Correct!
2. Comparison of the repeat 18FDG – PET scan to previous cross-sectional studies shows increasing nodularity within the anterior segment right upper lobe nodule
Comparing the current 18FDG – PET scan with previous cross-sectional studies suggests that the anterior segment right upper lobe nodule is developing increasing nodularity along its medial aspect. The application of volumetric analysis tended to corroborate this impression. The nodule still does not show significantly elevated tracer accumulation. There is no evidence of cavitation.
Following multiple cycles of hyper-CVAD therapy that had now failed, new approaches to lymphoma therapy were discussed with the patient, including CAR (chimeric antigen receptor) T therapy and BTK inhibitor therapy (interferes with B-cell signaling). The patient was considered not a candidate for stem cell transplant. Therapy with ibrutinib (tyrosine kinase inhibitor) was initiated. The patient was lost to follow up for 2 years, but re-presented 2 years later (7 years following his initial lymphoma diagnosis). New approaches to therapy, given the failure on hyper-CVAD therapy, were again discussed. Repeat 18FDG – PET scan was performed (Figures 11).
Figure 11. Comparison of anterior segment nodule size and metabolic activity over time. (A and B) Axial CT attenuation correction image (A) and 18FDG (B) image at initial diagnosis of lymphoma. (C and D) Axial CT attenuation correction image (C) and 18FDG image (D) obtained 2 years following initiation of therapy. (E and F) Axial CT attenuation correction image (E) and 18FDG image (F) obtained 3 years following initiation of therapy. (G and H) Axial CT attenuation correction image (G) and 18FDG image (H) obtained 5 years following initiation of therapy. (I and J) Axial CT attenuation correction image (I) and 18FDG image (J) at restaging 7 years after initial lymphoma diagnosis. (K-N) Axial CT attenuation correction images (K and L) and 18FDG images (M and N) at restaging 8 years after initial lymphoma diagnosis.
Which of the following represents an appropriate interpretation for this examination? (Click on the correct answer to be directed to the tenth of twelve pages)