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NM By Myself > Brain Classic NM > Flashcards

Brain Classic NM Flashcards

1
Q

AD FDG

A

Bilateral posterior parieto - temporal cortex
Posterior cingulate gyrus
Frontal lobe (advanced)
FDG 100% vs SPECT 90% sensitivity in discriminating AD patients

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2
Q

DLB FDG

A

Medial occipital cortex

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3
Q

FTD FDG

A

Fronto - temporal regions

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4
Q

Amyloid plaques in cortical gray matter

A

AD 100%
DLB 50-70%
Normal elderly

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5
Q

Amyloid imaging tracers

A

DD AD vs FTD
Identify MCI who will convert to AD
Early diagnosis of AD
C11PiB - - more sensitive than FDG
NeuraCeq
Amyvid
Vizamyl

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6
Q

NeuraCeq

A

F-florbetaben
8 mCi 120 min

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7
Q

Amyvid

A

F-florbetapir
10 mCi 45 min
Binding similar to PiB

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8
Q

Vizamyl

A

F-flutemetamol
5 mCi 90 min
Clinically diagnosed AD vs MCI in healthy elderly

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9
Q

Amyloid imaging AD

A

Frontal, parietal, temporal cortex
No dd AD vs DLB - - DatScan - - bilateral striatum - - AD

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10
Q

Amyloid imaging DLB

A

AD-like atrophy in parahippocampal area,
Lateral temporal, parietal cortex
Reduced Dat uptake

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11
Q

Amyloid imaging FTD

A

No amyloid - - no uptake

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12
Q

Brain SPECT tracers AD

A

Tc-ECD
TC-HMPAO
Both are small, lipophilic, neutral molecules - - cross intact BBB
Fast washout from extra-cerebral tissue, high contrast grey/white
Reduced perfusion in temporoparietal and frontal areas

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13
Q

DatScan preparation and protocol

A

I123-FP-CIT - cocaine analog
Thyroid block - lugol 100 mg or potassium perchlorate 400 mg 30-60 min before tracer injection
FOV with radius <16 cm, total time 30-45 min, min 1.5 ml counts
Scan after 3-6h when striatal/occipital binding ratio is stable

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14
Q

Sertraline in DatScan

A

Increase uptake but not interfere with visual presentation

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15
Q

Reduce binding to presinaptic dopamine transporter Dat

A

Cocaine, amphetamine, methylphenidate, ephedrine, phentermine
Anti Parkinson drug do not interfere with binding!!

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16
Q

FDOPA PD

A

Presynaptic dopamine transporter imaging
5 mCi 60-90 min
Striatal activity due to activity of AADC (aromatic amino acid decarboxylase)
Transport into storage vesicle by VMAT2
Reduced striatal uptake - - PD
Biomarker for in vivo striatal dopamine level

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17
Q

Postsynaptic D2 dopaminergic imaging tracer PD

A

Dd PD (presynaptic) and Parkinson plus (postsynaptic)
C11-raclopride
I123 - iodobenzamide = IBZM
Increased binding to putamen contralateral to more affected body side
Degeneration of presynaptic (PD untreated) - - upregulation of postsynaptic

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18
Q

I123 MIBG PD

A

Myocardial uptake - - no PD
Degeneration of adrenergic post-ganglion pathways - - no cardiac uptake - - PD
Presence of LB - hallmark of PD
Marker of DLB

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19
Q

PD symptoms

A

Bradykinesia
Rest tremor
Rigidity
Gait abnormality

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20
Q

Vascular cause of PD

A

Poor response to L-dopa

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21
Q

DatScan normal

A

Comma shaped uptake with symmetric borders
Rule out PD and DLB - - AD

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22
Q

DatScan abnormal

A

Reduced uptake in striatum, esp putamen, assymetrical (contralateral)
PD or DLB vs AD (normal)
One side caudate + putamen = infarct

23
Q

DatScan indication

A

Dd DLB vs AD (normal)
DD PD vs essential tremor (normal)
Early diagnosis of PD
DD PD vs drug-induced parkinsonism or psychogenic parkinsonism
Not for disease progression and response to treatment

