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CORE > NM > Flashcards

NM Flashcards

1
Q

PET –> how does it work?

A

1) radiotracer –> emit positron –> travel small distance in tissue
2) meet electron –> positron & electron annihilate
3) create two 511 keV photons –> travel 180 deg apart

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2
Q

PET –> what radiotracer?

A

Fluorine-18 fluorodeoxyglucose (F-18 FDG)

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3
Q

PET –> F-18 FDG –> MOA?

A

glucose analog –> GLUT1 & 3 -> transport into cells –> phosphorylated by hexokinase –> trapped in cell

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4
Q

F-18 –> half life?

A

110 min

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5
Q

standardized uptake value (SUV) –> proportional to what formula?

A

(ROI activity x body wt) / administered activity

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6
Q

PET: FDG uptake –> depend on what lab values?

A

serum glucose & insulin levels

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7
Q

PET: inc insulin –> what happen to FDG uptake?

A

inc uptake by muscle –> dec sensitivity for mild FGD-avid lesions

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8
Q

PET: how long NPO?

A

at least 4hr –> insulin at basal level

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9
Q

PET: blood glucose level should be?

A

<200 –> prefer

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10
Q

PET: inject F-18 FDG –> rest in quiet room –> how long?

A

1hr

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11
Q

PET –> effect of metformin?

A
  • inc colonic uptake

- small inc small bowel uptake

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12
Q

PET: salivary gland, tonsil, thyroid –> normal uptake?

A

symm –> mild-mod uptake

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13
Q

PET: bowel –> normal uptake?

A

diffuse –> mild-mod uptake

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14
Q

PET: heart –> normal uptake?

A

variable

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15
Q

PET: muscle –> normal uptake?

A
  • usu low
  • if elevated insulin –> inc uptake
  • if recent exercise –> inc uptake
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16
Q

PET: brown fat –> normal uptake? exacerbating factor?

A

mild-mod

cold

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17
Q

brown fat –> MC location?

A
  • supraclavicular

- intercostal

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18
Q

PET/CT –> evaluate what type of lung cancer? why?

A

only non-small cell lung cancer

small cell –> considered metastatic at dx

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19
Q

LN staging –> gold standard?

A

mediastinoscopy

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20
Q

PET –> malig LN –> sens? spec?

A
  • very sens

- not spec

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21
Q

pulm nodule –> smallest size that can be eval by PET?

A

8 mm

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22
Q

solitary pulm nodule –> not FDG avid –> next step?

A

short term f/u

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23
Q

solitary pulm nodule –> FDG avid –> next step?

A
  • bx

- resect

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24
Q

colon CA –> role of PET?

A
  • local colon cancer –> limited role

- good for mets eval

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25
Q

colon CA –> initial tx –> when can do f/u PET? why?

A

2mo

peritx period –> inc FDG uptake –> flare phenomenon

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26
Q

head/neck CA –> tx –> when can do f/u PET? why?

A

4mo

chemorad –> alter anatomy, inflamm –> dec specificity for recurrent dz

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27
Q

inc thyroglobulin –> whole body radioiodine scan –> neg –> next step?

A

PET –> look for thyroid CA:

  • undiff
  • medullary
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28
Q

PET –> lymphoma –> inc marrow uptake –> diffuse –> ddx? (3)

A
  • granulocyte colony-stimulating factor (G-CSF)
  • ctx –> rebound effect
  • malig marrow infiltration
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29
Q

esophagus CA –> role of PET?

A

ID mets –> not surg candidate

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30
Q

esophagus CA –> initial neoadjuvant tx –> dec FDG avid by how much –> favorable prognosis?

A

at least 30%

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31
Q

esophagus CA –> initial neoadjuvant tx –> unchanged FDG avid –> indicates what in terms of tx?

A

ctx ineffective –> stop ctx

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32
Q

cancers w limited role for PET? (4)

A
  • HCC
  • RCC
  • bladder CA
  • prostate
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33
Q

HCC –> limited role for PET –> why?

A

high phosphatase –> dephosphorylate FDG –> FDG diffuse out of cells

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34
Q

bladder CA –> limited role for PET –> why?

A

surrounding high urine FDG uptake

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35
Q

LV perfusion imaging –> evaluates what?

A

blood flow to myocardium

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36
Q

LV perfusion imaging –> perfusion abnormality –> factors to eval? (5)

A
  • ir/reversible?
  • size?
  • severity: mild (subendocardial), mod, severe (transmural)?
  • coronary A territory?
  • assoc abnormalities? –> RV uptake, ischemia dilation, wall motion abnormal?
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37
Q

LV perfusion imaging –> stress –> 3 methods?

A
  • physical –> treadmill
  • pharmacologic-adrenergic –> dobutamine
  • pharmacologic-vasodilatory –> dipyridamole, adenosine
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38
Q

myocardial perfusion imaging –> indications? (6)

A
  • eval acute chest pain
  • eval hemodynamic significance of coronary stenosis
  • risk stratification after MI
  • preoperative risk assessmt for noncardiac surg
  • eval viability prior to revasc therapy
  • eval myocardial revasc s/p CABG
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39
Q

risk stratification after MI –> myocardial perfusion imaging –> “high risk” findings? (5)

A
  • sig peri-infarct ischemia
  • defect in diff vascular territory –> mult-vessel dz
  • sig lung uptake –> LV dysfx
  • LV aneurysm
  • low EF <40%
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40
Q

what is “hibernating” myocardium?

