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Daniel Sheibley, MD
Daniel Sheibley, MD, Doctor
Category: Medical
Satisfied Customers: 1834
Experience:  MD Grad Jefferson Medical College 2009. Internal Med intern 2010 & Radiology residency 2011. Husband & father of two.
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If on a pet scan report it states there is a liver lesion ,

Customer Question

If on a pet scan report it states there is a liver lesion , but SUV uptake is not high (ie 2 8), would this still be a metastic lesion. ?
Submitted: 2 years ago.
Category: Medical
Expert:  Daniel Sheibley, MD replied 2 years ago.
Daniel Sheibley, MD :

Hello

Daniel Sheibley, MD :

This would have to be correlated with the scan itself. There are many factors including the patient's blood gluocose level at the time of examination as well as background SUV of the rest of the liver for this to be determined if 2.8 is high enough above background to be considered metastatic

Daniel Sheibley, MD :

2.8 is technically indeterminate

Daniel Sheibley, MD :

The best predictor as to whether this is significant for this patient is comparison of that lesion to the rest of the liver activity - i.e. if the rest of the liver is 1.5 or 2 then no i'd say it is not certain whether 2.8 is indicative of a metastasis.

Daniel Sheibley, MD :

Hello

Customer :

Background liver uptake is 3.4

Daniel Sheibley, MD :

then no a lesion with an SUV of 2.8 (two-point-eight) would not be a metastasis. If you meant 28 (twenty eight) then yes that would be indicative of a metastasis

Customer :

Rafiologist on report stated as a new finding it should b considered metastases

Customer :

But the mdt team said it's not

Daniel Sheibley, MD :

waht is it, 2-point-8 or twenty eight

Customer :

No it's 2.8

Customer :

It's a new finding . Was not there in April ct scan

Daniel Sheibley, MD :

if it is 2 point 8 then no it is not a metastasis or if it had previously been a metastasis but now has decreased in SUV activity then it would be a resolving metastasis. But in general if it is at or below background activity level it is not a metastasis

Customer :

Could it be a killed met?

Daniel Sheibley, MD :

that's what I meant by resolving metastasis. Yes

Customer :

I see. As before my dad was taking xeloda after the op. He had 4 cycles

Daniel Sheibley, MD :

That could have resulted in the killing or decreasing of activity in that metastasis

Customer :

Also it says ... There is indeterminate uptake in the mediastinal / hi liar nodes ... This could be metastases or possible sarcoid like reaction

Daniel Sheibley, MD :

That would have to be determined with a followup pet scan to see if the activity increases. However it could stay the same and still be metastasis that is being held in check by his chemo

Customer :

The team also didn't comment on that they just said 1 liver met n 1 node so I pressure they would have viewed the scans n decided right ?

Daniel Sheibley, MD :

The fact they described it as a met in the liver doesn't mean they meant a metabolically active metastasis, but may have meant that it was a developing metastasis or metastasis which had been killed by the chemotherapy

Customer :

The liver met uptake is 5.2. Background liver is 3.4. Is this high? Is it worse the higher the uptake?

Daniel Sheibley, MD :

you said it was 2.8?

Daniel Sheibley, MD :

5.2 is high enough to be indeterminate with regard to 3.4

Daniel Sheibley, MD :

while likely it is a metastasis

Customer :

Oh yes there were 2 . One 2.8 and one 5.2

Daniel Sheibley, MD :

ok well the 5.2 is probably a met but that could only be told with a tissue biopsy

Customer :

The thing is he was diagnosed nov 2013. All scans (ct) were clear

Daniel Sheibley, MD :

then yeah those would be mets to pop up that quickly

Customer :

Tumor removed march then on sept scans reveal these 2 mets ... Has something happened after surgery. ,?

Daniel Sheibley, MD :

it was metastatic at the time of surgery.

Customer :

They say the 5.2 one is a met but other one is not and the node is a met

Daniel Sheibley, MD :

If both were not there on the first ct but now are here they are mets

Customer :

They say he prob had the colon tumor 6,7 years but how come nothing spread up until after surgery ?

Customer :

So the 2.8 uptake one seems 1 that's been killed then ?

Daniel Sheibley, MD :

Since it is below the background activity most likely it is killed

Daniel Sheibley, MD :

there could always be a few surviving cells from which it would come back however

Customer :

Could these cells escaped after surgery ?

Daniel Sheibley, MD :

Yes that is possible, however far far more likely that it happened before surgery.

Daniel Sheibley, MD :

Far more likely that it was metastatic before surgery

Customer :

ok. Is it better the 2 mets have been picked up

Customer :

Early

Customer :

U think it's worth having the chemo ?

Daniel Sheibley, MD :

Yes. There are techniques of percutaneous ablation, embolic therapies as well that can be done in conjunction with the chemo

Daniel Sheibley, MD :

From what you've told me, chemo would be advisable

Customer :

Ok. Irinotecan is the one they give

Daniel Sheibley, MD :

They may want to readdress their chemo choice. That is always done after posttreatment pet scans. Discuss that with his oncologist

Customer :

Ok thx

Daniel Sheibley, MD and 3 other Medical Specialists are ready to help you
Customer: replied 2 years ago.

I forgot to ask, if the uptake is higher dies this mean the cancer is more aggressive ?

Expert:  Daniel Sheibley, MD replied 2 years ago.
Yes that is correct. It means the cells are more metabolically active.
Customer: replied 2 years ago.

So is 5.2 low? And is it better ?

Expert:  Daniel Sheibley, MD replied 2 years ago.
It is still above background appreciably and therefore represents tissue with elevated metabolism. This suggests it to be a metastasis.
Customer: replied 2 years ago.

I see. But is a lower uptake better than higher ?as I know some are like 10,15

Expert:  Daniel Sheibley, MD replied 2 years ago.
Low is better than higher, yes that is completely true
Customer: replied 2 years ago.

With a SUV of 5.2 would you say that the met is less active ?

Expert:  Daniel Sheibley, MD replied 2 years ago.
Yes, the lower the number the lower the metabolic activity