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Nucs Board Review > Oral Exam - Oncology > Flashcards

Oral Exam - Oncology Flashcards

1
Q

Poorly FDG-avid breast cancers

A

Lobular or tubular carcinoma
○ Typically low FDG uptake 2° to low-grade tumor
○ With aggressive behavior, mays how ↑ FDG uptake

DCIS
○ Variable linear/branching areas of FDGuptake

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2
Q

Primary malignant breast cancer

A

PET/CT
○ Sensitivities reported inrange of 79-90% ;specificity74- 80%
○ 5-7mm lesions routinely detected, especially if prone PET/CT used

PEM
○ Breast-specific imaging device
○ Optimized for small body parts,with higher sensitivity
than PET (1-2 mm for PEM; 4-6 mm for PET)
○ SensitivitycomparabletoMRandhigherthanPET(93%
vs. 68%)

MBI/BSGI
○ Emerging technology
○ Breast-specificimagingdevice
○ Achievegreaterresolutionbydecreasingdeadspace
between breast and imaging surface

Tc-99m MIBI
○ No longer used due to inferior results compared to PET/CT
Sensitivityof 76-90%; poor sensitivity(<50%) for smallor low-grade malignancies
– Lesion uptake dependent on increased blood flow,
mitochondrial activity and concentration in tumor

Thallium(Tl)-201
○ No longer used due to higher sensitivity with modalities
listed above
○ Poor sensitivity for lesions < 1.5 cm (40-60%)
○ Poor sensitivity for low-grade malignancy

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3
Q

Ddx breast abnormality

A

Benign breast lesion
Infection/inflammation
Trauma/surgery
Lactation

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4
Q

Brain mets - hypermetabolic on PET

A

Lung, breast, colorectal, head and neck, melanoma, thyroid

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5
Q

Brain mets - hypometabolic on PET

A

Mucinous, adenocarcinoma, renal cell carcinoma

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6
Q

Brain met ddx on PET

A

Abscess
INfarct
Primary brain tumour - benign or malignant
Epilepsy

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7
Q

Radiation necrosis vs tumour progression on Brain

A

Low uptake favors radiation necrosis or low-grade tumor

Thallium-201 or Tc-99m sestamibi SPECT
○ Radiation necrosis typically shows decreased uptake
○ Recurrent glioma typically shows increased uptake

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8
Q

Melanoma - most common mets

A 
○ Skin, subcutaneous tissue, and lymph nodes: 50-75% 
○ Lungs: 70-87%
○ Liver: 54-77%
○ Brain: 36-54%
○ Bone: 23-49%
○ GI tract: 26-58%
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9
Q

Timing of esophageal PET

A

Indicated to evaluate response to therapy
○ After neoadjuvant therapy, prior to surgery
○ Should be done 5-6 weeks after completion of therapy
• Indicated to detect recurrence
○ High sensitivity for detection of localre current tumoror
regional nodal disease

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10
Q

Ddx esophageal malignancy on PET

A

Esophagitis - infectious or inflammatory
Intramural primary esophageal tumour
Metastatic or adjacent tumour

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11
Q

Esophageal primaries that are FDG avid

A

Adenocarcinoma (Barret, reflux, motility disorders) and squamous cell carcinoma (smoking, alcohol) are F- 18FDG avid

□ F-18 FDG uptake in squamous cell carcinoma >
adenocarcinoma

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12
Q

Esophageal node evaluation

A

– Does not allow reliable differentiation between N0 and N1 disease, due to intense uptake by primary lesion masking adjacent metastatic nodes
– Regional nodes are considered to be cervical to celiac stations
– T1-T3±N+ are resectable

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13
Q

Ddx abnormal gastric FDG activity

A

Gastric Carcinoma

Gastric GIST

Physiologic - low level activity, non-focal

Gastritis/gastric ulcer - mild to moderate uptake

Gastric lymphoma - usually diffuse invovlement with adenopathy

Crohn’s - rarely affects stomach

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14
Q

Metastatic spread of CRC

A

Lymphatic (mostcommon) spread follows major venous outflow from involved segment
□ Colon - pericolic nodes, then superior and inferior mesenteric nodes
□ Upper rectum drains to superior rectal nodes, then
inferior mesenteric nodes
□ Lower rectum followssamedrainagepatternas
upper rectum and also middle rectal nodes, then
internal iliac nodes

