Director, Arizona Molecular Imaging Center - Phoenix PET imaging of cancer metabolism
More informationLearning Objectives. 1. Identify which patients meet criteria for annual lung cancer screening
Disclosure I, Taylor Rowlett, DO NOT have a financial interest /arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context
More informationMRI and CT of the CNS
MRI and CT of the CNS Dr.Maha ELBeltagy Assistant Professor of Anatomy Faculty of Medicine The University of Jordan 2018 Computed Tomography CT is used for the detection of intracranial lesions. CT relies
More informationRadiology-Pathology Conference
July 31, 2009 Radiology-Pathology Conference Daniel T Ginat, M.D., M.S. Sharlin Johnykutty,, M.D. Presentation material is for education purposes only. All rights reserved. 2009 URMC Radiology Page 1 of
More informationTake Home Quiz 1 Please complete the quiz below prior to the session. Use the Multiple Primary and Histology Rules
Take Home Quiz 1 Please complete the quiz below prior to the session. Use the Multiple Primary and Histology Rules Case 1 72 year old white female presents with a nodular thyroid. This was biopsied in
More informationCervical Cancer: 2018 FIGO Staging
Cervical Cancer: 2018 FIGO Staging Jonathan S. Berek, MD, MMS Laurie Kraus Lacob Professor Stanford University School of Medicine Director, Stanford Women s Cancer Center Senior Scientific Advisor, Stanford
More informationA fatal case of an adrenal gland melanoma with a mysterious primary lesion
ISPUB.COM The Internet Journal of Urology Volume 6 Number 2 A fatal case of an adrenal gland melanoma with a mysterious primary lesion A Adam, M Engelbrecht, I van Heerden Citation A Adam, M Engelbrecht,
More informationUnusual Osteoblastic Secondary Lesion as Predominant Metastatic Disease Spread in Two Cases of Uterine Leiomyosarcoma
49 Unusual Osteoblastic Secondary Lesion as Predominant Metastatic Disease Spread in Two Cases of Uterine Leiomyosarcoma Loredana Miglietta a Maria Angela Parodi b Luciano Canobbio b Luca Anselmi c a Medical
More informationT of patients with malignant melanoma
~~ RADIOGRAPHIC: EVALUATION OF METASTATIC MELANOMA JACK E. MEYER, MD*+$ Malignant melanoma can potentially involve any organ system in the body once it metastasizes beyond the regional lymph nodes. A survey
More informationImaging Decisions Start Here SM
Owing to its high resolution and wide anatomic coverage, dynamic first-pass perfusion 320-detector-row CT outperforms PET/CT for distinguishing benign from malignant lung nodules, researchers from Japan
More informationMolecular Imaging and Cancer
Molecular Imaging and Cancer Cancer causes one in every four deaths in the United States, second only to heart disease. According to the U.S. Department of Health and Human Services, more than 512,000
More informationDisclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None
What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department
More informationCOLORECTAL CANCER STAGING in 2010
COLORECTAL CANCER STAGING in 2010 Robert A. Halvorsen, MD, FACR MCV Hospitals / VCU Medical Center Richmond, Virginia I do not have any relevant financial relationships with any commercial interests COLON
More informationDr Rosalie Stephens. Mr Richard Martin. Medical Oncologist Auckland City Hospital Auckland
Dr Rosalie Stephens Medical Oncologist Auckland City Hospital Auckland Mr Richard Martin General Surgeon Melanoma Unit Team Waitemata District Health Board Auckland 8:30-9:25 WS #99: Interactive Case Studies
More informationMajor Topic. Malignant Melanoma Plastic and Reconstructive Surgery R3 陸尊惠 /VS 吳瑞星
Major Topic Malignant Melanoma Plastic and Reconstructive Surgery R3 陸尊惠 /VS 吳瑞星 Patient Data Name: OOO Age: 70 Gender: Male Date of admission: Day 1 Chief Complaint Black skin tumor at the back of the