A

myocardium:
- hypoperfused
- viable

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41
Q

myocardial viability imaging –> 2 methods?

A
  • # 1 F-18 FDG PET

- thallium-201 perfusion imaging

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42
Q

myocardium –> region of perfusion defect –> FDG uptake –> dx? tx?

A

viable myocardium –> CABG or percutaneous intervention

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43
Q

myocardium –> region of perfusion defect –> no FDG uptake –> dx?

A

non-viable scar –> medical therapy only

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44
Q

radionuclides used in nuclear cardiology? (5)

A
  • thallium-201
  • technetium-99m sestamibi (cardiolite)
  • rubidium-82
  • nitrogen-13 ammonia
  • F-18 FDG
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45
Q

thallium-201:

  • half life?
  • decay?
  • charact Xray?
  • MOA?
A
  • 73hr
  • electron capture
  • 69-81 keV
  • potassium analog –> ATP-dep Na-K transmembrane pump –> into cell –> uptake directly proportional to myocardial perfusion
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46
Q

thallium-201 –> myocardial perfusion imaging –> max exercise –> perfusion defect –> at least what % stenosis?

A

50%

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47
Q

thallium-201 –> undergoes redistribution –> T/F?

A

T

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48
Q

technetium-99m sestamibi (cardiolite) –> undergoes redistribution –> T/F?

A

F

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49
Q

technetium-99m sestamibi (cardiolite) –> MOA?

A

passive diffusion –> into cell –> bind to mitochondrial membrane proteins –> uptake proportional to myocardial perfusion

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50
Q

rubidium-82:

  • half life?
  • decay?
  • MOA?
  • perfusion vs viability?
A
  • 76 sec
  • positron
  • potassium analog
  • perfusion
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51
Q

rubidium-82 –> type of stress –> exercise vs pharmacologic –> why?

A

pharm only –> very short half life

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52
Q

nitrogen-13 ammonia:

  • half life?
  • decay?
  • perfusion vs viability?
A
  • 10min
  • positron
  • perfusion
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53
Q

myocardial imaging –> nitrogen-13 ammonia –> pro (2) vs con (2)?

A

pro:
- don’t travel far in tissue –> high resolution
- short half-life –> can give lrg dose

con:
- short half life –> must be produced by cyclotron on-site
- pharm stress only

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54
Q

F-18 FDG:

  • half life?
  • decay?
  • perfusion vs viability?
A
  • 110 min
  • positron
  • viability only –> must correlate w sestamibi perfusion study
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55
Q

myocardial perfusion study:

  • NPO how long? why?
  • should stop what meds? why?
A

NPO 6hr –> dec splanchnic blood flow –> reduce liver/bowel uptake

hold CCB/BB –> allow to reach target HR

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56
Q

myocardial perfusion study –> stress –> max heart rate? target heart rate?

A

max HR = 220 bpm - age

target HR = 85% of max HR

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57
Q

myocardial perfusion study –> dipyridamole –> MOA?

A

adenosine deaminase inh –> adenosine accumulate –> vasodilate –> coronary blood flow inc 3-5x

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58
Q

myocardial perfusion study –> dipyridamole –> what subst must be held for 24hr prior to study? (2) why?

A
  • theophylline
  • caffeine

reverse effects of dipyridamole

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59
Q

myocardial perfusion study –> dipyridamole –> antidote?

A

aminophylline

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60
Q

myocardial perfusion study –> differentiate: dipyridamole vs adenosine (3)

A

adenosine:
- same effect as dipyridamole
- faster effect
- very short half life –> no reversal agent required

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61
Q

myocardial perfusion study –> regadenoson –> MOA? pro compared to adenosine?

A

adenosine receptor agonist –> vasodilate

easier to administer than adenosine

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62
Q

myocardial perfusion study –> dobutamine –> MOA?

A

B1 agonist –> inc myocardial O2 demand

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63
Q

myocardial perfusion study –> dobutamine –> indication?

A

adenosine contraindicated:

  • severe asthma
  • COPD
  • recent caffeine
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64
Q

Tc-99m sestamibi perfusion study –> when image after injection (min)? why?

A

30min after inject –> allow liver activity to clear

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65
Q

Tc-99m sestamibi perfusion study –> gated SPECT show wall motion at time of what? perfusion imaging shows perfusion at time of what?

A

gated SPECT –> wall motion at time of imaging

perfusion imaging –> perfusion at time of inject

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66
Q

cardiac imaging –> Tc-99m sestamibi perfusion study vs PET perfusion –> which has grter sens, spec, accuracy?

A

PET perfusion

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67
Q

myocardial imaging –> significant RV uptake –> ddx? (2)

A
  • R heart dz

- pHTN

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68
Q

myocardial imaging –> pulm uptake –> ddx? (1)

A

LV dysfx

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69
Q

myocardial imaging –> stress –> LV dilate –> ddx? (1)

A

transient ischemic dilation (TID) –> 3-vessel dz (even if no focal defect)

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70
Q

myocardial imaging –> what is a small perfusion defect? med? large?

