•	Record: ANON
	•	Age: 64 years
	•	Name: ANON
	•	Examination Date: 02/06/2025
	•	Doctor: ANON
	•	Health Plan: ANON
	•	Unit: ANON

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

Technique:
	•	Radiotracer: PSMA-18F
	•	Dose: 7.2 mCi
	•	Uptake Time: 63 minutes

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 iodinated contrast. The study was complemented with CT images of the thorax during maximal inspiration. A venous diuretic (furosemide) was administered before imaging to minimize interference from physiological urinary elimination in pelvic images.

Clinical Context:

Restaging of a 64-year-old oncology patient diagnosed with prostate adenocarcinoma, Gleason 7 (3+4), previously treated with surgery, radiotherapy, and hormone therapy, presenting with increased PSA levels and no suspicious findings in conventional imaging exams.

Findings:

Fusion of molecular (PET) and anatomical (CT) images shows a faint uptake of the radiotracer in a small elongated tissue thickening (~5mm) in the presacral fat (SUVmax of 2.8). Although non-specific, this may represent a parasympathetic ganglion without oncological significance.

Additional PET/CT Findings:

No other PET/CT findings besides physiological distribution and elimination of the radiotracer appropriate for the patient’s age.

CT Findings Without Molecular Expression But Clinically Relevant:
	•	Prostatectomy performed, with no expansive lesions in the surgical bed.
	•	Bone structure without suspicious changes.
	•	Increased heart size.
	•	Small to moderate pericardial effusion.
	•	Small bilateral pleural effusion.
	•	Interstitial changes in the periphery of both lungs.
	•	Coronary calcifications.
	•	Small hypodense lesion in the cortex of the middle third of the right kidney, likely a cyst.
	•	Bilateral inguinal hernia, larger on the left, containing fluid.

Impression:
	•	The PSMA-positive finding in the presacral fat is non-specific and may represent a parasympathetic ganglion.
	•	Clinical follow-up is suggested at the physician’s discretion.
	•	No other PSMA-hyperexpressing findings suggestive of malignancy were detected.

Comments:
	1.	The standardized uptake value (SUV) should be cautiously interpreted regarding its diagnostic significance and should always be correlated with clinical and laboratory data. SUV values may vary depending on equipment and study protocols.
	2.	The CT performed as part of PET/CT follows a specific protocol and does not replace a dedicated diagnostic CT study.