More informationCase Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Bladder
Cronicon OPEN ACCESS CANCER Case Report Solitary Osteolytic Skull Metastasis in a Case of Unknown Primary Being latter Diagnosed as Carcinoma of Gall Kartik Mittal 1, Rajaram Sharma 1, Amit Dey 1, Meet
More informationMolecular Imaging and Breast Cancer
Molecular Imaging and Breast Cancer Breast cancer forms in tissues of the breast usually in the ducts, tubes that carry milk to the nipple, and lobules, the glands that make milk. It occurs in both men
More informationRadiology- Pathology Conference 4/29/2012. Lymph Nodes. John McGrath
Radiology- Pathology Conference 4/29/2012 Lymph Nodes John McGrath 1 Presentation material is for education purposes only. All rights reserved. 2012 URMC Radiology Page 1 of 24 Case 1: 51 year-old male
More informationF NaF PET/CT in the Evaluation of Skeletal Malignancy
F NaF PET/CT in the Evaluation of Skeletal Malignancy Andrei Iagaru, MD September 26, 2013 School of of Medicine Ø Introduction Ø F NaF PET/CT in Primary Bone Cancers Ø F NaF PET/CT in Bone Metastases
More informationPET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET
Positron Emission Tomography (PET) When calling Anthem (1-800-533-1120) or using the Point of Care authorization system for a Health Service Review, the following clinical information may be needed to
More informationA 76 year old male presented with sudden increase of dyspnoea on 15 November 2014, following a biopsy. A previous CXR was reviewed.
Question 1 A 76 year old male presented with sudden increase of dyspnoea on 15 November 2014, following a biopsy. A previous CXR was reviewed. Imaging A CXR was performed on 28 May 2014. A CT of the chest
More informationUncommon secondary tumour of the stomach
Uncommon secondary tumour of the stomach B. Bancel, Hôpital CROIX ROUSSE LYON Bucharest Nov 2013 Case report 33-year old man Profound mental retardation and motor disturbances (sequelae of neonatal meningeal
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
PET Scanning: Oncologic Applications Page 1 of 88 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Positron Emission Tomography (PET) Scanning: Oncologic Applications
More informationLYMPHATIC DRAINAGE IN THE HEAD & NECK
LYMPHATIC DRAINAGE IN THE HEAD & NECK Like other parts of the body, the head and neck contains lymph nodes (commonly called glands). Which form part of the overall Lymphatic Drainage system of the body.
More informationAlison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD
November Colon Cancer Alison Douglass, Harvard Medical School Year III Our Patient Mr. K. is a 67 year old man with no prior medical problems other than hemorrhoids which have caused occasional rectal
More informationMelanoma Case Scenario 1
Melanoma Case Scenario 1 History and physical 11/5/16 Patient is a single, 48-year-old male in good health who presented to his primary physician for a yearly physical exam during which a 3.4 x 2.8 x 1.5
More informationComputed Tomography of Normal Adrenal Glands in Indian Population
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 01 Ver. V January. (2018), PP 26-30 www.iosrjournals.org Computed Tomography of Normal Adrenal
More informationWhole body F-18 sodium fluoride PET/CT in the detection of bone metastases in patients with known malignancies: A pictorial review
Whole body F-18 sodium fluoride PET/CT in the detection of bone metastases in patients with known malignancies: A pictorial review Poster No.: C-1196 Congress: ECR 2014 Type: Educational Exhibit Authors:
More informationSubject Index. Dry desquamation, see Skin reactions, radiotherapy
Subject Index Actinic keratosis disseminated disease 42 surgical excision 42 AIDS, see Kaposi s sarcoma Amifostine, skin reaction prophylaxis 111 Basal cell carcinoma, superficial X-ray therapy Bowen s
