Tuesday, July 27, 2010

Ca lung with right hilar lymphadenopathy


57 year old man presented with haemoptysis. PETCT showed a small primary lung carcinoma with a lung right hilar lymphadenopthy. SUVmax for lung lesion is 7.9 while SUVmax for hilar lesion is 8.5.

Some pointers for lung cancer and PETCT:

PETCT criteria for lung malignancy:
  1. FDG uptake > background mediastinal uptake
  2. SUVmax >2.5
  3. Any activity above background level in lesions <1.5cm
  4. Tumours with low metabolic rate – low grade adenocarcinoma, BAC and carcinoids may not show any FDG uptake or poor FDG uptake
  5. Intense uptake in bone marrow also associated with poorer outcome
  6. Prognostic information from FDG PET: SUVmax >5.0 suggest aggressive neoplasm and poorer prognosis
  7. In determining response to treatment, decrease in FDG avidity by 60% following 2-3 cycles of chemotherapy indicates good response
  8. Some tumours may show falsely decreased SUV post-theapy (‘stunned’) but still represent treat to recurrence
(Blodget)

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