Needless to say this patient presented to our department with late stage melanoma. A new lung nodule had presented itself on the right lung from a chest x-ray and a PET/CT study was ordered and performed according to departmental protocol.
The patient has had extensive surgery to remove the melanoma from the lower back, along with excision of lymph nodes. The patient also had a previous bout Bowen's disease over the right breast with further metastasis to the left axillary nodes. Upon follow up with the medical oncologist, post surgery, a chest x-ray was performed and it noted a right solitary lung nodule.
The PET/CT was performed and the following images demonstrate extensive and diffuse metabolically active metastatic adenopathy, as well as skeletal, pulmonary, liver, splenic and small bowel metastases.
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| Fig. 1 Multiple foci of metabolic activity of F18-FDG |
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| Fig. 2 Sagittal fused image of the patient, noting multiple F18 FDG uptake in the spine |
At our facility for indications of single pulmonary nodule (SPN) or for non small cell carcinoma (NSCLC) we normally scan from the top of the head to mid thigh. If they have had a previous MRI of the head to determine brain metastases, then we will scan from the base of the skull to mid thigh. However in this case, the patient has had a previous history of melanoma, we decided to scan from the top of the head to their feet. This is our normal protocol with regards to melanoma patients. Basically we performed our melanoma protocol on the patient referred for a lung indication.
Generally it takes about 30-35 minutes to scan from the top of the head to their feet depending on the height of the patient. Considering that our PET/CT is an old Seimens Biograph with a 2 slice CT, it does take up a bit of time with respect to the CT acquisition. In addition to this, we do not have the the time of flight (ToF) capabilities to decrease our acquisition times of our PET. However, we are replacing our Biograph with a new machine, since the 2 slice Biograph has come to the end of life for servicing. Anyone interested in a PET/CT unit for training or for a back up?
Generally it takes about 30-35 minutes to scan from the top of the head to their feet depending on the height of the patient. Considering that our PET/CT is an old Seimens Biograph with a 2 slice CT, it does take up a bit of time with respect to the CT acquisition. In addition to this, we do not have the the time of flight (ToF) capabilities to decrease our acquisition times of our PET. However, we are replacing our Biograph with a new machine, since the 2 slice Biograph has come to the end of life for servicing. Anyone interested in a PET/CT unit for training or for a back up?
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