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NM By Myself > Endocrine NM > Flashcards

Endocrine NM Flashcards

1
Q

Adrenal glands location

A

Retroperitoneum
Below diaphragm
Superior and medially to kidney
Between D12 and L1

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2
Q

Glomerular zone

A

Mineralcorticoid hormones
Aldosterone - - control BP

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3
Q

Fascicular zone

A

75% of cortex
Glucocorticoid
Cortisol - - glycemic control

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4
Q

Reticular zone

A

Androgens

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5
Q

Medulla

A

25% adrenal mass
From entoderm, chromaphine cells
Catecholamines
Adrenalin, noradrenalin
Degrade to metanephrines

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6
Q

Adrenal uptake

A

Analog of cholesterol (precursor of steroid hormones)
50% modulated by ACTH
30% by RAS

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7
Q

NP-59 protocol

A

I131-iodomethylnorcholesterol
1 mCi
II, IV, VII day image
High energy collimator
20-30 min, 500k-1mln counts
Photopeak 364 keV

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8
Q

NP-59 preparation

A

Thyroid block 3 days before

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9
Q

NP-59 uptake

A

Liver
Gallbladder
Colon (require laxative)
Add Tc-colloid - - taken up by liver - - subtraction - - adrenal visualization

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10
Q

NP-59 normal

A

Symmetric uptake of adrenal on II day
Right adrenal closer to liver - - scatter - - more active uptake

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11
Q

Scintadren

A

Se75-selenomethylnorcholesterol
0.16-0.22 mCi
Middle energy collimator

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12
Q

Cushing

A

Hypercortisolism - - image of cortex by NP-59
ACTH-dependent - - intense symmetric uptake in enlarged glands
Cortisol hypersecreting adenoma - - monolateral uptake, contralateral not visualized
Cortical nodular hyperplasia - - bilateral asymmetric uptake
Corticoadrenal CA - - lack of adrenal glands

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13
Q

Primary hyperaldosteronism

A

Conn sy
Corticoadrenal adenoma
Bilateral hyperplasia of glomerular zone
Carcinoma

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14
Q

Secondary hyperaldosteronism

A

Renin elevated
Arterial hypertension
Hypokalemia
Muscular disorders

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15
Q

ACTH suppression with dexamethasone

A

1-4 mg dexamethasone PO 7 days before and continue
Stop ACE inhibitor, spironolactone, diuretics
Cholesterol uptake in fascicular zone decreased
Good image of glomerular and reticular zone
DD adenoma vs bilateral hyperplasia

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16
Q

Image interpretation
Limitation
Indication

A

Normal - symmetric uptake 4-5 days after
Adrenal visualization before 4th day - - adenoma (unilateral) or hyperplasia (bilateral)
Not identify adenoma in case of hyperplasia
Primary hyperaldosteronism + normal CT

17
Q

Adrenal incidentaloma

A

Benign adenoma - <3 cm, fat, <10 HU
Atypical - hemorrhage, no fat, necrosis, calcification, larger
>4 cm - malignant
>10 HU - - relative washout >40%, abs washout >60% (adenoma)

18
Q

Adrenal MTS

A

Lung
Breast
Renal
Ovaries
GIT
Lymphoma
Melanoma

19
Q

Adrenal medulla pathology

A

Pheo
Paraganglioma

20
Q

MIBG

A

Guanethidine analog
WBS, SPECT 4h and 24h
Optimal for Pheo
Identify extra adrenal Pheo, MTS, post surgery recurrence

21
Q

I131-MIBG

A

Image >24 h
False negative

22
Q

I123-MIBG

A

Higher photon flux
Greater detection
Efficiency
Better spatial resolution
Lower radiation
Easier acquisition

23
Q

Octreoscan = In111-pentetriotide

A

Somatostatin analog
WBS, SPECT 4h and 24h, >24h for uptake on abdomen
Less sensitive for adrenal lesions due to high physiologic kidney uptake
More sensitive for Paraganglioma of head and neck
More accurate in MTS

24
Q

FDG

A

Not in protocol for Pheo

25
Q

FDOPA

A

Analog of dopamine precursor
Same specificity as MIBG
Better spatial resolution
Greater signal-to-noise ratio
Esp Pheo of head and neck

26
Q

Adrenal Ca genetic

A

Beckwith - Wiedeman - - in children
Li-Fraumeni - - mutation in p53 gene
MEN1 25-40%

27
Q

Suspicious adrenal Ca

A

> 4 cm
Irregular margins
Central necrosis/haemorrhage
Enhancement
Invasion
Calcification

28
Q

Adrenal Ca poor prognosis

A

> 50 years
Positive resection margins
N, M
Poorly diff

29
Q

Functioning adrenal Ca

A

<5 cm
Female
Cushing
Female virilization or male feminization
Conn sy

30
Q

Non-functioning adrenal Ca

A

> 10 cm
Male
Abd pain
Fullness
Palpable mass

31
Q

Adrenal Ca image

A

CT - study of choice to dd benign vs malignant
FDG - limited uptake in adenoma, increased uptake in cancer

32
Q

Most appropriate indication for Corticoadrenal scintigraphy

A

Cortisol hypersecreting adenoma

33
Q

Suppression with dexamethasone

A

Stop ACTH stimulation - - reduce uptake in fascicular zone
For hyperaldosteronism and hyperandrogenism

34
Q

Drugs interfere with MIBG

A

Tricyclic antidepressants
Antipsychotics
Beta blockers
Reserpine
Ca-channel blockers
Cocaine
Sympathomimetics

35
Q
A

NP-59 + Tc-colloid subtraction

36
Q
A

NP-59
Right adenoma

37
Q
A

NP-59
Bilateral hyperplasia

38
Q
39
Q
A

Octreoscan
Paraganglioma

NM By Myself (25 decks)

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