Hematogenous spread
□ Via portal system to liver (most common site for distant metastases)
□ Lung

Peritoneal spread
□ Direct peritoneal seeding→peritoneal carcinomatosis

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15
Q

Salivary gland tumours and PET

A

F-18FDG PET/CT
○ Cannot reliably differentiate benign vs. malignant
salivary gland neoplasia
○ Hypermetabolic lesions on F-18FDGPET/CT have~30%
false-positive rate for malignancy (mostly due to high
uptake in Warthin tumor)

Any incidentally detected salivary gland neoplasm should
be evaluated by otolaryngology, whether cold, warm, or hot

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16
Q

Ddx salivary gland lesion

A

○ Parotid carcinoma (most common site of salivary gland
cancer) - different cell types, almost always FDG avid

○ Benign mixed tumors/pleomorphicadenoma - less FDG avid than malignancy or Warthin

○ Warthin tumor - positive on FDG and Tc99 pertechnetate SG studies; smoking history; often multiple

○ Primary lymphoma

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17
Q

SCC of head and neck locations

A

Nasopharynx, larynx, hypopharynx, oralcavity,

oropharynx, nasal cavity, paranasal sinuses, salivary glands, thyroid gland, and unknown primary

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18
Q

SCC of head and neck - PET findings

A

○ Best diagnostic clue
– Intensely FDG-avid, enlarged or necrotic lymphnodes (LNs) in neck on F-18 FDG PET/CT

Location
– Look for primary lesion along mucosal surfaces and
evidence for nodal or distant spread
– LN metastases in expected drainage pattern based on
primary tumor location
– Commonly involves base of tongue, tonsils, or
adenoids

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19
Q

SCC head and neck protocol advice

A

○ Scan with arms down on F-18FDG PET/CT to avoid beam
hardening artifact; use neck immobilization device

○ F-18 FDG PET/CT is superior to conventional imaging
modalities for radiation treatment planning, allowing for improved tumor coverage and sparing of normal tissues

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20
Q

SCC lymph nodes ddx

A

Inflammatory - dual time imaging at 3-6 hours helpful. CA retains more FDG for longer than inflammatory tissues.

Thyroid or Melanoma metastases

Abscess

Lymphoma - associated mucosal lesion or necrotic nodes favours SCC met

Brown fat - Measure HU usingCT; diagnostic if HU measure -50 to -150

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21
Q

Head and Neck lymph nodes

A

Level 1A = submental
Level 1B = submandibular
Level 1 drains anterior oral cavity, lip, sinonasal

Level 2A/2B
Inferior margin of hyoid, posterior margin submandib, SCM muslcles
Level 2 drains Oropharynx, posterior oral cavity, supraglottic larynx, and parotid gland

Level 3
Inferior margin of hyoid, inferior margin of cricoid

Level 4
Inferior margin of cricoid, clavicle
Drains subglottic, thyroid, and cervical esophagus

Level 5
Posterior border of SCM,clavicle; VA/VB inferior margin of cricoid
Drains nasopharynx, skin (neckor occipital scalp)

Level 6
Medial margins of carotid arteries, inferior margin of hyoid, superior aspect of manubrium
Drains subglottic, thyroid, and cervical esophagus

Level 7/superior mediastinal
Superior aspect of manubrium, innominate vein

Supraclavicular nodes
At or caudal to level of clavicle and lateral to medial edge of carotid arteries

Retropharyngeal nodes
Within 2cm of skullbase medial to carotid arteries

Parotid nodes
Primary drainage site: Skin of scalp, orbit, and
nasopharynx

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22
Q

HCC PET performance

A

□ Uptake in small tumors difficult to visualize on F-18
FDG PET/CT because of physiological F-18 FDG
uptake

□ Well-differentiated HCC isointense to liver on F-18
FDG PET/CT (low GLUT1 and high G6Pase
expression); higher SUV if poorly differentiated

□ Variable uptake with intrahepatic CCA

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23
Q

DDx liver lesion on PET

A 
Met
Abscess
HCC
Cholangiocarcinoma
GB CA
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24
Q

Hodgkin’s lymphoma - time to wait before PET

A

○ 6-8 weeks after chemotherapy or surgery
○ 8-12 weeks after radiation therapy
○ 2-4 weeks after (G-CSF)

