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71 Cards in this Set
- Front
- Back
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Nucs QC
Limit for Al breakthrough? Limit for 99Mo contamination? |
Al breakthrough
<10 microg / mL 99Mo contamination <0.15 microCi 99Mo /1 mCi 99mTc |
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Nucs QC
How often check -Gamma-Camera Peaking -Gamma-Cam Energy Resolution -Extrinsic field uniformity -Bar phantom -Field uniformity -Center of Rotation -Jaczak phantom |
Gamma-Camera Peaking - Daily
Gamma-Cam Energy Rez - Daily Extrinsic field unif - Daily Bar phantom - Weekly Field uniformity - Monthly Center of rotation - Monthly Jaczak phantom - Quarterly |
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Morphine dosing and administration
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- 0.04 mg/kg IV over 3-5 min, max 4 mg
- Causes functional obstruction -do not give until SB visualized |
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CCK dosing and administration
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- For GB EF, .02-0.04 microg/kg IV in 10 mL saline, injected slowly
- may also give if SB not seen (relaxes sphincter of Oddi) |
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Lasix dosing for renal nucs study
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0.5 – 1 mg/kg IV over 1 min
at 15 min. post-injection 99mTc-MAG3 |
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If suspect biliary atresia, what can be done prior to study?
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Phenobarbital 5 mg/kg/dy for 5 dys before study
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Diamox dosing and administration
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1 gm IV before Cerebral Perfusion study
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Captopril dosing for renal scan
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25-50 mg PO, 1hr. before imaging
BP should be measured q15 min |
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Dosage of aminophylline for reversal of persantine stress
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50-100 mg IV
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Bone scan shows cold bone lesion
DDx |
HM RANT
Histiocytosis X Multiple myeloma Renal cell carcinoma Anaplastic tumors (retic cell CA) Neuroblastoma Thyroid carcinoma |
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What cancers DON'T show up on PET scans?
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*Prostate CA
*Neuroendocrine – Carcinoid *Lung – BAC, carcinoid, mucinous AdenoCA *Breast – Lobular *Lymphoma – MALT *Thyroid – some 131I-positive *Colorectal – Mucinous AdenoCA *Also, small size (< 1 cm) |
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V/Q scan classification
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LOW
* single mod defect w/nl CXR * defect<CXR abnl * non-segmental * mult small HIGH * 2 large defects not accounted for by CXR Note: 1 lge = 2 mod |
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Gallium scan shows lung uptake
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Sarcoid/TB/fungus
CMV/PCP Lymphoma UIP, Asbestosis / Silicosis Radiation Drugs: Bleomycin, Amiodarone, Nitrofurantoin, Cytoxan (“BANC”) |
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DDx of "superscan"
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* Mets (usu focal)
- Prost(mc), Breast, Lung * Metabolic - Renal Osteodystrophy - Osteomalacia - Hyperparathyroidism - Paget's * Myelofibrosis (big spleen) * Mastocytosis (systemic) |
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Renal uptake of MDP
DDx |
NO SCAR
*Nephrocalcinosis *Obstruction *Sulfur colloid/thallium *Chemotherapy *ATN (think of SCD) *Radiation |
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Cold nodule on thyroid scan
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Adenoma/colloid cyst (85%)
CA (10%) Focal thyroiditis Hemorrhage Lymph node Abscess Parathyroid adenoma |
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What takes up MIBG?
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Neuroblastoma
Pheochromocytoma Carcinoid Medullary thyroid Cancer |
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What takes up octreotide?