A
  • small: 1-2 segmts
  • med: 3-4
  • lrg: >5
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71
Q

myocardial imaging –> fixed perfusion defect –> ddx? (2)

A
  • myocardial scar

- hibernating myocardium

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72
Q

LV –> vertical vs horizontal long axis –> U-shape point in which direction?

A
  • vertical: U to the left

- horizontal: U point down

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73
Q

I-131:

  • half life?
  • decay?
  • how produced?
A
  • 8day
  • beta particles & gamma photon (364 keV)
  • generator
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74
Q

I-131 –> use?

A

therapy only:

  • thyroid cancer s/p thyroidectomy
  • hyperthyroid (Graves, multinodular goiter)
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75
Q

I-123:

  • half life?
  • decay?
  • how produced?
  • mode of administration?
A
  • 13hr
  • electron capture & gamma photon (159 keV)
  • cyclotron
  • PO
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76
Q

I-123 –> use?

A

thyroid imaging

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77
Q

thyroid –> radiotracers? (3)

A
  • I-131
  • I-123
  • Tc-99m pertechnetate
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78
Q

Tc-99m pertechnetate:

  • half life?
  • decay?
  • mode of administration?
A
  • 6hr
  • gamma photon (140 keV)
  • IV
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79
Q

thyroid radiotracers –> ok during pregnancy? why?

A

no –> cross placenta –> taken up by fetus

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80
Q

when can resume breastfeeding?

  • I-131
  • I-123
  • Tc-99m
A
  • I-131: never
  • I-123: 2-3 days after administration
  • Tc-99m: 12-24hr
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81
Q

I-131/I-123 therapy/imaging –> patient pre-procedure prep? why?

A

non-suppressed TSH (high TSH level):

  • stop exogenous thyroid hormone for 4wk
  • 2 IM injection of TSH

inc thyroid uptake of radiotracer

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82
Q

ectopic thyroid tissue –> 3 types?

A
  • lingual thyroid
  • retrosternal thyroid (substernal goiter)
  • ovarian teratoma (struma ovarii)
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83
Q

ectopic thyroid tissue –> imaging options? (2)

A
  • I-123

- Tc-99m

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84
Q

thyroid nodule –> cytology indeterminate –> next step?

A

nuclear imaging

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85
Q

thyroid nodule –> hyperfxing –> ddx? (1)

A

benign adenoma

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86
Q

thyroid nodule –> cold –> ddx? (2)

A
  • 70-75% benign colloid cyst

- 20% malig

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87
Q

thyroid nodule –> warm –> ddx? (1)

A

cold nodule –> overlapping thyroid tissue

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88
Q

thyroid nodule –> warm –> next step?

A

oblique view –> still indeterminate –> bx

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89
Q

what is discordant thyroid nodule? next step?

A
  • Tc-99m –> hot –> can uptake technetium
  • I-123 –> cold –> can’t trap iodine

may be malig –> bx

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90
Q

thyroid imaging –> normal 6hr uptake? 24hr?

A
  • 6hr –> 6-18%

- 24hr –> 10-30%

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91
Q

Graves dz –> thyroid imaging –> dec/normal/inc?

  • 6hr uptake
  • 24hr
A
  • 6hr –> elevated

- 24hr –> elevated

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92
Q

thyroid imaging –> how can differentiate if I-123 vs Tc-99m?

A

Tc-99m –> salivary uptake

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93
Q

Graves dz –> how can differentiate if I-123 vs Tc-99m?

A

often not possible –> thyroid uptake too strong –> salivary glands often not seen

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94
Q

Graves dz –> definitive tx? MC?

A
  • # 1 I-131

- surg

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95
Q

MC inflamm dz of thyroid?

A

Hashimoto thyroiditis

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96
Q

Hashimoto thyroiditis -> thyroid scan –> appearance?

A
  • diffuse inc activity (like Graves)

- patchy uptake (like MNG)

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97
Q

subacute thyroiditis –> thyroid imaging –> dec/normal/inc?

  • 6hr uptake
  • 24hr
A
  • 6hr –> dec

- 24hr –> slight inc

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98
Q

thyroid cancer –> thyroidectomy –> 1-2mo later –> I-131 tx –> goal?

A

image + trt:

  • residual dz
  • potential mets
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99
Q

I-131 –> low dose (<30 mCi) vs high dose (100-200) –> indication?

A

low risk pt –> low dose:

  • <1.5 cm
  • no invasion of thyroid capsule

risk high –> high dose

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100
Q

thyroid cancer –> s/p I-131 ablation –> monitor?

A

follow thyroglobulin levels

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101
Q

thyroid cancer –> s/p I-131 ablation –> inc thyroglobulin –> next step?

A

I-123 scan –> assess for dz recurrence/mets

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102
Q

thyroid cancer –> s/p I-131 ablation –> inc thyroglobulin –> I-123 scan positive –> next step?

A

repeat I-131 ablation

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103
Q

thyroid cancer –> s/p I-131 ablation –> CI to monitor with thyroglobulin levels?

