Here is the report. So this means I am now N3M1. All but one of the lymph nodes are above the aortic bifurcation (in the abdomen where the aorta splits to go to the left and right sides of the body.
2/15/13 Pet/Ct Skull/Thigh No Iv Contrast
Narrative
NM: TUMOR GLUCOSE METABOLISM STUDY (PET-CT)ROUTINE
DATE OF SERVICE: 2/15/2013
INDICATION: History of urothelial carcinoma of the bladder, status post radical cystoprostatectomy 4 years prior, now with gross hematuria and prominent retroperitoneal lymph nodes. Evaluate for metastatic disease.
COMPARISON: CT IVP 1/25/2013. No prior PET/CT is available.
RADIOPHARMACEUTICAL: 12.5 mCi F-18-Fluoro-2-Deoxy-D-Glucose (FDG) IV
PROCEDURE: Immediately prior to radionuclide injection, blood glucose was measured by fingerstick and was 107 mg/dL (Normal range = 74-106 mg/dL).
Approximately one hour status post radionuclide administration, PET and helical CT of the body from the base of the skull to the proximal thighs were obtained and reconstructed in the axial (thickness 3.27 mm), coronal and sagittal views. Fusion images and a maximal intensity projection (MIP) image were also generated.
PET FINDINGS: There is the usual physiologic uptake of the glucose tracer.
Right common iliac lymph node, image 217, 1.3 cm, SUV max 7.4
Retrocaval node at the level of the kidneys, image 187, 1.2 cm, SUV max 5.8
Aortocaval node, image 176, 1.9 cm, SUV max 6.9
Node between the esophagus and descending aorta in the posterior aspect of the middle mediastinum, image 105, 0.9 cm, SUV max 2.9
There are no other abnormalities of glucose uptake.
CT FINDINGS:
Head and neck: Lobular low-density soft tissue inseparable from the inferior pole of the left thyroid gland (image 74) measures 3.1 x 1.9 cm and has normal background activity, likely colloid or duplication cyst.
Lungs and pleura: Unremarkable.
Thyroid: Unremarkable.
Heart and pericardium: Mild coronary artery calcification.
Mediastinum, Hilum and Vascular structures: Small hypermetabolic retrocardiac lymph node, as above.
Breast: Unremarkable.
Liver: Enlarged and diffusely low-density, suggesting steatosis.
Gall bladder and ducts: Unremarkable.
Spleen: Unremarkable.
Pancreas: Unremarkable.
Adrenal glands: Unremarkable.
Kidneys: Mild bilateral perinephric stranding has slightly increased since last month.
GI Tract: Unremarkable. No free fluid, pneumatosis, free air, fluid collection or bowel obstruction.
Retroperitoneum, mesentery, aorta, lymphadenopathy: Retroperitoneal and right common iliac lymphadenopathy as above.
Prostate and seminal vesicles: Changes of remote radical cystoprostatectomy.
Urinary bladder: Coarse trabeculation of the neobladder is unchanged.
Bones and Soft tissue: Mild lower lumbar spine degenerative disease. Midline anterior abdominal wall incisional scar.
IMPRESSION: Retroperitoneal, right common iliac, and retrocardiac lymphadenopathy with FDG avidity, consistent with metastatic disease.