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25
Q

Interim or post-therapy PET/CT: Deauville criteria

A

– Grades the most intense uptake (SUV) in initial site of disease on interim or end-of-treatment PET/CT
– 1: No uptake
– 2: Uptake ≤ mediastinal bloodpool
– 3: Uptake > mediastinal blood pool but ≤ liver
– 4: Uptake moderately higher thanliver
– 5:Uptakemarkedlyhigherthanliver&/ornewlesions
– X: New areas of uptake unlikely to be related to
lymphoma

○ Score of 1 and 2: Complete metabolic response (CMR)
○ Score of 3: Likely a CMR

Score 4 and 5: Residual hypermetabolic disease

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26
Q

Ann Arbour staging with Lugano modifiers

A

Modifiers
○ A or B: Absence (“A”) or presence (“B”) of B symptoms
○ E: Relevant only for limited extranodal disease in
absence of nodal involvement (IE) or in patients with stage II disease and direct extension to a non-nodal site (IIE)

StageI
– 1nodeorgroupofadjacentnodes(1lymphnode region) (I)

StageII
– 2ormorenodalregionsonthesamesideofthe
diaphragm (II)

Stage IV
– Nodal disease + noncontiguous extranodal
involvement

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27
Q

NHL

A

Hematogenous spread of NHL is unpredictable in
comparison to contiguous spread of HL

Report findings according to Deauville criteria (5-point scale)
– Score 1 and 2: Complete metabolic response (CMR)
– Score 3: Likely CMR
– Score 4 and 5: Residual disease
– Score 5 with no decrease in uptake or new FDG-avid
disease: Treatment failure

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28
Q

FDG avid NHL

A

Diffuse large B-cell DLBCL, Burkitt lymphoma,
anaplastic large cell, natural killer/T-cell, high-grade
follicular, adult T cell, peripheral T cell

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29
Q

Low grade minimally FDG avid lymphoma

A

– Chronic lymphocytic leukemia/small lymphocytic
(CLL), Waldenström macroglobulinemia, cutaneous T cell (mycosis fungoides), marginal zone (MZL), mantle cell, low-grade follicular

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30
Q

Carcinoid syndrome

A

Flushing, diarrhea, telangiectasia, and asthma

Secretes serotonin, which is metabolized to 5-
hydroxyindoleacetic acid (5-HIAA)
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31
Q

Lab values to check in NET

A

Elevated serum chromogranin A (sensitivity80%)

Elevated 24-hour urinary 5-HIAA

High Ki-67 implies worse survival

Number of mitoses/HPF

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32
Q

NET imaging

A

Somatostatin receptor imaging (SRI)
– Indium-111 octreoscan
– High percentage of lesions > 1.5cm positive

□ 4hr: Whole body anterior/posterior planar
optional; consider targeted SPECT based on history
and planar imaging (low bowel excretion then)
□ 24hr: Whole body anterior/posterior planar;
targeted SPECT, SPECT usually best at 24 hours
□ 48hr:Whole body anterior/posterior planar
optional; consider targeted SPECT

□ Image with large FOV at symmetric 20% energy
windows over 173 keV and 247 keV photopeaks of
In-111

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33
Q

NET other imaging options

A

FDG PET or I131 MIBG

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34
Q

Treatment options for NET

A

• Surgery
○ Curative resection of smaller masses
○ Debulk tumor to ↓symptoms and improve survival

  • Systemic chemotherapy with alpha interferon and cytotoxic agents
  • Livermetastases

○ Resection,radiofrequencyablation,cryotherapy,and
chemoembolization
• Somatostatinanalogs

○ Symptomaticblockade,butsubjecttotachyphylaxis

○ Radiolabelled analogs to target metastases

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35
Q

Pancreatic neuroendocrine tumours - octrepotide sensitivity

A

Wide variability in sensitivity by cell type: Gastrinomas typically high, insulinomas often low (50-60%)

36
Q

Pancreatic NET findings

A

○ In-111DTPA-D-Pheoctreotide(Octreoscan):
Radiolabeled derivative of octreotide, binds to
somatostatin receptor (subtypes 2, 5, rarely 3)

○ Determination of somatostatin-receptor status to guide
octreotide therapy
○ Selection of patients with metastatic tumors for peptide
receptor radionuclide therapy (PRRT)

37
Q

Other somatostatin receptor avid tumours

A

Pituitary adenoma; adrenal medullary tumors; paraganglioma; benign and malignant thyroid tissue; Merkel cell; melanoma; carcinoid; small cell lung cancer; non-pancreatic neuroendocrine carcinoma; meningioma; well-differentiated glial-derived tumor; breast, prostate, renal carcinomas; lymphoma, granuloma, infection, and inflammation