A

presence of anti-thyroglobulin Ab

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104
Q

Graves dz –> I-131 tx –> CI? (3)

A
  • preg
  • lactation
  • unable to comply w radiation safety guidelines
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105
Q

I-131 tx –> Graves dz vs multinodular goiter –> # of tx?

A
  • Graves –> single dose

- MNG: mult tx may be required

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106
Q

parathyroid imaging –> radiotracer?

A

Tc-99 sestamibi

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107
Q

nuclear imaging –> parathyroid –> indication?

A

localize suspected parathyroid adenoma

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108
Q

nuclear imaging –> parathyroid adenoma –> findings?

A
  • early phase: inc uptake

- delayed phase: persistent retained activity

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109
Q

nuclear imaging –> thyroid adenoma –> findings?

A
  • early phase: inc uptake

- delayed phase: washout

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110
Q

Tc-99m sulfur colloid –> uptake by what tissues?

A

reticuloendothelial cells:

  • # 1 liver –> Kupffer cells
  • # 2 spleen
  • # 3 BM
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111
Q

Tc-99m sulfur colloid:

  • Tc-99m physical half life?
  • sulfur colloid biologic half life?
A
  • Tc-99m: 6hr

- sulfur colloid: 2-3min

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112
Q

sulfur colloid scan –> what is photopenic defect? MCC?

A

complete absence of radiotracer

hepatic cyst

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113
Q

sulfur colloid scan –> focal dec uptake –> ddx? (3)

A

most hep mass:

  • HCC
  • adenoma
  • abscess
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114
Q

sulfur colloid scan –> focal inc uptake –> ddx? (3)

A
  • focal nodular hyperplasia
  • liver cirrhosis –> regenerating nodule
  • Budd-Chiari (hep V thrombosis) –> late stage –> inc uptake in caudate lobe
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115
Q

sulfur colloid scan –> what is colloid shift? ddx? (1)

A

spleen & BM –> inc sulfur colloid

liver dysfx –> #1 cirrhosis

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116
Q

sulfur colloid scan –> diffuse pulm uptake –> ddx? (4)

A

nonspecific:
- cirrhosis
- COPD w infx
- Langerhans cell histiocytosis
- high aluminum (antacids, excess Al in colloid preparation)

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117
Q

sulfur colloid scan –> focal nodular hyperplasia (FNH) –> appearance? (3)

A
  • normal liver (contain Kupffer cells)
  • inc uptake (Kupffer cells + hypervasc)
  • photopenic defect (insuff colloid concentration)
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118
Q

focal nodular hyperplasia (FNH) –> nuclear imaging options? (2)

A
  • sulfur colloid scan

- HIDA

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119
Q

focal nodular hyperplasia (FNH) –> HIDA finding?

A

contain bile ductules –> positive on HIDA

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120
Q

intra-pancreatic spleen –> nuclear imaging options? (2)

A
  • sulfur colloid scan

- Tc-99m damaged red cell study

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121
Q

GI bleed –> nuclear imaging options? (2)

A
  • Tc-99m labeled RBCs

- Tc-99m sulfur colloid

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122
Q

GI bleed –> Tc-99m sulfur colloid study –> cons? (2)

A
  • sig prep time

- vasc half-life 2-3min –> rapid blood clearance

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123
Q

GI bleed –> Tc-99m labeled RBCs study –> in vitro vs in vivo –> which is more commonly used? why?

A

1 in vitro –> 95% labeling efficiency

in vivo –> worse labeling eff –> free pertechnetate –> noisier images

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124
Q

GI bleed –> tagged RBC study vs IR angiography –> can detect bleeding rate of?

A
  • tagged RBC: 0.2 ml/min

- IR angio: 1 ml/min

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125
Q

GI bleed –> tagged RBC study –> appearance?

A

activity –> over time –> peristalsis of intraluminal blood –> change shape & position

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126
Q

Tc-99m pertechnetate –> localize to what tissue?

A

gastric mucosa

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127
Q

Meckel diverticulum –> radiotracer?

A

Tc-99m pertechnetate

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128
Q

Meckel diverticulum –> Tc-99m pertechnetate study –> finding?

A
  • RLQ –> focal inc activity

- lat view –> activity is ant, not post

129
Q

RLQ pain –> suspect Meckel diverticulum –> Tc-99m pertechnetate study –> diffuse regional inc uptake –> ddx? (2)

A

hyperemia:
- appendicitis
- intussusception

130
Q

Meckel diverticulum –> embryology?

A

omphalomesenteric duct remnant

131
Q

HIDA scan –> radiotracer?

A

Tc-99m iminodiacetic acid (IDA)

132
Q

HIDA scan –> disofenin vs mebrofenin:

  • max bili level?
  • % hep uptake?
A

disofenin:
- bili 20 mg/dL
- 90% hep uptake

mebrofenin:
- 30
- 98%

133
Q

HIDA scan: NPO how long?

A
  • must have eaten within 24hr

- NPO 6hr

134
Q

HIDA scan: NPO for >24hr –> next step?

A

cholecystokinin –> empty GB –> wait 2hr –> HIDA scan

135
Q

HIDA scan –> gallbladder visualized –> dx?

