Dynamic and Static (18)F-FDG PET/CT Imaging in SMARCA4-Deficient Non-Small Cell Lung Cancer and Response to Therapy: A Case Report

SMARCA4-deficient non-small cell lung cancer (NSCLC) is a more recently recognized subset of NSCLC. We describe the (18)F-fluorodeoxyglucose (FDG) PET/CT findings in a rare case of SMARCA4-deficient NSCLC and response to therapy. A 45-year-old male patient with a history of heavy smoking (10 years) underwent an (18)F-fluorodeoxyglucose (FDG) PET/CT dynamic (chest) + static (whole-body) scan for diagnosis and pre-treatment staging. (18)F-FDG PET/CT showed an FDG-avid mass in the upper lobe of the left lung (SUV(max) of 22.4) and FDG-avid lymph nodes (LN) in the left pulmonary hilar region (SUV(max) of 5.7). In addition, there were multiple metastases throughout the body, including in the distant LNs, adrenal glands, bone, left subcutaneous lumbar region, and brain. Pathological findings confirmed SMARCA4-deficient NSCLC. After four cycles of chemotherapy and immune checkpoint inhibitors (ICI), the patient underwent again an (18)F-FDG PET/CT scan (including a dynamic scan) for efficacy evaluation. We report a case that deepens the understanding of the (18)F-FDG PET/CT presentation of SMARCA4-deficient NSCLC as well as dynamic imaging features and parametric characteristics.