Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NM By Myself > Hepatobiliary Cancer NM > Flashcards

Hepatobiliary Cancer NM Flashcards

1
Q

Hypervascular lesion in cirrhotic liver

A

HCC - - washout in portal phase
Dysplastic nodule - - no washout in portal phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hypervascular lesion in noncirrhotic liver
Benign

A

Hemangioma
Adenoma
FNH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypervascular lesion in noncirrhotic liver
Malignant

A

MTS from breast, NET, melanoma
Fibrolamellar carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hypovascular lesion
Unknown primary

A

Liver cyst - - density similar to water (0-15 HU), no enhancement
Liver abscess - - hypervascular rim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypovascular lesion
Known primary

A

Cystic - - MTS from mucinous colon, ovaries
Solid - - MTS from colon, pancreas, stomach, lung, renal, adrenal or liver involvement from lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Liver cancer M

A

Lung
Bone
Adrenal
Peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fibrolamellar carcinoma

A

Rare
Better prognosis
No cirrhosis
Younger
Sharp margins
central scar with calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Radiation induced liver disease

A

Dose >40 Gy
Max acceptable dose 35 Gy
Radiation dose to kill solid tumor >70 Gy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Radioactive I131-Lipiodol

A

Lipidic particles injected into hepatic artery - - retain in tumor by pinocytosis
75% liver, 25% lung
Thyroid block
Fixed activity 65 mCi
Hospitalization for 1 week
Risk - interstitial pneumonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Re188-Lipiodol

A

Inoperable large or multifocal HCC
Higher tumor killing efficacy
Lower toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ho166-Microspheres = QuiremSpheres

A

Predict distribution before therapy
Predict radiation dose to tumor and normal liver
Highest paramagnetic properties - - MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Y90-Microspheres

A

Inoperable primary or metastatic liver tumor
Embolization of precapillary vessels
T1/2 64.2h
Pure beta emitter 0.936 MeV
Pair production 511 keV - - PET
Mean tissue penetration 2.5mm, max 10 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Y90-Microspheres type

A

Glass - TheraSphere - - 20-30 microm, carry 2500 Bq per particle, 1.2 mln are injected, high specific activity, total activity 81 mCi
Resin-Sirtex - - 20-60 microm, carry 50 Bq per particle, 40-80 mln injected, low specific activity, total activity 3 GBq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SIRT patient selection

A

ECOG >2 - - not ideal candidate
Contra: total bilirubin >2.0 mg/dL, serum albumin <3 g/dL
Ascites - - poor hepatic reserve
Peritoneal MTS - - poor prognosis
Cross sectional imaging and arteriogram - - tumoral and non tumoral volume, portal vein potency, extent of extra hepatic disease, arteroportal shunt, liver to lung shunt
Prophylactic embolization of gastroduodenal artery and right gastric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pretreatment angiography

A

Tc-MAA inject into hepatic artery
SPECT within 1h
Later - - degradation of MAA, radioactivity in capillary, free pert in stomach - - overestimate liver to lung shunt
To avoid - Na-perchlorate PO 30 min before MAA injection
Tc-HAS - Microspheres - - within 4h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LSF

A

Highest tolerable dose to lungs 30 Gy (50 Gy for cumulative)
Geometric mean of anterior and posterior views
LSF=lung counts/(lung counts+liver counts) *100
LSF <10% - - no restriction
LSF >20% - - contra
LSF 10-15% - - reduce activity by 20%
LSF 15-20% - - reduce activity by 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Y90-Microspheres indication

A

Neoadjuvant before resection/transplant
Alternative in portal vein occlusion
Combi with bio therapy
Combi with chemo
Salvage treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Y90-Microspheres administration

A

Under fluoroscopic guidance during transcutaneous arterial catheterization trying to copy the same positioning
One lobe - - selective procedure
Specific segment - - super selective
Manually - - to avoid early full embolization
Iodine contrast + sterile water/glucose solution for resin and saline for glass
Continuous fluoroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Post SIRT image

A

SPECT based on Bremsstrahlung emission - - very poor quality
PET based on beta+ - - detection of extrahepatic distribution and estimation of absorbed dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tumor response assess

A

AFP
CECT in 1m
NECT every 3 m
PET in 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HCC SIRT

A

Response after TARE/SIRT - 6 m for reduction in tumor size
Changes in vascular enhancement in 2m
Too advanced to meet transplant criteria without malignant portal vein thrombosis or MTS - - TARE downstages - - transplantation
Portal vein thrombosis - - better survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Intrahepatic Cholangiocarcinoma TARE