A

no acute cholecystitis

136
Q

HIDA scan –> 1hr –> gallbladder NOT visualized –> next step? why?

A

morphine –> contract sphincter of Oddi –> redirect bile into cystic duct

137
Q

HIDA scan –> 1hr –> gallbladder NOT visualized –> can’t give morphine in what situation? why?

A

tracer –> nonvisualized in small bowel

theoretical risk of worsening potential CBD obstruction

138
Q

HIDA scan –> 1hr –> gallbladder NOT visualized –> morphine –> when image again?

A

30min

139
Q

HIDA scan –> 1hr –> gallbladder NOT visualized –> morphine allergy –> next step?

A

image for total 4hr

140
Q

HIDA scan –> tracer in small bowel –> indicates?

A

patent CBD

141
Q

HIDA scan –> 1hr –> gallbladder NOT visualized –> morphine –> 30 min –> gallbladder NOT visualized –> next step?

A

finished

86-98% sens for acute cholecystitis

142
Q

6% –> false positive HIDA (GB non-visualized WITHOUT acute cholecystits) –> ddx (7)

A
  • recent meal or prolong fasting
  • admin CCK immed prior to exam –> persistent sphincter of Oddi relaxation
  • total parental nutrition
  • pancreatitis –> biliary stasis
  • severe illness
  • chronic cholecystitis
  • cholangioCA of cystic duct
143
Q

HIDA scan: what is rim sign?

A

inc hep activity surrounding GB fossa:

  • hyperemia
  • gangrenous cholecystitis
144
Q

very rare –> false negative HIDA (GB non-visualized WITHOUT acute cholecystits) –> ddx (3)

A
  • acalculous cholecystitis w patent cystic duct
  • duodenal diverticulum –> simulate GB
  • biliary cyst –> simulate GB
145
Q

what is chronic cholecystitis?

A

GB –> longstanding inflamm:

  • loss of GB fx
  • inc risk of stone formation
146
Q

chronic cholecystitis –> HIDA MC finding?

A

normal

147
Q

HIDA scan –> finding suggestive of chronic cholecystitis?

A

low GB ejection fraction <35%

148
Q

biliary leak –> nuclear imaging option? (1)

A

HIDA scan

149
Q

biliary leak –> HIDA scan –> what can do to inc detection?

A

do study in R lat decubitus position –> promote dep pooling of bile

150
Q

severe hepatic dysfx –> HIDA scan –> findings? (2)

A
  • very poor hep uptake

- delayed blood pool clearance

151
Q

hepatic mass –> HIDA scan –> finding?

A

focal photopenic defect

152
Q

V/Q scan –> radiotracers? (3)

A
  • Tc-99m-MAA –> perfusion
  • Xenon-133 –> vent
  • Tc-99m DTPA –> vent
153
Q

V/Q scan –> Tc-99m-MAA –> who should get half dose? (4)

A
  • child
  • preg
  • mild pHTN
  • R-L shunt
154
Q

V/Q scan –> Tc-99m-MAA –> relative CI? (1) why?

A

severe pHTN

obstruct pulm capillaries –> clinical worsening

155
Q

V/Q scan –> Tc-99m-MAA –> what is clumping of MAA?

A

MAA –> inadvertently drawn back into syringe –> coagulation w pt blood

156
Q

V/Q scan –> Tc-99m-MAA –> renal uptake –> ddx? (2) how differentiate?

A

free pertechnetate:

  • thyroid uptake
  • no brain uptake

R-L shunt:

  • no neck uptake
  • brain uptake
157
Q

Xenon-133:

  • physical half life?
  • biological half life?
  • decay?
  • critical organ?
A
  • physical half life: 5.3day
  • biological half life: very short
  • decay: gamma photon & beta emitter
  • critical organ: trachea
158
Q

preg –> PE –> CTA PE vs V/Q scan –> fetal rad dose?

A

CTA: similar to slightly higher than VQ

159
Q

PIOPED II –> high probability for PE?

A

> 2 large (>75% segmt) mismatched segmental defect –> no assoc XR abnormality

160
Q

PIOPED II –> intermediate probability for PE? next step?

A

1 lrg segmtal mismatched perfusion defect

not clinically helpful –> further imaging required

161
Q

VQ scan –> lower lung –> what is triple match? dx?

A

perfusion defect –> vent defect –> matching abnormality on CXR ==> intermediate probability

162
Q

PIOPED II –> low probability for PE? (3)

A
  • 1 mod-lrg MATCHED defect
  • > 3 small segmental lesions
  • entire lung –> no perfusion
163
Q

PIOPED II –> very low probability for PE? (3)

A
  • nonsegmtal lesion
  • stripe sign
  • mid-upper lung –> 1 triple match defect
164
Q

VQ scan –> what is stripe sign?

A

perfusion defect –> thin line of MAA uptake bw defect & pleura –> intervening perfused lung

165
Q

VQ scan –> possible impressions? (5)

A
  • normal
  • very low prob
  • low prob
  • interm
  • high
166
Q

bone scan –> radiotracer?

