2015 OSU NM

Question 1

Gallbladder EF range in HIDA scan?

Answer 1

<35% is abnormal.

35-50% is borderline.
<30% indicated chronic cholecystitis.
Must be related to clinical findings.

Question 2

Pt with bone mets shows increasing activity on bone scan 3-6 months after treatment. WHat phenomenon do you suspect?

Answer 2

Flare phenomenon. (It shows sclerotic rim on previously lytic lesions suggestive of healing) Good prognosis/response. Activity at sites after 6 months means progression of disease.

Question 3

Not a cause of superscan?

• Prostate mets
• Breast mets
• Multiple Myeloma
• Primary hyperparathyroidism

Answer 3

Primary hyperparathyroidism.

Both primary and seconday can cause superscan but typically secondary.

Question 4

Indium 111 can be used for?

• Diverticulitis
• Bowel inflammation
• Phlegmon

Answer 4

Phlegmon

Indium 111 is used for infxn, abscess, phlegmon.
No normal In-111 in bowel.
In-111 in bowel is nonspecific and may include: Crohn, UC, Pseudomembranous Colitis, Diverticulitis, GI infxn, Fistula, Ischemic/infected bowel, vigorous enimazation.

Question 5

Question regarding increased I-131 does for therapy:

Answer 5

When there is exogenously suppressed thyroid.

Use Thyrogen TSH analog

Question 6

Ga-67 lung scan does not show increased uptake in?

Answer 6

It is not taken up in late radiation.

No uptake in:
Most benign neoplasms
Hemangioma 
Cirrhosis
Cystic disease of breast, liver, thyroid
Reactive lymphadenopathy
Inactive granulomatous disease

Question 7

Bone scan uptake is seen in:

• Osteoid osteoma
• Sudek
• Shin splints
• Giant cell tumor

Answer 7

All are true.

• Osteoid osteoma
• Sudeck (Complex regional pain syndrome)
• Shin splints
• Giant cell tumor (Central photopenic region)

Question 8

PE study with a “non diagnositic” finding:

• Triple match in the lower lungs
• Match defect with no CXR finding
• Pleural effusion with matched defect
• Two small matched defects

Answer 8

• Triple match in the lower lungs (True, indeterminate)
• Match defect with no CXR finding (True, indeterminate)
• Pleural effusion with matched defect (False, low-prob)
• Two small matched defects (False, low-prob)

Question 9

I-131 treatment of cervical and mediastinal LAD

• over 200
• 10-15
• 1-5 rem
• 150-250 rem

Answer 9

150-200 rem

Question 10

Empiric therapy I-131 used for?

• Toxic diffuse goiter
• Multinodular goiter
• Subacute thyroiditis

Answer 10

-Toxic diffuse goiter (True)

Question 11

You’re going to give I-131 which condition would you give a 5 mCi test dose?

• Graves
• Subacute Thyroiditis
• Papillary cancer

Answer 11

Papillary cancer (look for osseous mets)

Question 12

Fluid density mass in porta hepatis that is also taken up on HIDA associated imaging finding would be?

• Abnormal pancreaticoduodenal junction
• Adenomyomatoisis
• Cavernous Transformation of the portal vein

Answer 12

• Abnormal pancreaticoduodenal junction (maybe?)
• Adenomyomatoisis (False)
• Cavernous Transformation of the portal vein (False)

Question 13

Hot on HIDA?

• Pulmonary metastasis
• HCC
• Adenoma
• Cavernous hemangioma
• FNH

Answer 13

• Pulmonary metastasis (False)
• HCC (True in approx. 50%)
• Adenoma (True)
• Cavernous hemangioma (False)
• FNH (True, most avid uptake)

Question 14

Hibernating myocardium:

• dyskinesia
• Can’t use fatty acid, use glucose
• Anaerobic

Answer 14

• dyskinesia (True)
• Can’t use fatty acid, use glucose (True, FDG shows preserved metabolism)
• Anaerobic (True)

(Side note: hibernating shows ABnormal perfusion and dyskinesia. Whereas Stunned shows normal perfusion and dyskinesia.

Question 15

Given normal dosages of radiopharmaceuticals, which one requires to stop breast feeding?

Answer 15

I-131