38
Q

Ddx pancreatic NET

A

Panc ductal adenocarcinoma
Mucinous or serous pancreatic tumour
Mets

39
Q

Pheo/paraganglioma findings

A

I-123 MIBG scintigraphy
○ Use for occult, ectopic, recurrent, metastatic tumors
○ Patient should discontinue drugs that interfere with
MIBG for 48-72 hrs prior

• F-18FDGPET
○ Sensitivity similar to MIBG, best for malignant pheochromocytoma/paragangliomas

40
Q

Pheo 10% rule

A 
10% familial
10% bilateral
10% malignant
10% in children
10% not associated with HTN

Malignancy diagnosed by presence of metastatic deposits, not by presence of local invasion

41
Q

Ddx pheo/paraganglioma

A

Other neuroendocrine tumours (MIBG + in carcinoma, neuroblastoma, ganglioneuroma)

Adrenal adenoma/myelolipoma - uptake < liver on MIBG/FDG

ACC

Adrenal mets

42
Q

Pheo or paraganglioma associations

A 
MEN IIA/IIB
NF
VHL
TS
SW
43
Q

Medullary thyroid CA findings

A

• Somatostatin receptor scintigraphy
○ Uptake in solid, usually well-circumscribed mass in
thyroid gland; ± calcifications; nodal and distant
metastases

• F-18FDGPET/CT:Sensitivity70-100%,specificity79-90%

• Tc-99m sestamibi or tetrofosmin scintigraphy: Sensitivity
25-40%, specificity 100%

• Not iodine avid: Scanning and treatment with radioiodine not effective

44
Q

Ddx medullary thyroid CA

A

Follicular adenoma
MNG
Parathyroid adenoma
Papillary/follicular thyroid CA

45
Q

Ovarian CA findings

A

○ FDG PET/CT
– FDG-avid ovarian mass (SUV>3)
– ± hypermetabolic lymphadenopathy, diffuse
peritoneal involvement
– ± distant metastases (usually liver/lung) or malignant
pleural effusion

– PET has difficulty with differentiation of benign vs.
malignant w/ borderline elevated SUV
– Physiologic uptake of ovary is highest in early
secretory phase, best to image just after menstruation to

46
Q

Cervical CA findings

A

○ FDG PET/CT
– Intense FDG activity in primary cervical mass
– Variable uptake in uterus, vagina, and parametria,
depending on spread
– Pelvic and paraaortic FDG-avid lymphadenopathy
– Distant metastases in lung, liver, bone

47
Q

Prostate mets

A

Metastases are usually axial, then follow distribution of
red bone marrow
○ Vertebra and rib involvement common due to tumor cell
dissemination from prostate through Batson venous plexus

• Uptake on Tc-99m MDP bone scan has low specificity for metastatic disease when PSA < 10 ng/mL in patient not on antiandrogen therapy

□ Recommended for symptomatic patients or
asymptomatic patients at risk for occult metastases

□ Patients considered at risk for occult metastases
include those with PSA > 20 ng/mL or PSA > 10 with
T2-T4 primary or Gleason score > 8

48
Q

Malignant pleural mesothelioma

A

F-18 FDGPET/CT
○ Directs biopsy to hypermetabolic pleuralplaques
○ Most complete staging when compared with CT
○ Hypermetabolic pleural masses &/ or pleural rind with
associated pleural effusion
○ Canbeassociatedwithhypermetabolicevidenceof
direct invasion or distant metastatic disease

49
Q

Malignant pleural mesothelioma ddx

A

Inflammatory - absbestos, talc, organized empyema

Other neoplasms - mets, fibrous pleural tumour, lymphoma

50
Q

NSCLC ddx

A

• Granulomatous disease
○ Symmetrical mildly FDG-avid hilar & mediastinal nodes

• Pneumonia
○ FDG uptake can be high, but more rapid temporal
change

• Mediastinal mass
○ Consider small cell lungcancer, lymphoma

• Hamartoma
○ Typically low FDG activity, popcorn calcification

• Pulmonary infarct
○ FDG uptake as great as with lung cancer

• Carcinoid
○ MaynotbehighlyFDGavid

• Small cell carcinoma
○ Requires biopsyt odifferentiate

51
Q

NSCLC cell types

A

○ Squamous cell carcinoma, large cell carcinoma,
adenocarcinoma, and adenocarcinoma in situ