A

Tc-99m MDP

167
Q

bone scan –> diffuse soft tissue uptake –> ddx? (1)

A

renal fail

168
Q

bone scan –> 3 phases?

A
  • angiogram (flow): eval blood flow
  • blood pool: eval extracellular distribution
  • delayed (skeletal)
169
Q

cancer pt –> bone scan –> 1 rib –> focal uptake –> low/high probability of mets?

A

low (10%)

170
Q

cancer pt –> bone scan –> 2 adj rib –> uptake in similar location–> low/high probability of mets? ddx? (1)

A

low

trauma

171
Q

cancer pt –> bone scan –> mult adj photopenic lesions –> low/high probability of mets? ddx? (3)

A

low

  • infarction
  • avascular necrosis
  • sequela of rad tx
172
Q

breast cancer pt –> bone scan –> 1 sternal lesion –> low/high probability of mets?

A

high

173
Q

cancer pt –> bone scan –> multifocal lesions in nonadj ribs –> low/high probability of mets?

A

high

174
Q

cancer pt –> bone scan –> 1 photopenic lesion –> low/high probability of mets?

A

high

175
Q

bone scan –> inc uptake in brain –> ddx? (1)

A

recent infarct

176
Q

bone scan –> inc uptake in heart –> ddx? (1)

A

recent infarct

177
Q

soft tissue mets –> positive on bone scan –> ddx? (4)

A

Ca-containing:

  • osteosarcoma
  • neuroblastoma

mucin-producing:

  • GI
  • ovarian
178
Q

inflamm dz –> bone scan –> uptake in soft tissues & muscles –> ddx? (3)

A
  • myositis ossificans
  • dermatomyositis
  • rhabdomyolysis
179
Q

bone scan –> what is superscan?

A

diffuse inc osseous uptake

180
Q

bone scan –> superscan –> ddx? (4)

A
  • # 1 metastatic prostate Ca
  • breast Ca
  • lymphoma
  • hyperPTH
181
Q

positive bone scan –> which bone tumors? (3)

A
  • osteosarcoma
  • Ewing sarcoma
  • osteoid osteoma
182
Q

bone scan –> double density sign –> ddx? (3)

A
  • osteoid osetoma
  • Brodie abscess
  • stress fx
183
Q

fx –> bone scan appearance:

  • acute (up to 3-4wk)
  • subacute (up to 2-3mo)
  • chronic
A
  • acute: 1day after injury –> uptake surrounding fx
  • subacute: more focal uptake
  • chronic: gradual dec uptake
184
Q

what is medial tibial stress synd (shin splint)?

A

exercise-induced stress injury that occurs at the medial tibial mid-to-distal shaft

185
Q

medial tibial stress synd (shin splint) –> bone scan appearance?

A
  • blood flow phase: normal
  • blood pool phase: normal
  • delayed: tibia –> postmed –> linear inc uptake
186
Q

osteoporosis –> sacrum –> insuff fx –> bone scan finding?

A

“Honda” sign –> sacrum –> H shaped uptake

187
Q

bone scan –> indications? (9)

A
  • bony mets
  • bone tumor
  • fx
  • jt prosthesis –> loose or infx
  • osteomyelitis
  • hypertrophic pulm osteoarthropathy
  • AVN
  • Paget
  • complex regional pain synd (reflex sympathetic dystrophy)
188
Q

cemented jt prosthesis –> bone scan –> normal appearance?

A

up to 1yr –> activity around prosthesis

189
Q

non-cemented jt prosthesis –> bone scan –> normal appearance?

A

up to 2yr –> activity around prosthesis

190
Q

hip prosthesis –> bone scan –> finding suggestive of loosening?

A

focal activity at lesser trochanter

191
Q

hip prosthesis –> bone scan –> finding suggestive of osteomyelitis?

A

generalized inc activity

192
Q

hip prosthesis –> bone scan –> grter trochanter/intertrochanteric region –> mild-mod activity –> ddx? (1)

A

heterotopic ossification

193
Q

normal XR –> bone scan –> positive on all 3 phases –> dx?

A

osteomyelitis

194
Q

methods to inc specificity for osteomyelitis? (2)

A
  • WBC imaging + Tc-99m sulfur colloid BM scan

- gallium-67 scan

195
Q

WBC imaging –> radiotracer? (2)

A
  • Indium-111 - WBC

- Tc-99m - WBC

196
Q

WBC imaging + Tc-99m sulfur colloid BM scan –> indication? (1)

A

underlying abnormality –> ie fx, prosthesis –> eval for osteomyelitis

197
Q

osteomyelitis –> WBC imaging + Tc-99m sulfur colloid BM scan –> appearance?

A

focal WBC activity –> no colloid activity

198
Q

osteomyelitis –> gallium-67 scan –> appearance?

A

area of concern:

  • bone scan –> inc activity
  • gallium scan –> high inc activity
199
Q

cellulitis –> bone scan findings?

A
  • blood flow phase: inc activity
  • soft tissue phase: inc activity
  • delayed skeletal phase: normal
200
Q

septic arthritis –> bone scan findings?

A

jt –> both sides –> positive –> all 3 phases

201
Q

bone scan –> delayed skeletal phase –> inc activity in 2 adj vertebral bodies –> ddx? (1)

A

discitis

202
Q

what is hypertrophic pulm osteoarthropathy?

