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Nuclear Med Class 2024 > CNS Part 1 And 2 > Flashcards

CNS Part 1 And 2 Flashcards

1
Q

What does the CNS contain?

A

The brain and spinal cord

It is responsible for generating thoughts and emotions, memories are formed and stored, and connects the body via cranial and spinal nerves to stimulate muscle contraction and gland secretion.

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2
Q

How many neurons does the adult brain have?

A

100 billion neurons

The brain weighs about 3 pounds and is somewhat shaped like a mushroom.

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3
Q

How many main parts can the brain be divided into?

A

4 main parts

Cerebrum, cerebellum, diencephalon, and brain stem.

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4
Q

What are neurons?

A

The fundamental units of the nervous system

Involved with the movement of Na, Ca, K ions across cell membranes. Neurons are responsible for impulses in the body, including motor neurons that tell muscles to move and sensory neurons that allow you to feel sensations.

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5
Q

Nerve impulses speed

A

Nerve impulses can travel from 1-280 mph

Means that your brains can work @ 280 mph

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6
Q

Cerebrum

A

Cerebrum is the bulk of the brain

This is your memory, intelligence, ability to read, write, speak and do calculations

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7
Q

Cerebral cortex

A

The surface is composed of gray matter

The gray matter is called cerebral cortex. The cerebral cortex contains your neurons

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8
Q

White matter

A

Beneath the cerebral cortex lies white matter

White matter contains nerve tracts

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9
Q

Cerebrum structure

A

The cerebrum is made up of 2 hemispheres and 4 lobes

The 2 hemispheres are connected by the corpus callosum. The 4 lobes are: Frontal, Temporal, Parietal, Occipital

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10
Q

Frontal lobe

A

Higher mental activities: Planning, judgment, personality and speech

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11
Q

Temporal lobe

A

Hearing languages, memory, and learning

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12
Q

Parietal lobe

A

Sensory function

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13
Q

Occipital lobe

A

Vision

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14
Q

What is the cerebellum shaped like?

A

The cerebellum is shaped like a butterfly

Example: The cerebellum is often described as resembling a butterfly in shape.

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15
Q

What does the cerebellum control?

A

The cerebellum controls the movement of skeletal muscles

Alcohol affects your cerebellum.

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16
Q

What does the cerebellum help with?

A

The cerebellum helps with your sense of equilibrium, coordination, and balance

The anatomy of the cerebellum is similar to the cerebrum.

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17
Q

Where is the cerebellum located?

A

The cerebellum is located in the inferior and posterior portion of the brain

Gray matter is on the outside (outer) and underneath white matter.

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18
Q

What does the diencephalon contain?

A

The diencephalon contains the thalamus and hypothalamus

Thalamus - majority of the diencephalon

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19
Q

What is the thalamus responsible for?

A

The thalamus relays sensory impulses to other parts of the brain and is responsible for the sensation of pain and temperatures

Consists mainly of gray matter.

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20
Q

What functions does the hypothalamus control?

A

The hypothalamus controls autonomic functions such as body temperature, water balance, pituitary function, hunger, and emotions

Picks up impulses such as sound, taste, and smell.

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21
Q

What are the components of the brain stem?

A

The brain stem consists of the medulla, pons, and midbrain.

Example sentence: The brain stem is responsible for controlling many basic life functions.

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22
Q

What is the function of the medulla?

A

The medulla contains tracts that connect the spinal cord to the brain, and is involved in motor function, cardiovascular control, and respiratory regulation.

Example sentence: Damage to the medulla can result in serious breathing problems.

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23
Q

What is the function of the pons?

A

The pons contains tracts that connect the spinal cord to the brain and other parts of the brain, and helps the medulla with respiration.

Example sentence: The pons plays a crucial role in coordinating breathing patterns.

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24
Q

What is the function of the midbrain?

A

The midbrain has tracts that connect the upper and lower parts of the brain, and contains reflex centers for the eyes, head, and neck to respond to visual and other stimuli.

Example sentence: The midbrain is important for processing visual information and coordinating reflex movements.

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25
Q

How many stacked bony vertebrae are in the vertebral column?

A

The vertebral column contains 25 stacked bony vertebrae.

Example sentence: The vertebral column provides structural support and protection for the spinal cord.

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26
Q

How many cervical nerves are in each vertebra?

A

Each vertebra has 8 cervical nerves.

