History:  A 72 year old man who, on routine follow-up for his Crohn's disease, was found to be more anemic than usual.  This led to follow-up with additional testing which revealed an elevated protein and the serum protein electrophoresis revealed the diagnosis of multiple myeloma.  He was started on high-dose Decadron and thalidomide therapy.  He was later referred for stem cell transplantation.

Family and Social History:  The patient has been married for 50 years.  The patient has three children.  the patient is retired from the Air Force and works part-time in real estate.  The patient enjoys fishing and doing outdoor activities with his grandsons.  The patient smokes 1-2 cigars a day, 1-2 drinks a day before dinner.  No drug abuse.

The anemia may be partially related to current disease given the iron deficiency on top of anemia of chronic inflammation due to the Crohn's disease.  The patient has a chronic abscess that was evaluated by an infectious disease physician prior to the stem cell transplant.  It was agreed that the patient was physiologically stable to proceed with melphalan therapy with prophylaxis with KGF, Invanz, oral Levaquin, oral Flagyl, acyclovir, fluconazole, and close monitoring of C-reactive protein.

COMBINED PET CT SCAN

RADIOPHARMACEUTICAL: 16.52 mCi F-18 FDG administered in the left antecubital fossa.

COMMENTS: The patient's blood sugar at time of injection was 111 mg%. The patient's height is 5 feet 11 inches and weight is 185 pounds.

PROCEDURE: Following injection of the radioisotope, imaging was performed from the top of the head to the hips. 90 minutes following injection of the radioisotope, emission and transmission imaging was performed with attenuation correction. Correction was also performed for random events. Iterative reconstructions were performed with axial, coronal and sagittal reconstructions, as well as with 3D volume rendering. Emission imaging of the lower extremities was performed from the hips to the toes, also with axial, coronal and sagittal reconstructions with 3D imaging. A noncontrast, nondiagnostic CT was performed for attenuation correction and anatomical localization purposes only.

REVIEW OF PREVIOUS EXAMINATIONS: A prior PET CT done on 11-29-05 showed mild homogeneous FDG uptake in the red marrow with an SUV of 1.6 based upon lean body mass. No focal lesions or extramedullary disease was seen. The patient had sinusitis and a persistent right pericolic abscess.

An MRI of the brain, spine, sternum, and pelvis dated 11-30-05 showed an iso- to hyperintense marrow on STIR weighted images. There was right maxillary and right ethmoid sinus disease. No new focal lesions were seen.

CURRENT PET CT SCAN FINDINGS: There is mild heterogeneous FDG uptake in the red marrow with an SUV of 1.6 based upon lean body mass, unchanged since the prior study.

No focal lesions are seen on today's study. No extramedullary disease or infection is seen.

On CT, there is one osteolytic lesion faintly seen in the thoracic spine.

Also noted on CT is right maxillary sinus disease without increased FDG uptake. The patient has a right central line which is in place. Degenerative changes are also noted.

Also noted is a persistent right pericolic abscess. The SUV today is 2.6 where previously it was 3.0. This is improved since the prior study.

IMPRESSION:
1. MILD HETEROGENEOUS FDG UPTAKE IN THE RED MARROW WITH AN SUV OF 1.6 BASED UPON LEAN BODY MASS.
2. NO FOCAL LESIONS ARE SEEN.
3. THERE IS NO EVIDENCE OF EXTRAMEDULLARY DISEASE OR INFECTION.
4. PERSISTENT PERICOLIC ABSCESS WHICH HAS SHOWN INTERVAL IMPROVEMENT ON TODAY'S STUDY. (may actually represent a blind loop of bowel - this will be closely monitored)

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Images courtesy of University of Arkansas for Medical Sciences Dept of Nuclear Medicine.