More informationMalignant Melanoma Early Stage. A guide for patients
This melanoma patient brochure is designed to help educate melanoma patients and their caregivers. It was developed under the guidance of Dr. Michael Smylie, Professor, Department of Oncology, University
More informationMelanoma Case Scenario 1
Melanoma Case Scenario 1 History and physical 11/5/16 Patient is a single, 48-year-old male in good health who presented to his primary physician for a yearly physical exam during which a 3.4 x 2.8 x 1.5
More informationI appreciate the courtesy of Kusumoto at NCC for this presentation. What is Early Lung Cancers. Early Lung Cancers. Early Lung Cancers 18/10/55
I appreciate the courtesy of Kusumoto at NCC for this presentation. Dr. What is Early Lung Cancers DEATH Early period in its lifetime Curative period in its lifetime Early Lung Cancers Early Lung Cancers
More informationQuestion 1 History. Likely Diagnosis Differential. Further Investigation or Management. Requires Paediatric Surgical referral for laparotomy
Question 1 Male newborn spilling green tinged vomit day 1 of life Imaging Abdominal X-Rays performed on 03/05/2012 Upper and lower gastrointestinal contrast studies performed on 03/05/2012 Abdominal X-Rays
More informationMEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES
MEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES Although response is not the primary endpoint of this trial, subjects with measurable disease will be assessed by standard criteria. For the purposes of this
More informationVaginal Cancer Early Detection, Diagnosis, and Staging
Vaginal Cancer Early Detection, Diagnosis, and Staging Detection and Diagnosis Catching cancer early often allows for more treatment options. Some early cancers may have signs and symptoms that can be
More informationRole of positron emission mammography (PEM) for assessment of axillary lymph node status in patients with breast cancer
Role of positron emission mammography (PEM) for assessment of axillary lymph node status in patients with breast cancer Poster No.: C-1260 Congress: ECR 2011 Type: Scientific Paper Authors: K. M. Kulkarni,
More informationThe Radiology Assistant : Bone tumor - ill defined osteolytic tumors and tumor-like lesions
Bone tumor - ill defined osteolytic tumors and tumor-like lesions Henk Jan van der Woude and Robin Smithuis Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital,
More informationA 64 y.o. man presents to the hospital with persistent cough and hemoptysis. Fernando Mut Montevideo - Uruguay
A 64 y.o. man presents to the hospital with persistent cough and hemoptysis Fernando Mut Montevideo - Uruguay Teaching case Bone # 1 A 64 y.o. man presents to the hospital with persistent cough and hemoptysis.
More informationIndex. pet.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A C a-aminobutyric acid, carbon-labeled, 94 ABCD(E)s, of melanoma, 2 Acral-lentiginous melanoma, 3 Adrenal glands, metastasis to, structural imaging
More informationTumor control with PD-1 inhibition in a patient with concurrent metastatic melanoma and renal cell carcinoma
Marmarelis et al. Journal for ImmunoTherapy of Cancer (2016) 4:26 DOI 10.1186/s40425-016-0129-x CASE REPORT Tumor control with PD-1 inhibition in a patient with concurrent metastatic melanoma and renal
More informationThyroid Cancer: Imaging Techniques (Nuclear Medicine)
Thyroid Cancer: Imaging Techniques (Nuclear Medicine) Andrei Iagaru, MD MIPS Molecular Imaging Program at Stanford Stanford University School of Medicine Department of Radiology Introduction Ø There are
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
PET Scanning: Oncologic Applications Page 1 of 42 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Positron Emission Tomography (PET) Scanning: Oncologic
More informationMelanoma: The Basics. What is a melanocyte?