24
Q
25
Q
26
Q
A

AD
Amyloid imaging

27
Q
28
Q
29
Q

MSA FDG

A

MSA = multiple system atrophy
Putamen and cerebellum

30
Q

PSP FDG

A

PSP = progressive supranuclear palsy
Upper brain stem, medial prefrontal cortex, medial thalamus, caudate, anterior cingulate, superior frontal cortex

31
Q

CBD FDG

A

CBD = corticobasal degeneration
Assymetrical cortical and subcortical regions

32
Q

DLB PD FDG

A

Visual hallucinations
Bilateral occipital cortex

33
Q

PSP and MSA postsynaptic dopaminergic imaging

A

Reduced striatal binding due to reduced D2 receptor binding
Also in patients taking dopaminergic drugs

34
Q

MSA MIBG

A

MSA - - orthostatic hypotension ass with parkinsonism
Cardiac uptake of MIBG
DD MSA vs orthostatic hypotension in PD treated by L-DOPA
Also no Lewy Body in MSA vs PD and DLB

35
Q

Brain perfusion SPECT

A

Multidetector gamma camera with LEHR or LEUHR or fan-beam collimator - - highest spatial resolution
Stop benzodiazepine
Stop dilantin
No coffee, smoke, alco
Sedation after tracer
10 min before and 5 min after injection silent and low light
SPECT 20 min after tracer
30 min acquisition - - FBP or iterative algorithm with low pass filter (Butterworth 0.5 cycle/cm, order 6-8)

36
Q

Benzodiazepine cause

A

Globul perfusion reduction

37
Q

Dilantin cause

A

Cerebellar hypoperfusion

38
Q

TC-HMPAO

A

15-30 mCi
Stable for 30 min
Cross intact BBB by simple diffusion
Labeled autologous leukocytes
More adequate to identify areas with hyperperfusion (epilepsy), but in vitro not stable
If subacute stroke - - better cerebral perfusion

39
Q

Tc-ECD

A

15-30 mCi
Stable for 6-8 h
Stereomer 1.1-ECD
More rapid clearance from bloodstream - - better target-to-background ratio
Cross intact BBB - - passive diffusion
If subacute stroke - - better metabolic activity

40
Q

Tc-DTPA

A

15-20 mCi
Brain death (not cross BBB)
Short T1/2 - - for children

41
Q

Brain death

A

Coma+absence of brain stem reflexes +apnea - - at least two of them - - no need for test
Dynamic - - frame/sec for 1 min - - late planar 20-30 min - - SPECT
“hot nose” sign = rerouted blood flow

42
Q

Epilepsy

A

Drug resistant - - surgery
First day - interictal SPECT (between seizures)
Second day - ictal SPECT under video-EEG (within 45 sec of seizure onset) - - hyperperfusion

43
Q

Diamox

A

= acetazolamide
Increase CO2 - - vasodilation - - increase blood flow 3-4 times
1g IV - - 20 min - - cerebral vascular reserve - - flow decreases if vascular disease and impaired reserve
Indication: carotid occlusion - - define risk of stroke and select patients for revascularization

44
Q
A

Reduced vascular reserve

45
Q
46
Q
A

Brain death

47
Q

Cysternography

A

IN111-DTPA, long T1/2
Intrathecal injection into subarachnoid space 0.5-1 mCi 1 ml (remove 1 ml CSF)
Early image over lumbar region 1-2H - - check injection
Planar image of skull 6, 24, 48 h

48
Q

Normal cysternography

A

Basal cisterns after 4h
Sylvian and interhemispheric cisterns
Subarachnoid space at 6h
Washout from basal cisterns at 24-48h

49
Q

Hydrocephalus

A

Lateral ventricles at 6h - - persists 24-48h
Reflux into ventricles

50
Q

Evaluate shunt patency

A

Tc-DTPA into reservoir of catheter of device under skin - - transit into peritoneal cavity within 30-60 min
No activity in peritoneal cavity - - distal obstruction
Fails to reach ventricles - - proximal obstruction

51
Q

CSF leakage

A

Rhinorrhea, otorrhea
Fistula - - place pledget in nostril after Intrathecal administration

52
Q

Cross compromised BBB

A

Tc-DTPA
Tc-pert

53
Q

Brain death tracers

A

Tc-DTPA
Tc-HMPAO
Tc–ECD

NM By Myself (25 decks)

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