Presentation
Past history colorectal cancer. Known liver metastasis - assessment for hepatic resection.
Patient Data
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FDG PET/CT of the upper abdomen showing intense isotope activity in the dome of the right hepatic lobe consistent with a metastasis.
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Multiple subtle lesions in the right lobe. On the arterial phase dynamic series, the PET avid lesion is clearly seen but there are two further lesions, i.e. in the gall bladder fossa and posterior right lobe. These are easily seen on the PET/CT scan as any higher isotope accumulation than the background liver.
Case Discussion
MRI especially with delayed post-contrast imaging using a hepatocyte agent (Primovist) is more sensitive than PET for hepatic metastases especially smaller masses and should be performed (as well as PET for extra-hepatic disease) prior to any planned resection so as to provide the surgeon with the best road map.
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