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Paraganglioma (glomus)
Pancreatic islet cell Pituitary adenoma Pheochromocytoma Carcinoid Gastrinoma Medullary CA of Thyroid Small Cell Lung Cancer |
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V/Q mismatch DDx
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* PE
* tumor compression of PA * hypoplastic PA * vasculitis * atelectasis (reverse mismatch) |
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Matched V/Q defects: DDx
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consolidation / atelectasis
COPD tumor bulla / pneumonectomy |
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Lung scan findings
*R->L shunt *central deposition of DTPA *liver uptake on perfusion *liver uptake on ventilation *Xe leak |
*R->L shunt – activity in kidneys & brain
*central deposition of DTPA – COPD *liver uptake on perfusion study – SVC obstruction *liver uptake on vent study – fatty liver *Xe leak – BPF |
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GB not visualized on HIDA
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acute cholecystitis
prolonged fasting recent meal cholecystectomy GB agenesis |
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Sulfur colloid study
-focal liver uptake -renal transplant uptake -colloid shift |
* Focal liver uptake - FNH, regen nodule, Budd-Chiari (hot caudate), SVC or IVC obstr
* Renal transplant uptake – rejection * Colloid shift (marrow, spleen, lungs, kidneys) – severe liver dysf * All liver masses cold exc for FNH * Filtered SC for sentinel node study – breast, melanoma |
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Abnormal tracer collections on HIDA scan
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*Bile leak
*Choledochal cyst *Caroli’s *Duodenal diverticulum * rim sign specific for acute cholecystitis |
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False positive HIDA
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-recent meal
-prolonged fasting -liver dysfunction -hyperalimentation |
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Bowel not visualized on HIDA scan
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choledocholithiasis
ampullary stenosis CCK given pre-scan |
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Meckel's scan shows RLQ hot spot
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*Meckel’s diverticulum w/ectopic gastric mucosa (25%)
*other duplication cyst w/ectopic gastric mucosa *renal *active bleeding sites *tumor *IBD prep w/pentagastrin & cimetidine |
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Testicular scan
Significance of: - high uptake - low uptake - ring sign |
High uptake - torsion, orchiectomy
Low uptake - epididymoorchitis Ring sign -late torsion -tumor w/ central necrosis -abscess -trauma |
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Hot spots on bone scan
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*Tumor
*inflamm – osteo, arthritis *congenital – OI, TORCH *metabolic – marrow hyperplasia, Paget’s, FD *trauma – fx (rib fxs linear), stress fx (e.g. Honda sign), avulsion injury, AVN, RSD, THR (neg within 6 mos), spondylolysis, child abuse *vascular – sickle cell *transient osteoporosis of hip *flare phenomenon – good response to chemo |
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Cold spots on bone scan
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*mets most common – myeloma, lymphoma, renal, thyr, neuroblastoma
*primary bone lesions – SBC, ABC, EG *vascular – infarct, AVN (get pinhole view), RTX *artifact – overlying pacemaker, barium, jewelry, prosthesis |
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Positive 3-phase bone scan
Appearance of -cellulitis -shin splints |
*Osteo, healing fx, tumor, orthopedic implants, AVN, RSD, neuropathic
*Cellulitis – flow & blood pool positive, delayed negative *Shin splints – flow & blood pool neg, delayed positive |
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Diffuse periosteal uptake (tramtrack)
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HPO
child abuse venous insufficiency thyroid acropachy |
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Bone scan shows uptake in soft tissues
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cellulitis
renal failure radiotherapy ports myositis ossificans dermatomyositis rhabdomyolysis tumors with calcifications neuroblastoma in child sinusitis SVC obstruction (upper body) IVC obstruction (lower body) lymphedema (arm + ant ribs) |
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Bone scan shows uptake in kidney
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Dehydration (most common)
Urinary tract obstruction hypercalcemia chemotherapy radiation Al contamination |
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Bone scan shows uptake in breast
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pregnancy
lactation mastitis inflammatory breast CA steroids radiation |
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Bone scan shows uptake in stomach
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free TcO4
HPT hypercalcemia bowel infarction prior MIBI scan |
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Bone scan shows uptake in spleen
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sickle cell
thalassemia breast CA lymphoma |
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Bone scan shows uptake in lung
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HPT
lung tumor pulmonary hemosiderosis alveolar microlithiasis metastatic osteosarcoma prior lung scan |
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Bone scan shows uptake in pleura
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malignant pleural effusion
pleural met mesothelioma chest wall tumor fibrothorax |
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Bone scan appearance of:
-hypercalcemia -Al contamination -excess TcO4 -bisphosphonates -amyloid |
*hypercalcemia – hot in lung, stomach & kidney
*Al contam – high uptake in liver & kidney *excess TcO4 – high uptake in soft tissues, salivary, thyr, stomach, choroid plexus, low uptake in bone *bisphosphonates – diffuse low uptake in bones *amyloid – diffuse increased uptake in myocardium |
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Bone scan shows uptake in liver