Example sentence: The cervical nerves control movement and sensation in the neck and upper limbs.

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27
Q

How many thoracic nerves are in each vertebra?

A

Each vertebra has 12 thoracic nerves.

Example sentence: The thoracic nerves innervate the chest and abdominal regions.

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28
Q

How many lumbar nerves are in each vertebra?

A

Each vertebra has 5 lumbar nerves.

Example sentence: The lumbar nerves control movement and sensation in the lower back and legs.

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29
Q

What is the function of the sacrum?

A

The sacrum has 5 bones and 5 pairs of nerves.

Example sentence: The sacrum connects the spine to the pelvis and supports the weight of the upper body.

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30
Q

What is the function of the coccyx?

A

The coccyx has 1 bone and 1 pair of nerves.

Example sentence: The coccyx is commonly referred to as the tailbone and provides attachment for muscles and ligaments.

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31
Q

What structure runs in the middle of the vertebral column?

A

Spinal cord

The spinal cord runs in the middle of the vertebral column

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32
Q

Where does the spinal cord extend to?

A

T-12

It extends to T-12

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33
Q

Where is a spinal tap usually performed?

A

Between L-2 and L-3

A spinal tap will be performed between L-2 and L-3 usually to make sure you don’t nick the spinal cord

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34
Q

What is the spinal cord the main highway for?

A

Nerve impulse conduction

It’s the main highway for nerve impulse conduction

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35
Q

What does the ventricular system consist of?

A

Cavities within the brain that produce cerebral Spinal Fluid (CSF)

The ventricular system consist of cavities within the brain that produce cerebral Spinal Fluid (CSF)

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36
Q

What are the cavities within the brain that produce CSF called?

A

Ventricles

The cavities are called ventricles

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37
Q

How many ventricles are there within the brain?

A

4 ventricles

There are 4 ventricles within the brain

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38
Q

What secretes CSF in each ventricle?

A

Choroid Plexus

The choroid Plexus of each ventricle secretes CSF

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39
Q

What is CSF?

A

CSF is a clear colorless fluid.

CSF circulates through sub-arachnoid spaces around the brain.

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40
Q

What are the functions of CSF in the brain?

A

CSF protects the brain from shock, delivers nutritive substances (like gloucose proteins), and removes waste (lactic acid + urea)

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41
Q

What is the normal ventricular system volume of CSF?

A

The whole system contains between 80 - 150 ml of CSF. It’s produced at a rate of 20ml/hr.

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42
Q

How is CSF pressure measured?

A

CSF in the ventricular system produces a pressure of 50-180 mm H2o. Similar to blood pressure but remains fairly constant.

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43
Q

How is CSF reabsorbed back into the body?

A

Reabsorption takes place in the Arachnoid Villi. CSF should be reabsorbed at the same rate it is produced.

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44
Q

What is a Lumbar puncture (Spinal Tap)?

A

Method used to insert a needle into the spinal cavity. Pressure of CSF can be determined and a sample can be taken.

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45
Q

What is the composition of the brain in terms of body weight?

A

The brain composes of 2% of body weight

However it consumes 20% of oxygen in the body at rest (brain needs a lot of oxygen)

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46
Q

What is the majority of blood vessels that enter the brain?

A

The majority of blood vessels that enter the brain form the cerebral arterial circle. (Circle of Willis)

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47
Q

What does the brain use as its main nutrient for energy?

A

The brain uses glucose as its main nutrient for energy

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48
Q

What determines the amount of oxygen and glucose needed by the brain?

A

The degree of mental activity determines the amount of oxygen and glucose

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49
Q

What does the Blood Brain Barrier (BBB) act like?

A

The BBB acts like a filter to keep certain substances out of the brain

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50
Q

What does the BBB do to protect brain cells?

A

Functions to protect the brain cells from harmful substances and pathogens

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51
Q

What is one difficulty associated with the BBB?

A

However, it makes it difficult for medicines to enter the brain

It’s hard to treat brain disorders

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52
Q

What is the composition of the brain in terms of body weight?

A

The brain composes of 2% of body weight

However it consumes 20% of oxygen in the body at rest (brain needs a lot of oxygen)

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53
Q

What is the majority of blood vessels that enter the brain?

A

The majority of blood vessels that enter the brain form the cerebral arterial circle. (Circle of Willis)

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54
Q

What does the brain use as its main nutrient for energy?

