These are the official reads of Max’s CT, MIBG & MRI scans last week.
CT HEAD w/ CONTRAST: volume scanning was performed through the entire brain after intravenous contrast adminsitration. Image data were displayed in the axial, sagittal and coronal planes. Comparison is made with examination of 06/10/08. Comparison is also made with non-contrast head CT of 7/14/08. Ventricles remain normal in size. The calcified midline frontal epidural mass consistent with metastic disease to the skull has decreased in size since the examination of 06/10/08 and does not appear to be significantly changed since the more-recent exam. The mass now measures approx 2.6cm in maximum dimension. Appearance of the brain is unchanged. No new intra-axial or extra-axial masses or areas of abnormal contrast enhancement are identified. No abnormality of the brainstem or cerebellum is noted. IMPRESSION: decreased size of frontal epidural mass consistent with metastic disease to the skull. Findings are otherwise unchanged since the previous exam.
CT CHEST w/ CONTRAST: Volume scanning was performed through the entire thorax after intravenous contrast administration. Image data were displayed in the axial, agaittal and coronal planes. Comparision made with exam of 06/10/08. A port-a-cath remains in place with the tip in the right atrium. Previously identified right hilar mass which demonstrates relatively low density has decreased in size. The mass mow measures slightly greater than 1cm in maximum dimension. Calcifications may be present in the right hilar region. No new mediastinal masses are idenitified. Previously identified low-density mass adjacent to the left hemidiaphragm appears to be slightly smaller. However, its location makes direct comparison with the previous exam difficult. An area of increasing atelectasis or air space consolidation is present posteriorly within the right upper lobe. Muliple nodular densities are again noted throughout both lungs which are increased in size since the previous exam and are consistent with metastic lesions. These lesions appear to be slightly increased in size and number since the previous exam. The largest lesion now measure greater than 5mm in diameter. Mulitple sclerotic vertebral lesions are again identified which are consistent with metastic disease and do not appear to be significantly changed. Decreased stature of a mid thoracic vertebral body is again noted. IMPRESSION: increased size and number of pulmonary nodules consistent with increas in metastic disease. Right hilar and left diaphragmatic masses appear to be slightly decreased in size. Multiple thoracic metastases are not obviously changed.
MIBG - A total of 3.1 mCi of iodine 123 MIBG was injected intravenously without complications. This exam is compared to the MIBG exam from 6/11/08. Once again, muliple areas of abnormal uptake are seen indicating metastases. In the skull, the lesion seen in the midline anteriorly has decreased significantly since the previous study. Foci of uptade in the left humerous are somewhat less apparent, however, the focus of abnormal uptake in the right humerous is probably unchanged. Further areas of abnormal uptake are seen in the upper chest, probably in posterior ribs. These are unchanged. In the pelvis continued abnormal uptake is seen in muliple locations in the pelvis fairly diffusely. I do not see any significant changes compared to the previous study. The left proximal tibia is once again hot although it does seem to be somewhat less extensive than previously. There is, however, somewhat more prominent uptake in the right proximal tibia and the proximal right tibial shaft. In the distal femurs bilaterally, there is also somewhat increased uptake compared with the previous study as well. Some abnormal vertebral body uptake is also present. This is essentially unchanged since the previous study. It is somewhat spotty and includes areas of abnormality probably at the level of T11 or T12 and probably in the lower lumbar spine. The whole body images also suggest areas of uptake posteriorly in the skull which are unchanged although, again, the area anteriorly is diminished. Some areas of abnormal uptake have decreased, expecially in the anterior skull. There are, however, increasing areas of uptake particularly around the knees. This probably indicates further metastic disease. Once again noted are abnormal areas of uptake in the left proximal tibia. Additional areas of abnormal uptake are seen in both proximal femurs.
MRI Entire Spine w/and w/o contrast. Comparison to 06/16/08 scan. Technique: Sagittal and axial T1-weighted images, sagittal and axial T2 fat saturated images, and sagittal and axial postcontrast T1-weighted images were obtained. FINDINGS: The bone marrow signal is diffusely abnormal. All levels of the vertebral column appear involved with the exception of the sacrum which may be spared vs. partially involved. Of note, there is no intraspinal abnormality. The spinal cord signal is intact. There are no enhancing masses within the canal. There are no paraspinal soft tissue masses. Of note, many of the vertebral bodies are slightly bowed compared to the prior study which represents multiple vertebral body mild compression not unexpected given the diffuse infiltrative involement of the bone marrow. IMPRESSION: Compared to the prior study, there has been interval onset of multiple vertebral body endplate bowing consistent with mild compression fractures, not unexpected given the diffuse bone marrow infiltration of the vertebral column related to the bone marrow infiltration. There is no obvious interval change in the degree of infiltration compared to the prior study.