A

pulm dz (ie lung CA) –> long bone –> diaphysis –> periosteal rxn

203
Q

hypertrophic pulm osteoarthropathy –> bone scan finding?

A

long bone –> cortex –> parallel line –> inc activity

204
Q

avascular necrosis –> bone scan –> finding? (2)

A
  • initial phase –> dec activity

- hyperemic phase –> inc activity

205
Q

avascular necrosis –> bone scan –> SPECT finding? (1)

A
  • rim of inc activity

- central photopenia

206
Q

spontaneous osteonecrosis of knee (SONK) –> bone scan finding?

A

med femoral condyle –> intense inc activity

207
Q

Paget dz –> lytic phase –> XR appearance? bone scan?

A
  • XR: normal

- bone scan: positive

208
Q

Paget dz –> mixed phase –> XR appearance? bone scan?

A
  • XR: positive

- bone scan: positive

209
Q

Paget dz –> sclerotic phase –> XR appearance? bone scan?

A
  • XR: positive

- bone scan: activity subside

210
Q

Paget dz –> bone scan –> persistent cold lesion –> ddx? (1)

A

malig degeneration –> central necrosis

211
Q

complex regional pain synd (reflex sympathetic dystrophy) –> MCC? ssx?

A

minor trauma –> persistent pain/tender/swell

212
Q

complex regional pain synd (reflex sympathetic dystrophy) –> bone scan –> appearance?

A
  • blood pool: variable –> usu inc
  • soft tissue phase: variable –> usu inc
  • skeletal: hand/foot –> mult small jts –> juxta-articular –> diffuse inc activity
213
Q

kidney –> radiotracers? (3)

A
  • Tc-99m DTPA
  • Tc-99m MAG3
  • Tc-99m DMSA
214
Q

kidney –> Tc-99m DTPA –> what eval?

A
  • eval renal perfusion

- measure GFR

215
Q

kidney –> Tc-99m MAG3 –> what eval?

A
  • eval renal perfusion

- estimate renal plasma flow

216
Q

kidney –> Tc-99m DMSA –> what eval?

A

renal scarring assoc w pyelonephritis

217
Q

kidney –> Tc-99m DTPA –> excreted by?

A

glomerular filtration

218
Q

kidney –> Tc-99m MAG3 –> excreted by?

A

tubules

219
Q

kidney –> Tc-99m MAG3 –> better than Tc-99m DMSA –> for which conditions? (2) why?

A
  • renal insuff
  • obstruction

higher extraction fraction –> better images for renal insuff/obstruction

220
Q

nuclear renogram –> flow phase –> slow upslope –> suggests?

A

dec perfusion

221
Q

nuclear renogram –> cortical fx phase –> delayed uptake –> suggests?

A

dec renal fx

222
Q

nuclear renogram –> clearance phase –> slow/lack of clearance –> suggests?

A

hydronephrosis

223
Q

renal A stenosis –> nuclear imaging options? (2)

A
  • Tc-99m MAG3

- Tc-99m DTPA

224
Q

Tc-99m MAG3/DTPA study –> what med is administered for eval renal A stenosis?

A

ACE-inh

225
Q

renal A stenosis –> Tc-99m MAG3/DTPA study –> appearance?

A

after ACE-inh –> renogram –> abnormal or more abnormal

226
Q

renal A stenosis –> Tc-99m MAG3 –> findings:

  • % uptake at 2-3min
  • difference in cortical activity
  • time to peak activity
A

compared to pre-ACE inh):

  • <40% uptake
  • 20% difference in cortical activity
  • > 2min delay in time to peak
227
Q

diuretic renogram –> general procedure?

A

Tc-99m MAG3 –> 20min after –> administer lasix

228
Q

diuretic renogram –> goal?

A

hydronephrosis –> cause:

  • obstruction
  • non-obstructive cause
229
Q

diuretic renogram –> clearance half time:

  • normal?
  • borderline
  • obstruction
A
  • <10min –> normal
  • 10-20min –> borderline
  • > 20min –> obstruction
230
Q

diuretic renogram –> false positive? (3)

A
  • dehydration
  • distended bladder
  • renal fail (dec response to diuretic)
231
Q

Tc-99m DMSA –> normal –> dx?

A

no acute pyelonephritis

232
Q

pyelonephritis –> Tc-99m DMSA –> appearance? (3)

A
  • focal cortical defect
  • multifocal cortical defect
  • diffuse dec activity
233
Q

pediatric vesicoureteral reflux –> radionuclide cystography vs voiding cystourethrogram:

  • sens
  • rad exp
A

radionuclide cystography:

  • no sens
  • less rad exp
234
Q

radionuclide cystography –> radiotracers? (3)

A
  • Tc-99m pertechnetate
  • Tc-99m DTPA
  • Tc-99m sulfur colloid
235
Q

radionuclide cystography –> general procedure?