A

The brain uses glucose as its main nutrient for energy

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55
Q

What determines the amount of oxygen and glucose needed by the brain?

A

The degree of mental activity determines the amount of oxygen and glucose

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56
Q

What does the Blood Brain Barrier (BBB) act like?

A

The BBB acts like a filter to keep certain substances out of the brain

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57
Q

What does the BBB do to protect brain cells?

A

Functions to protect the brain cells from harmful substances and pathogens

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58
Q

What is one difficulty associated with the BBB?

A

However, it makes it difficult for medicines to enter the brain

It’s hard to treat brain disorders

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59
Q

What happens if the blood brain barrier becomes injured?

A

It can be altered or broken down.

Substances that normally do not pass, can breach the barrier. Toxins may enter the brain. This could be due to trauma, inflammation, or toxins.

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60
Q

What are some studies being done related to the blood brain barrier?

A

Studies are being done to breach the barrier to allow certain drugs to enter the brain. This can help in the treatment of the brain.

No example sentence provided.

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61
Q

What is a Cerebrovascular Accident (CVA)?

A

It is a stroke when there is a compromised blood supply to the brain for ≥ 24 hrs.

No example sentence provided.

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62
Q

What are the two principle types of CVA’s?

A

Ischemia - decreased blood supply (due to blockage).
Hemorrhage - rupture of blood vessel.

No example sentence provided.

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63
Q

What are some symptoms of CVA?

A

Dizzy, weak, numb, paralysis, drooping of side of the face, headache or slurred speech.

No example sentence provided.

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64
Q

What are some causes of CVA?

A

Intracerebral hemorrhage, emboli, atherosclerosis, compression of a tumor on a blood vessel.

No example sentence provided.

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65
Q

What are some risk factors for CVA?

A

High BP, high cholesterol, TIA, diabetes, smoking, obesity, alcohol, family history, or age.

No example sentence provided.

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66
Q

What can PET + SPECT determine at the onset of a stroke?

A

Perfusion defects

Show blood flow and metabolic abnormalities

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67
Q

What do CT + MRI show in relation to strokes?

A

Anatomic lesions

There has to be anatomic changes to show a CVA

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68
Q

What is a possible treatment for a stroke?

A

Medications that dissolve blood clots or prevent new ones from forming

A surgery to remove blood clots, prevent bicecling or, in some cases, to re-open the blocked arteries

Endarterectomy - surgery done to remove a clot or plaque

A rehabilitation program at a social facility or in the patient’s home to help recovery

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69
Q

What is a Transient Ischemic Attack (TIA)?

A

A temporary impaired blood supply to the brain for less than 24 hrs

TIA usually subsides within a few mins to hours

70
Q

What are some symptoms of a TIA?

A

Dizzy, weak, numb, paralysis, drooping of one side of face, headache and slurred speech

71
Q

Causes of transient ischemic attack (TIA)

A

Most are caused from atherosclerosis or emboli

Example sentence: A TIA can be caused by a blood clot traveling to the brain.

72
Q

Risk factors for TIA

A

Same as stroke

Example sentence: High blood pressure and smoking are common risk factors for both TIA and stroke.

73
Q

Percentage of TIA patients who will have a stroke within 5 years

A

43%

Example sentence: Nearly half of patients who experience a TIA will go on to have a stroke within 5 years.

74
Q

Alzheimer’s Disease

A

A disabling neurological disorder affecting 11% of the population over the age of 65

Symptoms are characterized by loss of memory and cognitive skills.

75
Q

Causes of Alzheimer’s Disease

A

Unknown

There is currently no known cause for Alzheimer’s Disease.

76
Q

Treatment for Alzheimer’s Disease

A

No cure, but drugs can help contain it and slow down progression

Effects of Alzheimer’s Disease are irreversible.

77
Q

Cerebral Palsy

A

A motor disorder resulting in muscular incoordination

There is damage to motor areas of the brain.

78
Q

Causes of Cerebral Palsy

A

Lack of oxygen during birth, hydrocephalus

Cerebral Palsy usually occurs before or during birth.

79
Q

Treatment for Cerebral Palsy

A

No cure, but training and therapy can help improve function

Example sentence: Physical therapy and occupational therapy can help individuals with Cerebral Palsy lead more independent lives.

