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NM By Myself > Lympha NM > Flashcards

Lympha NM Flashcards

1
Q

Chylous Ascites

A

Triglycerides >110 mg/dL
Total protein count 1.4-6.4 g/dL

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2
Q

Primary lymphedema

A

<0.5%
Congenital, during puberty, adult
Praecox/tardal

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3
Q

Familial form lymphedema

A

Milroy disease - early onset, VEGFR3
Meiges sy
Klippel - Trenaunay sy

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4
Q

Hereditary lymphedema

A

Lymphedema-distichiasis (double row of eyelashes)
FOXC2 gene

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5
Q

Genetic lymphedema

A

Turner sy
Noonan sy

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6
Q

Particles <100 nm

A

Enter lymphatic capillaries and transport to LN
Phagocytosis

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7
Q

Particles <30 nm

A

Migrate rapidly
Additional LN

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8
Q

Particles >100 nm

A

Trapped in interstitial compartment

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9
Q

Two compartment image

A

0.2-0.3 ml 11-18 MBq
Inject in epifascial and subfascial space (intramuscular)
Evaluate first deep and then superficial circulation

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10
Q

Lymphedema protocol

A

High resolution parallel hole collimator
12 cm/min

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11
Q

Transit time

A

Time to inguinal LN

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12
Q

Tracer appearance time

A

Time of drainage to locoregional LN
<10 min normal

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13
Q

Transport capacity

A

Clearance rate in first 2h
15% normal

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14
Q

Removal rate constant

A

Local lymph flow
Reduced by 25% if lymphedema

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15
Q

Depot clearance rate

A

Uptake index of left inguinal / right inguinal
Activity ratio at 2h

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16
Q

Abnormal pattern

A

Assymetrical lymphatic channels
Interrupted lymphatic vessel
Assymetrical or absent regional LN
Dermal flow
Dermal back flow

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17
Q

Main lymphatic vessel without collateral at 4h

A

Predictor for favourable response in patients with stage I

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18
Q

Lymph capillaries

A

Many anastomoses

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19
Q

Collecting lymphatic

A

Deep and superficial
Valves, smooth muscle wall

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20
Q

Lymphatic trunk

A

Right - from right upper body
Thoracic duct - rest of body
Drain into right and left subclavian veins

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21
Q

Acute phase of infection

A

Increased flow of lymph drainage
Weak LN visualisation

22
Q

Previous history of cellulite or lymphangitis

A

Low or no lymphatic flow
Obstruction of lymphatic collectors and thrombosis

23
Q

Radiocolloid uptake depends on

A

Particle size
Speed of drainage
Increase in venous pressure decrease concentration of leukocytes in lymph
Temperature and pH-dependent
Exercise increase lymph flow

24
Q

Deep injection

A

2 aliquotes on each side
Leg - first and second inter-metatarsal space 0.1 ml 7 MBq
Hand - second and third intermetacarpal space

25
Q

Superficial injection

A

15-18 MBq
2 aliquotes subdermally 1-2 cm proximally to interdigital web

26
Q

Colloid

A

All particles from 1 nm to 4 micrometer

27
Q

Tc-Nanocolloid

A

5-100 nm
95% <80 nm

28
Q

Sulfur colloid

A

15-5000 nm
Filtered 100-220 nm

29
Q

Tc-Antimony sulfide

A

3-30 nm
Less retained in SLN

30
Q

Breast cancer axillary dissection

A

80% no MTS

31
Q

Breast cancer axillary staging

A

Radioguided SLN biopsy

32
Q

Internal mammary chain

A

3% from deeper portions

33
Q

Tc-Tilmanocept

A

7.1 nm
Lymphoseek

34
Q

SLN breast protocol

A

5-30 MBq same day
Up to 150 MBq prior surgery
Peritumoral - gold standard (not for non palpable and multicentric)
Co57 point source

35
Q

SLN breast indication

A

T1 or T2
Older age
Obesity
Male breast cancer
DCIS with mastectomy
Before neoadjuvant

36
Q

SLN breast Contra

A

Inflammatory breast cancer

37
Q

Head and neck region

A

30% of all LN

38
Q

Oropharyngeal cancer

A

Injection intramucosally
15-120 MBq
0.1-0.2 mL

39
Q

Oropharyngeal cancer most frequent pitfall

A

Skin or mucosal contamination

40
Q

Invasion of at least one sample

A

Complete neck dissection

41
Q

Failure to visualise SLN oropharyngeal

A

Lower sensitivity for floor of mouth cancer

42
Q

Massive MTS in LN

A

False negative SLN

43
Q

Indication for oropharyngeal SLN

A

Early cancer with negative LN status by palpation and imaging
Stage T1 or T2 N0
Resectable tumor <4 cm

44
Q

Cervix SLNB

A

4 Peritumoral or periorificial
After conization - pericatricial

45
Q

Uterus SLNB

A

Periorificial or during hysterectomy around tumor or injection in myometrial or subserosal location during surgery

46
Q

SLNB gyn location

A

83% Daselers medial inguinal region
Minimum to lateral inferior groin

47
Q

SLNB gyn indication

A

Cervix Ia2, Ib1 and IIa1
Uterus Stage I and II high risk
Vulva Ib/II <4 cm N0
Vulvar melanoma

48
Q

SLNB gyn Contra

A

Suspected extrauterine involvement
Pathologic pelvic or paraaortic LN
History of surgery or radio of LN
General Contra

49
Q

SLNB penile indication

A

Non palpable LN
Only G3 tumor T2-T4

50
Q

SLNB penile

A

Intradermally around tumor or 2, 6, 10 o’clock
20 MBq for single day
40 MBq for 2-day protocol
Image 1 hour post injection, 1 hour before surgery
Co57 point source

NM By Myself (25 decks)

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