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NM By Myself > Lung NM > Flashcards

Lung NM Flashcards

1
Q

FDG in lung

A

Sarcoidosis
TB
Occult infection
Autoimmune fibrosis
Pneumonia
Cystic fibrosis
Acute lung injury
Acute RDS

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2
Q

Ga67-citrate

A

Cells with increased metabolic rate
Fe analog - - binds to transferrin receptor
Highly sensitive for FUO, sarcoidosis, idiopathic pulmonary fibrosis, Pneumocystis carinii/jirovecii pneumonia, drug induced pulmonary toxicity

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3
Q

Lung perfusion imaging

A

TC-MAA 15-100 microm - - microembolization - - lung perfusion
95% bound to MAA - - free Tc pert in stomach, thyroid
Shake vial, repeatedly invert syringe
Withdraw blood back into syringe - - microemboli - - hot spots

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4
Q

Lung perfusion dose

A

Adult - - 2-5 mCi - - 200-700k particles
Pulmonary hypertension or right-to-left shunt - - 100-200k particles
Inhomogenous distribution <100k particles
Children - - 1.11 MBq/kg (min 14.8 MBq) without ventilation or 2.59 MBq/kg with ventilation - - <0.3% of capillary bed (particles)

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5
Q

Pulmonary hypertension diagnostic criterion

A

Physiologic gradient of lung perfusion from base to apex in upright position and from back to front in supine position is altered

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6
Q

Tc-MAA injection

A

Patient keeps position for 4-5 min before administration
Cough - - several deep breaths before injection
Inject slowly 30s during 3-5 respiratory cycles
Not distal port of Swan-Ganz catheter or indwelling line or port with filter
Large matrix
Min 500k counts per view

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7
Q

Lung perfusion pregnant

A

2 days protocol
First perfusion with reduced activity
If normal - - avoid ventilation

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8
Q

Upright better

A

Increase chest cavity size
Minimize diaphragmatic motion

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9
Q

Low dose CT

A

Data for attenuation correction
Not during deep breath holding but tidal breathing

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10
Q

Lung ventilation with radioaerosol tracers

A

Tc-DTPA (highest dose), Tc-colloid, Tc-technegas (superior quality than DTPA and Xe)
Through mouth piece, nose occluded - - tidal breathing
COPD - - prefer Technegas
Upright while inhaling, supine acceptable
Ventilation before perfusion - - smaller amounts 20-40 MBq

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11
Q

Lung ventilation with radioaerosol
Disadvantage

A

Substantial airway disease - - turbulent airflow in central airways - - central deposition - - aerosol in major bronchi - - limit evaluation of alveoli

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12
Q

Ventilation with Xe133
Advantage

A

T1/2 5.3 days, gamma, some beta, 10-20 mCi
Single breath, wash-in or equilibrium and washout images
More complete characterization
More sensitive for COPD
Liver uptake because it is fat soluble - - fatty liver

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13
Q

Lung ventilation with Xe133

A

Room should be equipped with appropriate exhaust/trapping system for radioactive gas
Patient upright or supine, facemask or mouthpiece connected via bacterial filter to Xe delivery system
Breath in closed system for 3-4 min - - equilibrium phase
Usually before perfusion
After perfusion - - background activity from down scatter of 140 keV Tc with energy window 80 keV
Washout phase - - posterior oblique
High radiation burden - - not recommended

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14
Q

Ventilation with Kr81m
Advantage

A

All view without interference from prior perfusion due to gamma 190 keV - - better quality

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15
Q

Ventilation with Kr81m
Disadvantage

A

Short T1/2 of parent Rb81 4.5h - - breath continously from generator - - T1/2 13s
Low availability, high overall cost
Collimator with low septal penetration

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16
Q

Ga67 citrate scintigraphy

A

WBS - - 1.5-2 mln counts or 25-35 min
Min scan speed 6-8 cm/min
Spot views of chest - - 250k-1 mln counts or 5-20 min
At 48h remain in liver, spleen, bone, bone marrow, nasopharynx, lacrimal glands, thymus, breast

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17
Q

Acute PE ECG

A

Inversion of T waves in V1-V4
QR pattern in V1
S1Q3T3 pattern
RBBB
40% sinus tachycardia - in mild cases

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18
Q

Normal perfusion scan

A

Excludes PE

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19
Q

Focal perfusion defect

A

Tumor
Granuloma
Emphysema
Interstitial fibrosis
Bronchiectasis
Pneumonia consolidation
Atelectasis

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20
Q

Perfusion defect in PE

A

Wedge-shaped
Base facing pleura
Apex toward hilum
Around - forced perfusion due to redistribution of blood flow

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21
Q

PIOPED 2 criteria

A

Normal or not segmental match - - no acute PE
High probability - - >2 segmental perfusion defects with mismatch
Non diagnostic - - not typical multiple abnormalities

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22
Q

Match pattern

A

Reduced oxygen - - reduced blood flow
Preexisting parenchymal condition affecting both perfusion and ventilation - - PE unlikely

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23
Q

Mismatch pattern

A

Ventilation preserved area of reduced perfusion
Acute PE

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24
Q

Untreated or poorly treated acute PE

A

Chronic thromboembolic pulmonary hypertension

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25
Q

Recurring PE

A

> 30% death within 2 years

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26
Q

PE time line

A

Baseline scan - immediately (within 24h)
Soon after - at 1 and 4 weeks
At 3, 6, 12 months

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27
Q

Diffuse non segmental mismatch

A

Perfusion redistribution towards upper lung regions (ventilation less)
Left heart failure