80
Q

Causes of transient ischemic attack (TIA)

A

Most are caused from atherosclerosis or emboli

Example sentence: A TIA can be caused by a blood clot traveling to the brain.

81
Q

Risk factors for TIA

A

Same as stroke

Example sentence: High blood pressure and smoking are common risk factors for both TIA and stroke.

82
Q

Percentage of TIA patients who will have a stroke within 5 years

A

43%

Example sentence: Nearly half of patients who experience a TIA will go on to have a stroke within 5 years.

83
Q

Alzheimer’s Disease

A

A disabling neurological disorder affecting 11% of the population over the age of 65

Symptoms are characterized by loss of memory and cognitive skills.

84
Q

Causes of Alzheimer’s Disease

A

Unknown

There is currently no known cause for Alzheimer’s Disease.

85
Q

Treatment for Alzheimer’s Disease

A

No cure, but drugs can help contain it and slow down progression

Effects of Alzheimer’s Disease are irreversible.

86
Q

Cerebral Palsy

A

A motor disorder resulting in muscular incoordination

There is damage to motor areas of the brain.

87
Q

Causes of Cerebral Palsy

A

Lack of oxygen during birth, hydrocephalus

Cerebral Palsy usually occurs before or during birth.

88
Q

Treatment for Cerebral Palsy

A

No cure, but training and therapy can help improve function

Example sentence: Physical therapy and occupational therapy can help individuals with Cerebral Palsy lead more independent lives.

89
Q

What is epilepsy?

A

Is a neurological disorder it effects 1 out of 100 people

Epilepsy causes sudden, uncontrollable electrical surges in the brain.

90
Q

What are the effects of epilepsy?

A

Effects - seizures, brief interruptions in brain activity, periods of unawareness, may involve changes of consciousness, involuntary movement, muscle spasms or convulsions.

Treatment for epilepsy includes medications, special diets, or surgery.

91
Q

What can cause epilepsy?

A

Epilepsy can be caused by head trauma, infection, neurological disorders, and hereditary factors. People cannot swallow their tongues as epilepsy is not contagious.

92
Q

What is Parkinson’s Disease?

A

Is a progressive disorder of the CNS. Certain neurons are destroyed in the brain, which produce dopamine. An imbalance of neurotransmitter activity occurs.

The cause of Parkinson’s is unknown, but a defective gene has been found in some cases.

93
Q

What is hydrocephalus?

A

Occurs when fluid spaces in the brain are enlarged

The fluid spaces are the ventricles

94
Q

What are the 3 types of hydrocephalus?

A
  1. Communicating - CSF inside the ventricles ‘communicates’ or is open to the fluid spaces around the brain
  2. Non-communicating - obstruction in a ventricle
  3. Normal Pressure Hydrocephalus (NPH) - enlargement of a ventricle without increased pressure
95
Q

What causes communicating hydrocephalus?

A

CSF flows normally throughout the CNS but is not being reabsorbed

Causes build up in the ventricles

Usually caused by an infection (meningitis) that forms an obstruction

Can be treated with a shunt

Usually caused by an infection (meningitis) that forms an obstruction

96
Q

What causes non-communicating hydrocephalus?

A

CSF can’t ‘communicate’ outside the ventricle

CSF builds up within the ventricle

The ventricle doesn’t expand and pressure of CSF increases (usually caused by a tumor)

Usually caused by a tumor

97
Q

What is Normal Pressure Hydrocephalus (NPH)?

A

Enlargement of a ventricle without increased pressure

CSF within a ventricle increases

98
Q

Normal Pressure Hydrocephalus (NPH) causes:

A

Could be due to reabsorption problem or blockage with increased CSF the ventricles expanding, the ventricle expands the pressure of the CSF remains normal

99
Q

What are the main reasons for the decrease in Nuclear Medicine imaging of the brain?

A

Mainly due to the availability of CT + MRI

This answer highlights that the availability of CT and MRI has led to a decrease in Nuclear Medicine imaging of the brain.

100
Q

In what instances can Nuclear Medicine imaging be used for the brain?

A

Function and perfusion of cerebral abnormalities

CSF imaging

Nuclear Medicine imaging can be used for assessing function and perfusion of cerebral abnormalities, as well as for CSF imaging.

101
Q

What are the two groups into which brain imaging can be divided?

A

Planar Brain Imaging & SPECT Brain Imaging

Brain imaging can be divided into Planar Brain Imaging and SPECT Brain Imaging.

