Clinical case - Improvement in staging accuracy

Who we are

Doctor Renée Ahond-Vionnet
Senior Clinical lecturer in Nuclear Medicine Department

Centre Hospitalier De Nevers, Nuclear Medicine Department Nevers, France

The nuclear medicine department of CH NEVERS, France, led by Dr Ahond-Vionnet, has 2 Gamma-Camera systems (one double-head Millenium MG and one hybrid Infinia Hawkeye4).

Since April 2008, the department is equipped with a GE PET/CT Discovery RX with Motion Free and PET VCAR applications.

This PET/CT system helps clinicians to improve diagnostics and therapy follow-up of patients with cancerous lesions.

Thanks to Motion Free, we help radiotherapy physicists and physicians to define more accurately the irradiation dose and volume for RT planning.

Patient History

Male - 67 years old - 182cm - 78kg

Excision of adenopathies 6 months ago. The PET acquisition pointed out numerous adenopathies with a pulmonary suspicion.

Last CT exam from May 2007 revealed the 2 left cervical adenopathies with two round right nodules intra-parenchymatous in the middle lobe.

No chemotherapy or radiotherapy for the past 6 months.

Acquisition

Scanner: GE Discovery RX

PET acquisition: Whole-body then dedicated Head & Neck acquisition

  • 3D acquisition
  • Whole-body PET – 1 min30 /bed - VUE Point reconstruction
  • Head & Neck acquisition: one bed position - VUE Point HD reconstruction
  • Post-injection time: 1h
  • Dose: 274 MBq of 18F-FDG

CT acquisition: Head & Neck acquisition

  • Detector configuration: 16 x 1.25 mm
  • Slice thickness : 1.25mm
  • kVp : 120 ; mA : 80

Findings

Fused coronal views of the jugular – carotid chains

                    

No uptake separation                  Small anterior uptake seen using VUE Point HD
using VUE Point

Fused axial view – VUE Point HD

Neck: individualization of five high jugular-carotid chains uptakes located in the area III and IV. The lowest and inferior uptake shows the existence of a very small anterior uptake.

Thorax: high anterior-mediastinal uptake

Lungs: No uptake in the two nodules described on the diagnostic CT

Conclusion

Confirmation of high uptakes on the left jugular-carotids chains on the areas III and IV. Using VUE Point HD provides more accurate diagnosis improving the clinician’s staging confidence.

No abnormal uptakes of 18F-FDG on the lungs area.