A

Improve survival, downstage
Combi with chemo - - downstage - - resectable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Metastatic colorectal cancer TARE

A

Unresectable liver MTS on chemo
FDG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Metastatic NET TARE

A

Carcinoid, VIPoma, gastrinoma, somatostatinoma - - liver MTS well arterialized - - ideal candidate

25
Q

TARE/SIRT Contra

A

Absolute
Lung to liver shunt
Inability to prevent deposition of radiolabeled microspheres in GIT
HCC - distant MTS
Relative
Reduced pulmonary function
Poor functional liver reserve
Creatinine >2
PLT <75 - - Consider Lipiodol

26
Q

TARE/SIRT toxicities

A

Immediate - lymphopenia
Post-embolic sy - most common - fatigue, abd discomfort, pain, fever
Cholecystitis
Gastric Ulceration
Gastroduodenitis
Pancreatitis
Pneumonitis
RILD = radiation induced liver disease

27
Q

Intrahepatic Cholangiocarcinoma M

A

LN (celiac, paraaortic, paracaval)
Peritoneum
Lung
Bone
Brain

28
Q

Intrahepatic Cholangiocarcinoma risk

A

Age
Primary sclerosing Cholangitis
Smoke
Chronic ulcerative colitis

29
Q

Intrahepatic Cholangiocarcinoma

A

90% adenocarcinoma
Obstructive jaundice without malignancy - - elevated CA19-9 - - not persist after decompression
CA125–peritoneal involvement
CEA non specific
FNA of perihilar mass - - peritoneal seeding

30
Q

Pancreas Carcinoma M

A

Liver
Peritoneum

31
Q

Pancreas Carcinoma

A

No capsule - - early local spread
Perineural spread 80%
Majority from ductal structure
Head 60-70%
Body 20%
Tail 5%
Diffuse 10-20%

32
Q

Pancreas Carcinoma high risk

A

Borderline resectable
Elevated CA19-9
Large tumor
Large LN
Very symptomatic

33
Q

Pancreas Carcinoma resectable

A

No arterial contact
No contact with SMV or PV or <180° contact without vein contour irregularity
M0

34
Q

Pancreas Carcinoma unresectable

A

M1
Solid tumor contact with SMA or CA >180°
Unreconstructible SMV/PV due to tumor involvement or occlusion

35
Q

Post-op perivascular soft tissue thickening and induration

A

Local recurrence vs post op changes
Time for recurrence 20 m
Progressive thickening - - suspicious

36
Q

Liver abscess after surgery

A

Mimic MTS
Liver function abnormality
Double target sign

37
Q

Head and ulcinate tumor

A

Whipple = pancreatoduadenectomy

38
Q

Body and tail

A

Distal pancreatectomy + splenectomy

39
Q

HCC staging

A

CT preferred for MTS
MRI - local staging, most sensitive, gold standard in cirrhosis
Tc sulfur colloid - focal defect in cirrhosis
Hepatobiliary scan
Gallium scan
FDG - not recommended due to limited sensitivity

40
Q

Intrahepatic Cholangiocarcinoma FDG

A

Not for primary lesion
Limited if large fibrosis
Focal uptake + elevated CA19-9

41
Q

Pancreas imaging

A

CeCT - best for diagnosis and initial management
FDG - local extent and distant MTS esp high risk, recurrence vs fibrosis
Increased sensitivity for MTS if PET after CT
Generally increased uptake, unless mucinous
11% change management
False-negative: <8 mm, sugar >150

42
Q

Intrahepatic Cholangiocarcinoma resectable

A

Resectable - - LN at porta
Unresectable - - Celiac, retropancreatic, paraaortic LN

43
Q
A

HCC
Solitary large mass
well-defined margins
peripheral pseudocapsule

44
Q
A

Intrahepatic Cholangiocarcinoma
Arterial - peripheral contrast enhancement with progressive fill, early thick rim with patchy central enhancement
Portal - persistent enhancement, without nodular or globular pattern, > liver parenchyma

45
Q
A

MTS

46
Q
A

Cyst

47
Q
A

Hemangioma

48
Q
A

FNH

49
Q
A

MTS

50
Q
A

Hemangioma

51
Q
A

Adenoma

52
Q
A

Hemangioma

53
Q
A

Breast MTS

54
Q
A

Hemangioma

55
Q
A

FNH

56
Q
A

HCC

57
Q
A

Intrahepatic Cholangiocarcinoma

58
Q
A

MTS

59
Q
A

Pancreatic adenocarcinoma
Poorly enhancing
Hypoattenuating mass

NM By Myself (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions