Melanoma - Restaging

HISTORY:
37 year old male with a history of melanoma for restaging PET•CT.

IMAGING FINDINGS:
There are multiple soft tissue FDG avid lesions in the abdomen involving the bowel/mesentery (left flank, mid lower abdomen), porta hepatis region, the right lower quadrant subcutaneous tissue and the right adrenal gland. In the chest, there is increased metabolic activity in the right hilum. Incidental note is made of prior right thoracotomy site with minimal reactive uptake in a posterior rib and adjacent soft tissues. The most active lesions are within the right adrenal gland, a porta hepatis node as well as a soft bowel associated soft tissue mass in the left lower quadrant. A soft tissue nodule associated with distal ileum in the lower pelvis and the right lower abdominal soft tissue subcutaneous nodule have less metabolic activity. Minimal irregular activity within the spine is likely degenerative in nature.

IMPRESSION:
Multiple FDG-avid lesions consistent with metastatic disease

DISCUSSION:
This patient had recurrent melanoma diagnosed by a recent PET and CT scan before coming for reevaluation. Because many of his lesions on PET did not have correlative CT abnormalities, his physicians thought it was necessary to do a combined PET•CT study to get the most accurate assessment (by coregistration) of the extent and location of disease. Unfortunately, this patient had multiple sites of metastatic disease located on his study. The figures show some of these lesions. The main benefit of having the combined modality in this setting is improving the interpreting physician's confidence level about the extent of disease (presence of disease) even when the lesions are subtle or indistinct on CT and then being able to accurately convey the location to the referring physician or surgeon.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center

Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.