• Best diagnostic clue
○ Irregular mass in bronchus or lung parenchyma
– Squamous cell carcinomas tend to be more central in location
– Adenocarcinomas tend to occur more peripherally
– Large cell carcinomas tend to be peripheral

52
Q

False - PET for NSCLC

A

Tumor with low metabolic rate (low-grade
adenoCA, adenocarcinoma in situ, carcinoid), tumor < 10 mm, “stunned” tumor post therapy, high serum glucose (competition)

53
Q

Associated findings NSCLC

A

Recurrent laryngeal nerve: Hoarseness

Superior vena cave syndrome

54
Q

Small cell lung CA findings

A

○ Hilar mass with bulky mediastinal adenopathy
○ Often infiltrates submucosa, obstructs bronchus
○ May have small primary tumor

55
Q

Thymoma/thymic carcinoma findings

A

○ Thymoma
– Low-risk thymoma: TypesA, AB, and B1
– High-risk thymomas: Types B2 and B3

○ Thymic carcinoma

  • Higheruptake of F-18 FDG with thymic carcinomas in comparison to thymomas
  • Thymic carcinoma has more heterogeneous uptake
  • Thymic rebound may have increased F-18 FDGuptake
56
Q

SPN ddx

A 
FDG positive: 
Malignant 
- Primary lung
- Metastases
- Lymphoma

Benign
Infection
Inflammation (sarcoid, RA, granulomatosis with polyangitis)
Round atelectasis

Variable to low FDG uptake
Malignant
- Primary lung (adencarcinoma spectrum, carcinoid)
- Mets (mucinous adenocarcinoma, RCC, prostate, hepatocellular)

FDG negative
Inactive granulomatous disease
Hamartoma
AVM

57
Q

Papillary and follicular thyroid Ca findings

A

I-123 whole-body scan
○ I-123 localizes to thyroid tissue that transports and
organifies iodine
○ Detects thyroid remnant, lymphadenopathy, and distant
metastatic or recurrent disease
○ 159 keV gamma rays more optimal for LEAP collimators
○ Physiologic uptake in salivary glands, stomach, lactating
breasts
○ Renal excretion

I-131 whole-body scan
○ I-131 is gamma (364 keV) and beta (0.606 MeV) emitter
○ Higher radiation burden as compared to I-123
○ Possible risk of thyroid stunning prior to I-131ablation
due to high-energy beta
○ Imaging characteristics not as good as I-123

F-18 FDG PET/CT
○ Uptake of radioactive glucose analogue into thyroid
tissuethrough GLUT1 transporter
○ Can be used to evaluate patients with tumors that are
not iodine avid and have elevated thyroglobulin levels (>
10 ng/mL)

Tc-99m MDP bone scan
○ For skeletal survey if bone metastases suspected

58
Q

Thyroid procotol

A

TSH stimulation
□ Thyroid hormone withdrawal for 3weeks (goal TSH
> 30 mU/L)
□ Thyrogen stimulation: Thyrogen (human recombinant TSH) stimulation with 0.9 mg IM on 2 consecutive days

– Low-iodine diet: Usually followed for 7-14 days to increase uptake of radioactive iodine by thyroid tissue

59
Q

RCC findings

A

Iso or hypermetabolic mass on FDG PET

60
Q

Transitional cell carcinoma

A

F-18 FDG PET/CT
– Focal increased FDG activity in primary tumor, regional
nodes, and distant metastases
– Best for staging and monitoring for recurrenceq

61
Q

Ewing Sarcoma findings

A

• Destructive osseous lesion with associated soft tissue mass
• Femur is single most common site (~ 20%)
• > 85% in pelvis, extremities and ribs
– Long bones
□ Metadiaphyseal > diaphyseal
□ Proximal > distal
– Originate in medullary canal, spread outward

○ Extraosseous ES
– Paravertebral and lower extremity most common

MDP
• Tc-99m MDP bone scan shows increased uptake in tumor in all phases, but is not adequate for local staging (poor sensitivity for “skip lesions”)

• FDG PET/CT
○ Defines primary tumor better than MDP bones can

62
Q

Ewing ddx

A

Other malignant bone primary (osteosarcoma, primary lymphoma)