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Mets
Prior sulfur colloid scan Al contamination |
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Tc-99m
T 1/2 energy decay type |
6 hr
140 keV IT |
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I-123
T 1/2 energy decay type |
13.3 hr
159 keV EC |
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I-131
T 1/2 energy decay type |
8.1 d
364 keV beta |
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In-111
T 1/2 energy decay type |
2.8 d
172, 247 keV EC |
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Ga-67
T 1/2 energy decay type |
78 hr
93, 185, 300 keV EC |
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Co-57
T 1/2 energy decay type |
270 d
122, 136 keV EC |
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Cr-51
T 1/2 energy decay type |
28 d
320 keV EC |
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F-18
T 1/2 energy decay type |
109 min
511 keV positron |
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Xe-133
T 1/2 energy decay type |
5.3 d
81 keV beta |
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Tl-201
T 1/2 energy decay type |
73 hr
69-83 keV EC |
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Diffuse increased thyroid uptake
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-Graves
-early Hashimoto’s thyroiditis -toxic MNG -functioning adenoma (focal) |
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Diffuse decreased thyroid uptake
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*thyroiditis – subacute, postpartum, late Hashimoto’s
*meds – thyroid therapy, iodine intake or contrast, PTU, tapazole *thyroid ablation – surgery, I131 *lingual thyroid *unilat – surgery, replacement by hypofunctioning tumor, suppression by hot nodule |
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Heterogeneous thyroid uptake
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MNG
multiple autonomous nodules Hashimoto’s CA |
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Positive parathyroid scan
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*parathyroid adenoma
*hyperplasia *thyroid adenoma *lymph node *CA |
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I-131 therapy
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*Graves 10-15 mCi
*Plummer’s 30 mCi *residual tissue 30-100 mCi *mets 100-200 mCi |
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Cardiac nucs
-reversible -fixed -wall motion |
reversible =ischemia
fixed =infarct or hibernating wall motion – normal, akinesis (scarred), hypokinesis (injured), dyskinesis (paradoxical, CABG, aneurysm) tardokinesis RUG – adriamycin stopped if EF<45% or drops 15% |
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Stress test endpoints:
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-severe angina
-hypotension -arrhythmias -AMI -fatigue, dyspnea -target workload achieved |
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Pharmacologic stress
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unable to exercise:
-use persantine (0.142 mg/kg/min), reverse w/ theophylline (50-100mg) -use dobutamine if COPD on theophylline -use pharma stress for LBBB (o/w may see reversible septal defect) |
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Increased lung uptake on thallium
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-LV failure
-pulmonary venous HTN |
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Viable myocardium
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Viable myocardium: normal, reversible defect, fixed defect with >50% tracer uptake of normal myocardium
*hibernating – blood flow & function chronically down *stunned – blood flow normal, function down |
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Causes of thallium being
-false neg -false pos |
False neg: submax exercise, noncritical stenosis, small ischemic area, meds
False pos: cardiomyopathy, LBBB, infiltrative cardiac dz, ST attenuation |
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Paradoxical septal movement
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-septal ischemia
-previous cardiac surgery -LBBB or pacemaker -RV overload |
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Pyrophosphate uptake
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MI
LV aneurysm cardiomyopathy myocarditis pericarditis amyloid |
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Gastric emptying
-what's nl? -delayed DDx -rapid DDx |
* Nl >= 50% in 50 min
* delayed – diabetic gastroparesis, obstruction * rapid - postoperative, PUD, ZE syndrome, drugs |
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Focal cold defect on nuclear renal scan
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tumor, cyst, abscess, scar, duplex collecting system, trauma, infarct
DMSA – pyelonephritis, scar |
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Focal hot spot on nuclear renal scan
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collecting system
leak cross-fused ectopic horseshoe |
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Nuclear scan shows delayed uptake and excretion (renal failure)
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prerenal – poor flow and uptake, unilateral, RAS (ascending pattern with captopril, beware of hypotension), RVT
renal – bilateral, ATN (nl uptake, poor excretion), GN (poor uptake and excretion), CRF postrenal – obstruction |
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Nonvisualized kidney
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nephrectomy
ectopic kidney renal artery occlusion transplant - hyperacute reject |
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Nucs brain scan
Focal brain cold defect DDx |
Infarct
neoplasm hemorrhage interictal seizure focus X-ed cerebellar diaschisis (contralateral cerebellum no uptake after stroke) diagnostic patterns – Alzheimer’s (temp, pariet) Pick’s (front, temp) multiinfarct dementia |
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Gallium positive scan:
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*sarcoid (lambda & panda sign)
*PCP *lymphoma (Thal better for low-grade) *osteo (better than wbc study for discitis/osteo) *KS is Ga(-)/thal(+) *high lung uptake – sarcoid, PCP, TB, MAI, CMV, lymphoma, chemo (bleomycin), lipiodol *increased parotid & lacrimal uptake – sarcoid, Sjogren’s, radiation |