102
Q

What is an important characteristic of radiopharmaceuticals used in planar brain imaging?

A

They do not cross a normal (intact) BBB

Radiopharmaceuticals used in planar brain imaging do not cross a normal (intact) BBB.

103
Q

Where does 99mTc accumulate in the brain?

A

99mTc accumulates in the choroid plexus of the brain

99mTc accumulates in the choroid plexus of the brain, making imaging difficult in some situations.

104
Q

What can be administered to block the accumulation of 99mTc in the choroid plexus of the brain?

A

Oral Potassium Perchlorate

Oral Potassium Perchlorate can be administered to block the accumulation of 99mTc in the choroid plexus of the brain.

105
Q

When should Tc-99m DTPA be given before a brain scan?

A

30-60 minutes before the scan

Example sentence: Dose 15-25 mCi of Tc-99m DTPA in a brain scan by injection

106
Q

What is the imaging time range for Tc-99m DTPA?

A

0-4 hours, with 0 hours being for flow and 4 hours for brain lesions

107
Q

Does Tc-99m DTPA cross the BBB?

A

Does not cross the BBB

Example sentence: Dose of 15-20 mCi of Tc-99m DTPA will allow us to image at 0-60 minutes

108
Q

What is the target/nontarget ratio of Tc-99m DTPA?

A

Good target/nontarget ratio

Reasons: - Tc-99m DTPA clears the blood and into the brain rapidly - Tc-99mDTPA will also leave the body via urine quickly

109
Q

What is the dose range for Tc-99m Gluconsptonate (GH) and the imaging time range?

A

Dose of 10-20 mCi, and image from 0-4 hours

Example sentence: Going out 4 hours gives more time for accumulation in tumors

110
Q

What do 99mTc Radiopharmaceuticals have in common?

A

They all use 99mTc

Good for perfusion
Give similar imaging results
Give higher doses

111
Q

What are the differences between DTPA + GH

A

GH are more expensive
They are all good for flow studies but the time it takes for them to localize and allow for delayed images is different.
DTPA is the quickest -0-60 mins
Then GH -0-4 hours like regular Tc
Finally Tc-99m

112
Q

What are the characteristics of Thallium-201?

A

Dose - 2-3 mCi
Imaging time - 0-60 mins.
Not especially good for flow studies but localizes fairly well in METS

Example sentence: Thallium-201 is commonly used for myocardial perfusion imaging.

113
Q

Ga localization

A

Localizes in inflammatory and infectious areas

114
Q

Ga dose

A

Dose - 3-6mCi

No additional information

115
Q

Ga imaging timing

A

Imaging - 24-72 hrs

No additional information

116
Q

99mTc- Phosphate’s (MDP + HDP)

A

Good for differentiating cerebral infarcts

Dose:15-20 mCi
Imaging :0-4 hours

117
Q

Indications to use RP : 67 Ga/99mTc

A

Evaluate Brain: Perfusion, Brain Death, Evaluate stroke (CVA)

118
Q

Planar Brain Imaging

A

RP→ Depends on the indications

There is:

Patient Prep → No Prep for these studies

119
Q

Evaluate Localization of RP

A

Metastatic brain tumors
Cerebral infection
Cerebral inflammation

120
Q

Evaluate Localization of RP

A

Metastatic brain tumors
Cerebral infection
Cerebral inflammation

121
Q

What is the first step in Procedure Prep?

A

To keep brain function normal (not over-functioning)

Always use an IV and start the IV at least 20 min pre-injection. Have patient lie supine and still for at least 20 min pre-injection.

122
Q

What should be done in the Imaging room for Procedure Prep?

A

The Imaging room should be quiet and dimly lit. Keep the patient calm and still for at least 20 min pre-injection.

This helps in maintaining normal brain function.

123
Q

What does the Procedure consist of?

A

The Procedure consists of 2 phases: A dynamic study of rapid sequential images (Flow Study) and Immediate brain perfusion. Measures Regional Cerebral blood Flow. Delayed static images taken when the activity settles in the brain. Represents the distribution of the activity in the cerebral regions.

Usually 1-4 hours when using Tc based tracers.

124
Q

Flow Images

A

Patient should be positioned supine

Head strap may be used if necessary

125
Q

Camera positioning

A

Camera is usually positioned for an ANT image.