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28
Q

Reverse mismatch

A

Ventilation worse than perfusion
Stripe sign
Pneumonia

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29
Q

Obstructive lung disease

A

inhomogenous
Ventilation more informative, but poor compliance
Convective ventilation from upper airways to bronchioles
Diffuse ventilation - - all remaining lung
Obstruction - - both components of ventilation are impaired

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30
Q

Asthma

A

Central deposition

31
Q

Chronic bronchitis and Emphysema

A

Inhomogenous deposition
Spotty distribution

32
Q
A

Central deposition
Asthma

33
Q
A

Spotty deposition
Emphysema

34
Q
A

Inhomogenous deposition
Normal

35
Q
A

Mixed deposition

36
Q
A

COPD

37
Q
A

Chronic PE or interstitial lung disease

38
Q
A

Ventricular septal defect

39
Q
A

Tumor

40
Q
A

תסנין דלקתי

41
Q
A

Chronic PE

42
Q

Interstitial lung disease

A

Inflammation, scarring, edema - - thickening of interstitium
Sarcoidosis - - bilateral pulmonary hilar and mediastinal lymphadenopathy
Ga67 citrate - - lambda sign, panda sign (lacrimal and parotid glands)

43
Q

Ga67 citrate limitations

A

Time consuming - - 48-72h after IV
Variability of image interpretation
Sensitivity and specificity variable
High radiation exposure

44
Q
A

Ga67 citrate vs FDG
Sarcoidosis

45
Q
A

Lambda sign
Panda sign

46
Q

Solitary pulmonary nodule

A

Round
diameter <3 cm
No lymphadenopathy
No Atelectasis
No Pleural effusion

47
Q

Benign pulmonary nodule

A

Mass stable for 2 years
Peripheral subpleural
Polygonal, smooth margins
Diffuse, central, laminated, popcorn calcification
Pure solid or ground glass
<15 HU

48
Q

Malignant pulmonary nodule

A

> 3 cm, growing mass
Lobulated margin
Corona radiata = thin spiculated edge
Any other calcification
Mixed solid and ground glass
Air bronchogram sign
15 HU

49
Q

Granulomatous disease

A

TB
Aspergillosis
Histoplasmosis
Sarcoidosis

50
Q

Benign tumor

A

Hamartoma
Pulmonary pseudotumor

51
Q

Malignant tumor

A

Peripheral bronchial carcinoma
Bronchoalveolar carcinoma
Multiple MTS
Carcinoid
Kaposi sarcoma
Lymphoma

52
Q

Other conditions. Solitary Pulmonary nodule

A

Septic embolism
Intra pulmonary LN
Arteriovenous malformation
Round atelectasis

53
Q
A

Air bronchogram
Bacterial pneumonia

54
Q
A

Central calcification

55
Q
A

1 - Pleural lesion
2 - pulmonary lesion
3 - Pleural effusion
4 - extrapleural lesion
5 - Pleural and chest wall involvement

56
Q

Anterior mediastinum 54%
5 Ts

A

Thymic mass
Thyroid or parathyroid
Terrible lymphoma
Teratoma
Thoracic aneurism

57
Q

Thymic mass

A

Thymoma 50%
Max transverse diameter 15 mm
Benign - - well define round mass with soft tissue enhancement
Invasive
Thymic cysts after chemo or radio - - from - 15 to +80 HU due to bleeding

58
Q

Lymphoma

A

Hodgkins - - single enlarged LN or large conglomerated mass, calcification after treatment
Non Hodgkin - - advanced disease

59
Q

Extra gonadal germ cell tumor

A

Dermoid cysts - round, capsule, hydric or cystic density
Teratoma - - calcification of ossification foci
Seminoma

60
Q

Thoracic aneurism

A

Ascending aorta >4 cm
Descending aorta >3 cm

61
Q

Middle mediastinum 20%

A

Lymphadenopathy - - normal size <10 mm in short transverse diameter - - subcarinal <15 mm
Vascular malformations
Congenital mediastinal cysts

62
Q

Congenital mediastinal cysts

A

Bronchogenic - - paratracheal or carinal location
Enteric
Esophageal duplication cyst - - not communicate with esophagus lumen
Pericardial cyst - - right cardiophrenic angle, water density

63
Q

Posterior mediastinum 26%

A

Neurogenic tumor - - schwannoma, neurofibroma paravertebral - - neuroblastoma, benign ganglioneuroma next to aortic arch or posterior pericardium
Foregut duplication cyst
Lymphoma
Lymphadenopathy
Extramedullary hematopoesis - - thalassemia, sickle cell anemia paravertebral, ass with splenomegaly

64
Q
A

Lymphoma

65
Q
A

Interstitial pneumonia

66
Q
A

Uptake in spleen and kidney, no stomach - - right-to-left shunt
Next step - - planar of brain

67
Q

Acute PE

A

Within minutes to few hours - - local bronchoconstriction + hypocapnia
Within 18-24h - - reduced production of surfactant distal to embolization - - shrinkage of alveolar space
40% normal saturation
20% normal alveolar-arterial oxygen gradient

68
Q

Modified PIOPED II

A
69
Q
A

Acute PE

70
Q

Perfusion defect persist 3 months

A

Less likely to resolve

71
Q

Count rate of second imaging

A

3-4 times count rate of first imaging

72
Q

DTPA vs Xe

A

Better photon flux
Acquisition of multiple projections
Xe is more sensitive in COPD

73
Q

How many capillaries blocked when perfusion scan with Tc MAA

A

<0.1%
1 in 1000 capillaries

NM By Myself (25 decks)

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