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FDG PET CT response evaluation gastric cancer chemotherapy SUV interpretation

Here is a plain-language interpretation of both pages of this PET-CT scan report:

¹⁸F-FDG Whole Body PET-CT Scan Report

Patient: Mr. Banda Srinivas | Age: 51 years | Date: 28 July 2026 Indication: Locally advanced stomach cancer (carcinoma stomach), on chemotherapy - this scan checks how well the treatment is working.

What is this scan?

A PET-CT scan combines two technologies - PET (which detects metabolic/cancer activity using a radioactive sugar called FDG) and CT (which gives anatomical detail). Cancer cells consume more sugar than normal cells, so they "light up" on PET as areas of high FDG uptake. The metabolic activity is measured as SUV (Standardised Uptake Value) - higher SUV = more active disease.

Findings, Region by Region

Brain & Paranasal Sinuses - NORMAL

Brain tissue and ventricular system appear normal. No brain spread detected (though the report notes MRI is more sensitive for brain metastases if clinically needed).

Head & Neck - NORMAL

Throat, pharynx, and thyroid are all normal. No enlarged lymph nodes in the neck.

Chest - NORMAL

  • Lungs are clear - no tumor spread to lungs
  • No fluid around lungs (no pleural effusion)
  • No enlarged lymph nodes in the chest (mediastinum)
  • Heart vessels are normal

Abdomen (the key area)

Stomach tumor:
  • There is asymmetric irregular thickening in the fundus (top part) and body of the stomach - this is where the cancer is.
  • The maximum wall thickness is ~6 mm in the body, and ~12 mm in the fundus.
  • The FDG uptake (metabolic activity) is low grade - SUV max 2.7 (body) vs. 4.9 (fundus). These are relatively low values, suggesting the tumor is not very metabolically aggressive at this point.
  • The perigastric fat stranding (tissue reaction around the stomach) is non-FDG avid (not lighting up) - a positive sign.
Lymph nodes:
  • A few small hepatogastric lymph nodes (~6 mm) are present but are non-FDG avid (not metabolically active) - this means they are likely reactive/inflammatory, not cancerous.
  • No significant lymph node enlargement in the rest of the abdomen or pelvis.
Other abdominal organs:
  • Liver - completely normal, no metastases
  • Spleen - enlarged at ~14 cm (normal upper limit is ~12 cm), with diffuse increased FDG uptake (SUV max 4.4). This likely reflects reactive/treatment-related changes rather than metastatic disease, given the context.
  • Gallbladder, pancreas, adrenals, kidneys - all normal
Peritoneal cavity:
  • No ascites (no abnormal fluid in the abdomen)
  • Peritoneal fat planes are normal
  • No peritoneal spread of cancer

Bones

  • Diffuse increased FDG uptake throughout the skeleton (both spine and limb bones) - this is described as hyperproliferative marrow changes, meaning the bone marrow is very active. This is commonly seen as a reactive response to chemotherapy (the marrow works harder to replace blood cells suppressed by chemo). It does not mean bone metastases.
  • Degenerative changes in the spine - this is age-related wear and tear, not cancer-related.

Overall Impression (Doctor's Summary)

Compared to the previous PET-CT done on 21 May 2026, this scan shows:
FindingStatus
Stomach tumor (fundus & body)Mild decrease in wall thickness and metabolic activity - residual lesion (some cancer remains but is responding)
Locoregional lymph nodesNon-FDG avid (tiny, not active) - favorable sign
Rest of the bodyNegative for any new or significant disease

What Does This Mean in Simple Terms?

The chemotherapy is working. The stomach cancer has shown a partial response - the tumor has become slightly smaller and less metabolically active compared to before. However, it has not completely disappeared - what remains is called a "residual lesion."
The cancer has not spread to the liver, lungs, brain, lymph nodes (beyond the stomach area), or the peritoneum (lining of the abdomen). This is an encouraging result.
The report recommends clinical correlation and follow-up - meaning the oncologist needs to review this alongside symptoms, blood tests, and other factors to decide the next steps, which may include continuing chemotherapy, re-staging, or considering surgery.
Important note: This interpretation is for educational purposes. Please discuss these findings with the treating oncologist (Dr. Rajesh Bollam) who has the full clinical context and can guide further management.
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