Patient Information:
	•	Name: ANON
	•	Age: 77 years
	•	Examination Date: 04/02/2025
	•	Physician: ANON
	•	Insurance: Private
	•	Facility: ANON

PET/CT - Positron Emission Tomography Associated with Computed Tomography Using PSMA-18F

TECHNIQUE:
	•	Radiotracer: PSMA-18F
	•	Dose: 10.50 mCi
	•	Uptake time: 75 min

Protocol:
Tomographic images from the skull to the upper thigh were acquired using a dedicated PET/CT scanner after intravenous injection of the radiotracer. Diagnostic CT images of the same region were also obtained with intravenous administration of iodinated contrast. The study was complemented with thoracic CT images taken during maximum inspiration. A venous diuretic (furosemide) was administered before imaging to reduce interference from physiological urinary elimination in pelvic images.


CLINICAL CONTEXT:
Patient: 70 years old
Diagnosis: Prostate adenocarcinoma (Gleason 8) with disease progression to the bones.
Current treatment: Under therapy with Zoladex and Zometa.
Past treatments: Chemotherapy until December 17, 2024, and radiotherapy targeted at the right shoulder, completed in December 2024.
Purpose of the PET-CT study: Evaluation of therapeutic response.


DESCRIPTION:

A comparative analysis was performed with the previous PET-CT scan dated September 12, 2024, revealing:
	•	Stability or decrease in radiotracer uptake intensity in some pre-existing bone lesions, including:
	•	Right scapula: SUVmax 12.7 (previously 30.8), associated with increased sclerosis.
	•	Left clavicle: SUVmax 3.6 (previously 9.1).
	•	Anterior left 3rd rib arch: SUVmax 57.5 (previously 71.1).
	•	Increased radiotracer uptake in other pre-existing lesions and appearance of new slightly sclerotic bone lesions, indicating abnormal molecular expression of PSMA:
	•	Right occipital bone: SUVmax 17.4.
	•	Posterior portion of the right 12th rib arch: SUVmax 16.6.
	•	Left iliac crest: SUVmax 60.8.
	•	Lower sacrum (left side): SUVmax 6.2.
	•	New hypermetabolic focus in the left thyroid cartilage (posteriorly): SUVmax 17.8.
	•	Persistent diffuse and heterogeneous hyperuptake in the prostate gland, which remains enlarged (SUVmax 5.4, previously 4.4).


REMAINING PET/CT FINDINGS:
	•	Only physiological distribution and elimination of the radiotracer within the expected range for the patient’s age.


CT FINDINGS WITHOUT MOLECULAR EXPRESSION BUT RELEVANT TO THE CLINICAL CONTEXT:
	•	Bilateral calcified pulmonary nodules associated with calcified para-aortic mediastinal lymph nodes (residual aspect).
	•	Signs of hepatic steatosis, slightly more evident in the current study.
	•	Small simple cortical cyst in the right kidney.
	•	Spinal fusion (arthrodesis) from D12 to L3.
	•	Diffuse vascular calcifications.
	•	Bilateral inguinal hernias.

IMPRESSION:

The bone findings with increased molecular PSMA expression are consistent with malignancy and indicate disease progression compared to the previous study from September 12, 2024.

COMMENTS:
	1.	The Standardized Uptake Value (SUV) should be interpreted with caution when used as an isolated diagnostic parameter. It should be correlated with clinical and laboratory data. SUV values may vary depending on different equipment and study protocols.
	2.	The CT scan performed within the PET/CT study follows a specific protocol for PET imaging and does not replace a dedicated diagnostic CT scan.