A bolus injection of 15-20 mci of imaging agent

126
Q

Injection technique

A

Use the oldendorf technique for your injection

127
Q

Timing of images for Flow Images

A

2-3 second images are obtained for 60 seconds

128
Q

Delayed Images

A

Patient is again supine and should remain as still as possible

Static images will start 20-60mins post injection

129
Q

Duration of Static Images

A

Static images can be taken out to 3-4 hours using the same agent

130
Q

Count for Images

A

Images will be taken for 500,000 counts

ANT, POST, R, +L LAT

131
Q

Consistency in counts and views

A

Remain consistent with your counts and views if delays at different times are taken

132
Q

Brain Death

A

Determines if any blood flow is going to the brain
Positive flow will show tracer in the carotids, but nothing in the cerebral arteries
Positive delay images will continue to not show activity in the brain
A positive scan will show some extracerebral activity

133
Q

Primary Brain Tumor

A

Will show as a single focus of activity
May or may not show on the flow
Depends on the blood flow to the tumor
Should show on delays
Depends on the rate of blood flow

134
Q

Metastases

A

Usually shows as multiple small focal hot spots
Will show on flow and delayed views depending on blood flow to the METS

135
Q

Cerebrovascular Disease

A

Will show an asymmetric flow (uneven)
Delays will show a wedge-shaped defect

136
Q

Inflammation or infection

A

Focal area of increased uptake with an area of decreased activity in the center
Called a Doughnut sign

137
Q

What are radiopharmaceuticals used for in SPECT brain imaging?

A

Rp used for SPECT imaging cross the BBB

BBB stands for blood-brain barrier.

138
Q

How do radiopharmaceuticals enter the brain in SPECT imaging?

A

They actually enter the brain substances

No additional information provided.

139
Q

Where do radiopharmaceuticals remain in the brain in proportion to?

A

They remain in the brain in proportion to the regional cerebral blood flow

Cerebral blood flow is abbreviated as CBF.

140
Q

Tc-99m HMPAO(Ceretec or exametazime) *The good

A

The good: this agent also has rapid first pass uptake
- The use of 99mTc enables a 20 mCi dose and is great for SPECT dose
-Once it is the brain it will not diffuse out it will remain until it decays

141
Q

Tc-99m HMPAO (Ceretec or exametaazime) * The Bad

A

Unstable in-vitro( outside the body)
Should be injected 30 mins after preparation

142
Q

____ is currently the RP of choice but there is another one dose on its tail

A

Ceretec

143
Q

Tc-99m ECD(Neurolite or Biscate) The Good:

A

More rapid clearance of the blood pool than Ceretec
Reducing background activity
Increasing target to non target ratio
More stable than ceretec
Longer post injection time

144
Q

Xe-133 is also good for brain imaging

A

It can be inhaled or dissolved in saline and injected either way it goes into the blood stream and goes to the brain.
-It localizes quickly in the brain and then washes out quickly allows us to measure rCBF

145
Q

Doses for Xe-133

A

1-10 mCi which is an average dose for SPECT the low energy of Xe-133 creates limitation for detection especially behind the skull.

146
Q

Sagittal

A

Cut Right to Left

147
Q

Coronal

A

Cut from front to back

148
Q

Transverse

A

Cut from top to bottom

149
Q

SPECT Brain Imaging Indications

A

Evaluate Cerebravascular disease( infraction hemorrhage TIA’s)
Evaluate dementia
Evaluate trauma
Locate seizure foci

150
Q

SPECT Brain Imaging Patient Prep

A

No patient prep

151
Q

SPECT Imaging Dose

A

Inject 20 mCi of 99mTc brain agent IV
The flow is optional-Inject a bonus if a flow is desired
SPECT images can be obtained 20 mins post injection with a 360 degree rotation
Then data is reconstructed to give Transverse/Coronal/Sagittal

152
Q

SPECT Brain Clinical Applications - Normal

A

Crosses the BBB and localizas proportional to blood flow
More blood to gray matter of the brain

153
Q

SPECT Brain Clinical Applications - Brain Death

A

Same principle as planar imaging
A little more sensitive than planar imaging
SPECT is not as dependant on the flow study

154
Q

SPECT Brain Clinical Applications - Brain Tumor

A

Localize a focal defect in both primary and metastatic lesions
Using same Tc-agents

155
Q

SPECT Brain Clinical Applications - Infarction

A

Will show as a reduced or no blood supply to a particular area

156
Q

SPECT Brain Clinical Applications - TIA

A

Temporary hypoperfusion defect
TA defects are time dependent
The longer you wait, the less sensitive the scan is to detect the effects of a TA
Will show as a reduced blood supply to a particular area.

