Understanding and Improving ¹⁸F-Fluciclovine PET/CT Reports: A Guide for Physicians Treating Patients with Biochemical Recurrence of Prostate Cancer

Figure 7

Images of a 68-year-old male who had undergone radiation therapy, followed by short-term androgen deprivation therapy. He was referred for ¹⁸F-fluciclovine imaging, on no treatment, when his PSA rose to 10.5 ng/mL. Five rows of images from his study are shown, to demonstrate varying intensities of uptake. SUVs, a semiquantitative measure of uptake intensity, are given, with higher values denoting greater intensity; compare to marrow uptake at the same level (yellow arrows in PET images). First (top) row: the first, left-hand image identifies a 1.4-cm left obturator node (SUV: 7.6) (white arrow). The blue arrow points to physiologic bowel uptake. The yellow arrow points to physiologic uptake in the marrow of the left iliac bone. The image on the right is the corresponding CT view; the yellow arrow points to the left obturator node. Second row down: left-hand image shows metastasis at the level of the common iliac nodes (SUV: 5.8). The blue arrow points to typical, heterogeneous bone marrow uptake (normal). The corresponding CT image on the right shows the node adjacent to the psoas muscle. Third row down: the left-hand image identifies a 1-cm aortocaval metastasis (SUV: 3.2). The yellow arrow on the corresponding CT view points to a lymph node at this site. Fourth row down: the left-hand image identifies a 1-cm left external iliac node (SUV: 3.5). The yellow arrow on the right points to the node on the CT view. Fifth (bottom) row: the left-hand image shows a 6-mm right obturator node (white arrow). Although the SUV is only 2.7, the node still clearly shows enhanced uptake compared to the adjacent iliac marrow. CT image on the right identifies the node (yellow arrow).

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