Hello Sir,a
My wife has Hodgkin disease now. Today PET-CT Scan for the whole body was done. I am furnishing hereunder the details of the report and also was here mentioning below the reports of PET-CT before starting chemotherapy i.e., on 30/1/2015 and the review PET-CT report after undergoing 6 cycles of ABVD chemotherapy held each fortnight i.e., after IIIB chemo sessions for your kind perusal.
CT FINDINGS on 26/05/2015:
BRAIN: Normal
NECK:
-Few lymph nodes noted in both sides of neck at levels Ib,II&IV,largest of 6X6mm-S/o residual nodes.
-Naso ,oro,hypo-pharynx and larynx are normal.
Chest :
-Few small lymph nodes noted in both axillae, largest of 9X5mm- S/o residual nodes.
-Few lymph nodes noted in pretracheal and subcarnial regions, largest of 23X12mm - S/o residual nodes.
-Rest of the lung fields are clear.
-Chest Wall is normal.
- No pleural effusions.
ABDOMEN:
-Spleen mildly enlarged in size.
-Multiple small lymphnodes noted in preaortic, paraaortic, aortocaval, precaval regions and in small bowel mesentery, largest 10X6mm- S/o residual nodes.
- Liver, gallbladder, Kidneys,pancreas, uterus and ovaries are normal.
-No free fluid in the abdomen/pelvis.
BONES:
-No demonstrable lytic lessions.
CT FINDINGS ON 30/1/2015:
BRAIN: Normal
NECK :
-Left level Ib& bilateral level II to VI cervical nodes,largest measuring 2.8cm
-Naso ,oro,hypo-pharynx and larynx are normal.
Chest :
-Bilateral supraclavicular,right axillary,pleural,prevascualr,pre/paratracheal,bilateral hilar,subcarnial&cardiophrenic nodes, largest measuring 5X3.2cm.
-Patchy consolidation in right middle lobe& multifocal well-defined nodules in right lung,largest 15X9mm-Lymphomatous infiltration.
ABDOMEN:
-Enlarged liver& spleen with evidence of multifocal hypodense lesions in spleen largest measuring 3X2.1cm-splenic deposit.
-Gastro hepatic,periportal, retroperitoneal, splenic hilar, bilateral common & Internal & left exernal iliac nodes. Largest discrete node measuring 2.5cm.
-Uterus & ovaries are normal.
-Gall bladder, kidneys, pancreas are normal.
-No free fluid in the abdomen/pelvis.
BONES:
-No demonstrable lytic lesions.
PET FINDINGS ON 26/05/2015:
-Normal physiological 18F-FDG tracer uptake is seen in brain,pharyngeal tonsils, vocal cords,myocardium,liver,gut,kidneys and urinary bladder.
-No abnormal 18F-FDG tracer uptake is noted anywhere in the entire torso including in the radiologically detected small nodes in the cervical, axillary, mediastinal & abdominal region.
-No other abnormal FDG avid lesion is seen on whole body survey.
PET FINDINGS ON 30/1/2015:
-Normal physiological 18F-FDG tracer uptake is seen in brain,pharyngeal tonsils, vocal cords,myocardium,liver,gut,kidneys and urinary bladder.
-Abnormal increased 18F-FDG tracer uptake is noted in :-
-Multiple bilateral cervical nodes, bilateral supraclavicular nodes, right axillary nodes.
-PreVascular,pre/paratracheal, bilateral hilar,subcarnial & cardiophrenic nodes.
-Multiple nodules in both the lungs.
-Multiple hypodense lesions in spleen.
-Gastro hepatic, periportal, retroperitoneal,splenic hilar, bilateral common & internal & left external iliac nodes.
-Foci of increased FDG uptake noted in sacrum,lumbar vertebra(L1,L4,L5) and left frontal skull.
-No other abnormal FDG avid lesion is seen on whole body survey.
IMPRESSION ON 26/5/2015:
1.Scan doesnot reveal any abnormal hypermetabolic lesion anywhere in the entire torso.
2.Mild Splenomegaly.
3. Only non FDG- avid small nodes noted in the cervical,axillary, mediastinal & abdominal region.
4. No other evidence of metabolically active disease in present whole body scan.
5.Compared to previous PET-CT scan done on 30.1.2015,cervical axillary, mediastinal and abdominal nodes has significantly decreased in number & size. There is evidence of complete metabolic response.
IMPRESSION ON 30/1/2015:
1.Hypermetabolic multiple lymphnodes at various stations above and below diaphragm as described noted.
2. Hypermetabolic multiple hypodense splenic lesions as described noted.
3. Foci of hypermetabolic noted in above mentioned skeletal sites with no corresponding CT detected lesions as described noted- Likely marrow involvement.
4.Hypermetabolic multiple lung nodules in both lungs as described noted.
5.Overall PET-CT findings are consistent with lymphomatous involvement.
6. No other evidence of metabolically active disease in present whole body scan.
You are requested to kindly compare the above PET-CT reports held on two different dates and interpret whether the patient needs to still undergo the chemotherapy sessions, if so what is the most likely number of chemo sessions that are required. Is the disease still active?? What are the precautions that are needed to be taken in this condition?
Awaiting for reply,