157
Q

What should a normal SPECT brain look like?

A

Bilaterally symmetrical activity on the SPECT images
• Activity is also high in the regions corresponding to the basal ganglia and thalamus
• Regions between the basal ganglia and thalamus
• Regions between the basal ganglia and the convexity corresponding anatomically to cortical white matter and the ventricles have less activity
• SPECT images can be seen in a number of different color scales

158
Q

What does CSF imaging involve?

A

CSF runs around the brain and down the spinal column
We can image the fluid pattern in this system as well
• CSF imaging
• Cisternogram

Cerebral Spinal Fluid Imaging

159
Q

What is the most widely used radiopharmaceutical for CSF imaging?

A

In-111 DTPA

It has a longer half-life of 2.8 days images are commonly taken up to 72 hours, has abundant gamma emissions, mixes well, and has a good affinity for CSF.

160
Q

What are the indications for CSF imaging procedure?

A

Diagnose normal pressure hydrocephalus (NPH), identify CSF leaks, verify CSF shunt patency.

161
Q

How is In-111 DTPA administered for CSF imaging?

A

0.5 - 1.0 mCi injected intrathecally (lumbar). Indium-111 DTPA can be used for shunt patency.

162
Q

Who typically performs the injections for CSF imaging?

A

Injections are done by the doctor, usually the radiologist or neurologist.

163
Q

Is patient prep necessary for CSF imaging?

A

No patient prep is necessary.

164
Q

CSF Imaging Procedure

A

Procedure with the patient laying on their side, the doctor will inject intrathecal

22 gauge or smaller needle is recommended to minimize leaks

165
Q

Injection Location

A

Injection will be between the vertebrae L-2 or lower, and will go into the subarachnoid space

The patient needs to stay horizontal for 2 hours post injection. Pt movement can initiate headaches

166
Q

Image Acquisition

A

Images will be taken @ 2, 6, 24, 48, 72 hours if necessary. An initial image can be taken POST to verify the injection site

Patient will be positioned supine for the images. Images will be acquired for 100k to 200k counts.

167
Q

Noncommunicating Hydrocephalus

A

Since In-DTPA is mixed in with CSF, it should not normally flow in the ventricles. We cannot diagnose this using a lumbar puncture. However, if you must use In-DTPA, you can inject it directly into the ventricles. Not very common.

Example sentence: Sounds painful but it has been done.

168
Q

CSF Leaks

A

We can localize the site of the leak. Plugs can be placed in the nose or ears. This is a common spot for leaks. Then count the plugs. If activity shows up, there is your leak. This method is not very common either.

Additional information: This metrod is not very common either.

169
Q

Abnormal Radiopharmaceutical Flow

A

Shunt Patency. A shunt will drain CSF from the brain into other areas. By injecting into the shunt, we can watch the flow of the RP. An open shunt will show activity draining. An obstructed shunt will show retention of the tracer. Remember we can use 99mTc-DTPA due to the short duration of the study. 1-3 mCi given. 99mTc-DTPA. Can also be used 500 uCi of In-DTPA

170
Q

CSF RP Flow

A

-RP will ascend up the spinal column
-At 2-4 hours the RP should be in the basal cisterns
-From 6-24 hours the ascent of In-111-DTPA will continue up the Sylvia’s and interhemispheric fissures
-Activity will start into subdrachoid spaces (cerebral convexities)
-At 24 hours there should be complete ascent of the RP over the cerebral convexities
And some if not all activity will clear from the cisterns
-48 hours the RP should appear as a cap as it is completely filled into the sinuses
-When In-111 DTPA doesn’t follow the normal pattern different clinical applications may apply

171
Q

Normal Pressure Hydrocephalus

A

-111-In-DTPA should not enter lateral ventricles by 4-6 hours
-Persistent activity in the lateral ventricles at 24 -48 hours
-Delay in the ascent of activity from the parasagittal region
-Possible delayed clearance of activity from the basal cisterns
-Remember the CSF is created in the ventricles
-CSF should flow out of the lateral ventricles but not back in

Nuclear Med Class 2024 (14 decks)

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