Case Author(s): Akash Sharma, M.D. and Farrokh Dehdashti, M.D. , September 17, 2004 . Rating: #D3, #Q4
Diagnosis: Diffuse bony metastatic disease (involving the clivus/skull base)
Brief history:
67 year old woman with prior malignancy admitted to an outside hospital with high fevers, right otalgia, and dizziness.
Images:
Coronal Images
View main image(pt) in a separate image viewer
View second image(pt).
Selected axial images PET
View third image(pt).
Selected fused PET-CT images
View avi cine image (.2 meg)
Full history/Diagnosis is available below
Diagnosis: Diffuse bony metastatic disease (involving the clivus/skull base)
Full history:
67 year old woman who underwent treatment for breast cancer with chemotherapy was subsequently diagnosed with Hodgkin's disease. The patient received further treatment for Hodgkin's disease. She was subsequently admitted to an outside hospital in January, 2004 with high fevers, right otalgia, and dizziness. After her treatment, her constitutional symptoms did not resolve. Evaluate for recurrent Hodgkin's disease.
Radiopharmaceutical:
F-18 FDG i.v.
Findings:
Multi-planar PET-CT images demonstrate diffusely increased uptake in the bone marrow with uptake in the region of the clivus. On non-contrast CT images, the patient has evidence for prior bilateral mastectomy. Axillary clips suggesting prior lymph node dissection are noted.
Discussion:
Diffusely increased uptake in bone marrow can often be seen in patients who present for restaging evaluations. The differential diagnosis for diffuse uptake is quite narrow. While the possibility of recurrent or metastatic disease in the bone marrow should always be considered, it is important to find out whether the patient is (or recently has been) on bone marrow stimulating agents.
Many patients who undergo chemotherapy also receive bone marrow stimulating agents. In that setting, bone marrow will often show increased uptake on a PET study. Thus, a delay of three to four weeks after completion of treatment with short acting bone marrow stimulating agents or longer for long acting bone marrow stimulating agents is recommended.
Reference:
Mayer D, Bednarczyk EM. Interaction of colony-stimulating factors and fluorodeoxyglucose f(18) positron emission tomography.
Ann Pharmac. 2002 Nov;36(11):1796-9. Review.
Sugawara Y. Zasadny KR. Kison PV. Baker LH. Wahl RL. Splenic fluorodeoxyglucose uptake increased by granulocyte colony-stimulating factor therapy: PET imaging results. J Nucl Med 1999; 40:1456-62.
Sugawara Y. Fisher SJ. Zasadny KR. Kison PV. Baker LH. Wahl RL. Preclinical and clinical studies of bone marrow uptake of fluorine-1-fluorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy. J Clin Oncol 1998; 16(1):173-80.
Followup:
Patient underwent a biopsy of her iliac bones which revealed the diagnosis recurrent Hodgkin's lymphoma
View followup image(mc).
Extensive bone marrow involvement by lymphoma
ACR Codes and Keywords:
References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Skeletal System, Category:Neoplasm, Neoplastic-like condition)
Search for similar cases.
Edit this case
Add comments about this case
Return to the Teaching File home page.
Case number: pt116
Copyright by Wash U MO
