Mirada Casebook

Case study 1: Colorectal

• Indication: T3 N1 R0 sigmoid colectomy August 2009• CT demonstrated solitary segment VI/VII liver metastasis• PET/CT 18FDG Whole Body: skull base to upper thigh.

Findings• Blood glucose = 5.6 mmol/l• There are two definite foci of increased uptake in keeping with hepatic

metastases • F1: posteriorly in segment VI/VII (1.4 cm SUV max = 6.8) and • F2: segment Iva (1cm SUV max = 5.1)

• No evidence of residual or recurrent disease at the primary tumour site. No FDG avid locoregional or distant lymph-nodes. No other PET evidence of malignancy.

Case 1: 18FDG PET/CT Colorectal Restaging

This presentation uses Mirada Casebookwhich can be downloaded free fromhttp://www.mirada-casebook.com/

How Casebook was used in this example

• The bookmarks in the presentation relate to the findings in the corresponding scan. During a presentation these may be discussed while showing the finding in Casebook.

• In the sample bookmarks we have shown some of the features of Casebook including:

• Bookmark 1: Shows only the base layer, illustrates the lesion in CT only• Bookmark 2: Shows the same view with the PET overlay on, and the cross-hairs off• Bookmark 3: Shows the same lesion, adjusting window, level, zoom and pan• Bookmark 4: Demonstrates a change of colormap, view layout and overlay transparency• Bookmark 5: Showing the second lesion in all views and hiding the overlay text• Bookmark 6: Changes to the coronal view and adjusts the base window and level• Bookmark 7: Switches to axial view, hides the cross-hairs and adjusts the overlay transparency

• All the navigation and image display adjustments are available during presentation.• For example, if a question is asked for which a bookmark has not been prepared, you can

navigate or adjust the display appropriately.• Another advantage of Casebook is that you can adjust the window and level or fusion

transparency to compensate for poor projection.