Symbia T6 SPECT•CT Imaging in a Patient with Prostate Carcinoma
Detection of mesenteric metastases
Partha Ghosh, MD
Case data provided by MD Anderson Cancer Center, Orlando, Fla., USA
A 74-year-old male with prostate cancer treated with prostatectomy seven years ago presented with gradual increase in PSA. He was diagnosed with prostate cancer in 2002 with Gleason score of 8 and PSA of 5.3 and underwent prostatectomy followed by external beam radiation. PSA decreased to undetectable levels following therapy with recent increase to a level of 6.6 ng/ml. Patient was referred for immunoscintigraphy with radiolabelled monoclonal antibody for evaluation of possible pelvic recurrence.
Study shows multiple focal uptake of labeled antibody in the abdomen localized on CT to subcentimeter lymph nodes in the mesentery which suggest mesenteric nodal metastases. Contrast CT also demonstrates several small retroperitoneal nodes which are not ProstaScint® avid. Small cyst in the right lobe appears to be a benign hepatic cyst. The final conclusion was of multiple mesenteric metastases from prostate carcinoma without pelvic or skeletal metastases.
The study demonstrates the dramatic improvement in image quality, integrated contrast CT coregistration capability and diagnostic confidence has been achieved with the current generation SPECT•CT with integrated multislice diagnostic CT (Symbia T6 in this example). The accurate delineation of small mesenteric metastases in spite of low 111In ProstaScint uptake reflects the improved detector sensitivity, high image quality achieved by 3D iterative reconstruction as well as accurate diagnostic CT-based attenuation correction.