Osteomyelitis

Benign bone tumours

Fracture

Bone mets (neuroblastoma, rhabdomyosarcoma)

63
Q

PRRT - things to consider

A

Treat with Lu-177 dotatate if Krenning 3-4

Kidneys are dose limiting organs - need to protect with amino acids (inhibits proximal tubular resportion)

Marrow suppression

Liver failure

64
Q

MIBG therapy - considerations

A

Thyroid blockade - SSKI day before, day of, and continue 10-15 days after

Discontinue interfering meds

Slow administration - anaphlyaxis

65
Q

Liver - intra-arterial therapy

A

Yttrium 90 microspheres (non-resectable primary and secondary lesions)

Must assess lung shunt ratio with MAA

  • if < 10%, no reduction
  • if 10-15%, 20% reduction
  • if 15-20%, 40% reduction
66
Q

Neuroendocrine tumour types

A

Adrenal/sympathetic chain:

  1. Neuroblastoma
  2. Pheochromoctytoma
  3. Paraganglioma

Gastropancreatic neuroendocine tumours:

  • Carcinoid, neuroendocrine carcinoma
  • Pancreatic endocrine

Medullary thyroid cancer

Syndromes MEN I, II, VHL, NF

67
Q

Pheochromocytoma biochemical testing

A

Plasma/urine metanephrines

Plasma/urine catecholamines

68
Q

Paraganglioma types

A

Carotid body
Glomus tympanicum - middle ear mass; pulsatile tinnitis
Glomus jugulare -
Glomus vagale

Octreotide or MIBG avid

Ddx always includes meningioma or neuroendocrine tumour met (as both octreotide avid) +/- pituitary adenoma

69
Q

MEN 2

A

2A: MTC, pheo, hyperparathyroidism

2B: MTC, pheo, multiple neuromas

70
Q

Gastropancreatic NETs classification

A

Grade 1 NET: < 2 mitoses/HPF, <3% ki-index
Grade 2 NET: 2-20 mitosees/HPF, 3-20% Ki-index
Grade 3 NET: >20, >20

71
Q

Scintimammography false postive

A

Fibroadenoma

Malignant tumours other than breast CA

72
Q

Blood work carcinoid

A

Chromogranin A levels elevated

5-HIAA levels elevated

73
Q

Other octreotide avid tumours

A 
Carcinoid
Gastrinoma
Glucagonoma
Pheochromocytoma
Neuroblastoma

MTC

Small cell lung cancer
Lymphoma 
Breast cancer
Astrocytoma
Meningioma
Pituitary adenoma
Thymoma
74
Q

FDG prep

A

NPO 4 hrs; ideally 8-12

Blood sugar < 10

75
Q

Laryngeal nerve injury

A

Paralysis/Decreased FDG on that side

Compensatory hypermetabolism on other side

Ddx: malignancy/infection/inflammation on the hypermetabolic side

76
Q

Thallium for brain spect

A

Distinguish radiation necrosis from recurrent disease

Distinguish lymphoma/other malignancy from toxoplasmosis

77
Q

MIBG uptake

A

NB
Pheochromoctyoma
Carcinoid
MTC

78
Q

Pheochromocytoma markers

A

MIBG is not screening test

Need elevated serum or urinary catecholamine levels

79
Q

Benign pelvic uptake FDG in females

A 
CLC
Dermoid cyst
Diverticulitis
Leoiomyoma
Fibroma/thecoma
Ureteric 
Endometriosis
80
Q

Gallium avid tumours

A 
HL
NHL
Melanoma
Sarcoma
Hepatoma
Lung CA

+ sarcoid, infection

81
Q

Diffuse marrow uptake FDG

A

Benign marrow stimulatiomn
Widespread marrow-based tumour
Altered biodistribution

82
Q

Ddx hypermetabolic solitary nodule

A

Primary lung CA
Pulmonary metastases
Inflammation/Infection (TB, histo, sarcoid)

83
Q

Hypermetabolic focus pancreas

A

Panc adenocarcinoma
Focal pancreatitis
Metastasis

84
Q

FDG avid focus parotid gland

A

Primary salivary gland tumour

Focal parotatitis

85
Q

Ddx increased abdominal uptake on octreotide study

A

Neuroendocrine tumour
Other malignancy expressing somatostatin receptors (melanoma, breast)
Inflammatory conditions expressing somatostatin receptors (granulomatous disease)

Nucs Board Review (21 decks)

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