First, SUV is the value they place on the radiotracer uptake observed in your tissue based upon a set/normal value (in this case, 1). Values below 5 aren’t usually of great concern, but are worrisome. However, in my case previously, the SUV of my now removed tumor was only 4.3, not much higher than the current value of the most troublesome spot in the pleura.
If you don’t feel like the whole report, you just skip to the impressions section of ANY report and the radiologist gives a synopsis of the findings, sort of in layman’s terms.
Impression 1: you would be hard pressed to ever get a PET scan without any nodal activity. They are your lymph nodes and are always active in fighting off something. With a disease like cancer, you always become suspicious of random nodal activity. The nodes in question are small with very little uptake (1.8 and 2.7), but there location is what is worrisome as well, especially the mediastinal ones (mediastinum is the region defined between your lungs and pretty much from the bottom of your neck to the bottom of your sternum). The key to remember is the comparison to previous scans. It is wonderful that they have not grown at all. It is not wonderful that they were there previously in any extent. Again, comparing a 1.7 x 1 and 2.4 x 1 to previous nodal imaging is minimal in concern as things can and do change all the time with your lymphatics. My question to the good doctor on this impression is if he is concerned or not, and to what degree. What is a normal value of nodal activity when actively fighting of, let’s say, a cold? Is there a cluster of enhanced nodes, or just a few (cluster would possibly indicate infection or a cold of some sort)?
Impression 2: This impression is the most worrisome for me. For those that remember, when I had my surgery for my lung removal, the surgeon took a pleural implant that looked suspicious (in other words, a section of the pleural lining). The pleura is the lining of your lungs – it is a double layered membrane (visceral and parietal pleura) with pleural fluid in between. The main purpose is for friction reduction between your lungs expanding and contracting with each breath against other body parts (the same goes for your heart except it’s called visceral and parietal pericardium with pericardial fluid that does the exact same friction reduction).
Any who, this area has always been a very big concern and is the main reason for 6 months of additional chemo after surgery. The most detectable thing with pleural disease is a pleural effusion – build up of fluid in the pleural space. I see no mention of this but I don’t know how much of my left pleura is still in tact. As far as postoperative inflammatory changes (in other words, you get cut, your body responds in healing via an inflammatory response), I am quite skeptical. However, it was a massive surgery so I am unsure as to how long you can blame post inflammatory response as a cause for remarks on a scan. My questions to Dr. Ravi are as follows: what are his impressions of the mass? with a year from surgery coming up, how long can one expect post inflammatory responses to register any kind of remark on a scan? If he suspects disease, what is the next step?
Impression 3: My thymus has been enlarged and active since the beginning. It is quite common to happen while on chemo. Nothing much to report on this except I am curious as to what the normal physiologic glucose uptake of the thymus is. And is the doctor concerned about this.
This is it in a nut shell. Don’t hesitate to ask any questions because it not only teaches you, it allows me to learn more as well and to take a closer look!
I love you all!