Melanoma: The Basics What is a melanocyte? A melanocyte is a normal cell, found in the skin, which produces melanin. Melanin is a black or dark brown pigment that is seen in the skin, hair, and parts of
More informationRanbir Singh Sandhu Gillian Lieberman, MD. Orbital Lymphoma. Ranbir Singh Sandhu, University College London Medical School Gillian Lieberman MD, BIDMC
Orbital Lymphoma Ranbir Singh Sandhu, University College London Medical School Gillian Lieberman MD, BIDMC 1 Our Patient Clinical Picture This topic will be presented in the context of our patient. She
More informationApproach to Pulmonary Nodules
Approach to Pulmonary Nodules Edwin Jackson, Jr., DO Assistant Professor-Clinical Director, James Early Detection Clinic Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and
More informationNuclear medicine in oncology. 1. Diagnosis 2. Therapy
Nuclear medicine in oncology 1. Diagnosis 2. Therapy Diagnosis - Conventional methods - Nonspecific radiopharmaceuticals cumulating in tumours - Specific radiopharmaceuticals (receptor- and immunoscintigraphy)
More informationMulti-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report
Multi-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report Dr. Mohammed Raza 1, Dr. Sindhuri K 2, Dr. Dinesh Reddy Y 3 1 Professor, Department of Surgery, JSS University, Mysore, India
More informationPage: 1 of 29. For this policy, PET scanning is discussed for the following 4 applications in oncology:
Emission Tomography Scanning Page: 1 of 29 Last Review Status/Date: June 2015 Description Positron emission tomography (PET) scans are based on the use of positron-emitting radionuclide tracers coupled
More informationNuclear Medicine and PET. D. J. McMahon rev cewood
Nuclear Medicine and PET D. J. McMahon 150504 rev cewood 2018-02-15 Key Points Nuclear Medicine and PET: Imaging: Understand how Nuc Med & PET differ from Radiography & CT by the source of radiation. Be
More informationBone and CT Scans Are Complementary for Diagnoses of Bone Metastases in Breast Cancer When PET Scans Findings Are Equivocal: A Case Report
Bone and CT Scans Are Complementary for Diagnoses of Bone Metastases in Breast Cancer When Scans Findings Are Equivocal: A Case Report Yuk-Wah Tsang 1, Jyh-Gang Leu 2, Yen-Kung Chen 3, Kwan-Hwa Chi 1,4
More informationHEALTHFIRST 2011 RADIOLOGY PROGRAM CODE LIST
HEALTHFIRST 2011 RADIOLOGY PROGRAM CODE LIST Outpatient Radiology utilization call Carecore at 1-877-773-6964 Modality CPT CODE Description CT SCANS 70450 CT HEAD/BRAIN W/O CONTRAST CT SCANS 70460 CT HEAD/BRAIN
More informationGUIDELINES FOR CANCER IMAGING Lung Cancer
GUIDELINES FOR CANCER IMAGING Lung Cancer Greater Manchester and Cheshire Cancer Network Cancer Imaging Cross-Cutting Group April 2010 1 INTRODUCTION This document is intended as a ready reference for
More informationVIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy
CYRIC Annual Report 2003 VIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy Yamaura G., Yoshioka T., Yamaguchi K. *, Fukuda
More informationPrimary enteric adenocarcinoma with predominantly signet ring features of the lung: A case report with clinicopathological and molecular findings
CASE REPORT Primary enteric adenocarcinoma with predominantly signet ring features of the lung: A case report with clinicopathological and molecular findings Makoto Nagashima 1, Ayako Moriyama 1, Yasuo
More informationAn Overview of Melanoma. Harriet Kluger, M.D. Associate Professor Section of Medical Oncology Yale Cancer Center
An Overview of Melanoma Harriet Kluger, M.D. Associate Professor Section of Medical Oncology Yale Cancer Center Melanoma Statistics Median age at presentation 45-55 55 years Incidence: 2003 54,200 cases
More informationHIP RADIOLOGY PROGRAM CODE LISTS
EFFECTIVE OCTOBER 1, 2012 70336 MAGNETIC RESONANCE IMAGING TMJ 70450 COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT 70460 COMPUTED TOMOGRAPHY HEAD/BRAIN WITH 70470 COMPUTED TOMOGRAPHY HEAD/BRAIN WITHOUT AND WITH
More informationFDG-PET value in deep endometriosis
Gynecol Surg (2011) 8:305 309 DOI 10.1007/s10397-010-0652-6 ORIGINAL ARTICLE FDG-PET value in deep endometriosis A. Setubal & S. Maia & C. Lowenthal & Z. Sidiropoulou Received: 3 December 2010 / Accepted:
More informationpulmonary metastasis 80EE4727C6037E7F69A9981B7E55A238 Pulmonary Metastasis 1 / 6
Pulmonary Metastasis 1 / 6 2 / 6 3 / 6 Pulmonary Metastasis Metastatic tumors in the lungs are cancers that developed at other places in the body (or other parts of the lungs). They then spread through
More informationPublished Evidence. Hicks C, Foss AJE, Hungerford JL: Predictive power of screening tests for metastasis in uveal melanoma. Eye 12: , 1998
Published Evidence Hicks C, Foss AJE, Hungerford JL: Predictive power of screening tests for metastasis in uveal melanoma. Eye 12:945-948, 1998 245 patients UM screened at diagnosis with FBC, LFT, CXR,
More information