A

radiotracer –> retrograde inject into bladder

236
Q

I-123 MIBG –> use? (2)

A
  • adult –> image pheochromocytoma

- ped –> image neuroblastoma

237
Q

MIBG –> uptake by what conditions? (5)

A
  • pheochromocytoma
  • neuroblastoma
  • carcinoid
  • medullary thryoid CA
  • paraganglioma
238
Q

I-131 MIBG –> use? (1)

A

ped –> tx neuroblastoma

239
Q

I-123 MIBG –> normal distribution?

A

sympathetic innervation:

  • salivary glands
  • heart
  • thyroid
  • liver
  • kidney
  • bladder
240
Q

I-123 MIBG –> how dec thyroid uptake?

A

Lugol’s soln

241
Q

Indium-111 pentetreotide (Octreoscan) –> indication? (2)

A

image:
- carcinoid
- islet cell tumor –> gastrinoma

242
Q

Indium-111:

  • half life?
  • decay?
  • production?
A
  • 67hr
  • electron capture
  • cyclotron
243
Q

Indium-111 pentetreotide (Octreoscan) –> uptake MOA?

A

octreotide analog –> somatostatin receptor:

  • carcinoid
  • islet cell tumor
  • amine precursor uptake and decarboxylation (APUD) tumor
  • head/neck –> glomus tumor (extra-adrenal pheochromocytoma)
244
Q

Indium-111 pentetreotide (Octreoscan) –> normal distribution?

A
  • kidney –> intense uptake
  • spleen –> intense uptake
  • liver –> less uptake
245
Q

Gallium-67:

  • half life?
  • decay?
  • production?
A
  • 78hr
  • electron capture
  • cyclotron
246
Q

Gallium-67 –> uptake MOA?

A

bind to transferrin:

  • infx
  • inflamm
  • neoplasm
247
Q

Gallium-67 –> normal distribution?

A
  • bowel, colon –> high activity
  • liver –> less
  • skull
  • BM
  • salivary glands
248
Q

Gallium-67 –> 24hr –> kidney –> activity –> dx?

A

renal dz

249
Q

Gallium-67 –> lungs –> diffuse uptake –> dx?

A

infx/inflamm

250
Q

Gallium-67 –> what is panda sign?

A

inflamm –> inc uptake:

  • nasopharynx
  • parotid gland
  • lacrimal gland
251
Q

Gallium-67 –> panda sign –> ddx? (4)

A
  • classically –> sarcoidosis
  • Sjogren
  • lymphoma after irrad
  • AIDS
252
Q

sarcoidosis –> Gallium-67 study –> signs? (2)

A
  • panda sign

- lambda sign –> bilat hilar + R paratracheal LAD

253
Q

thallium-201:

  • half life?
  • decay?
  • production?
A
  • 73hr
  • electron capture
  • cyclotron
254
Q

thallium-201 –> normal distribution?

A
  • kidney
  • heart
  • liver
  • thyroid
  • bowel
255
Q

indium-111 oxine leukocytes (WBCs) –> normal distribution?

A

spleen > liver&raquo_space; BM

256
Q

indium-111 oxine leukocytes (WBCs) –> pro (1) vs con (3) –> compared to gallium study?

A

pro:
- no physiologic bowel accumulation –> can eval abd/bowel infx/inflamm

con:
- tedious labeling procedure
- higher rad dose
- less accurate for spinal osteomyeltis

257
Q

gallium study –> liver –> focal uptake –> dx?

A

HCC

258
Q

gallium + thallium study –> indication? (3)

A
  • Kaposi sarcoma
  • TB, atypical myobacteria
  • lymphoma
259
Q

Kaposi sarcoma –> gallium + thallium study –> findings?

A

KaT: Kaposi is Thallium avid

  • thallium avid
  • no gallium uptake
260
Q

TB, atypical myobacteria –> gallium + thallium study –> findings?

A

TuG: Tuberculosis is Gallium avid

  • gallium avid
  • no thallium
261
Q

lymphoma –> gallium + thallium study –> findings?

A

Lymphoma likes both:

  • gallium avid
  • thallium avid
262
Q

brain –> radiotracers? (3)

A
  • Tc-99m DTPA
  • Tc-99m HMPAO
  • Tc-99m ECD
263
Q

brain –> Tc-99m HMPAO vs ECD –> demonstrates what?

A
  • HMPAO: perfusion

- ECD: living cells

264
Q

brain death scan –> what is hot nose sign?

A

inc collateral flow –> nonspecific –> abnormal cerebral perfusion –> ie. brain death

265
Q

brain –> acetazolamide challenge –> indication?

A

eval cerebral perfusion reserve

266
Q

brain –> acetazolamide challenge –> appearance?

A

after acetazolamide:

  • normal brain –> inc perfusion
  • areas that have already maxed their autoregulatory mechanisms –> relatively lower activity compared to rest of brain
267
Q

seizure –> Tc-99m HMPAO/ ECD –> appearance?

A
  • ictal imaging (inj during sz or 30 sec after end of sz) –> hypermetabolic
  • inter-ictal —> hypometab
268
Q

dementia –> Tc-99m HMPAO/ ECD –> appearance?

  • Alzheimer dz
  • Lewy body dementia
  • multi-infarct dementia
  • Pick dz
A

symm dec activity:

  • Alzheimer –> post temporal + parietal lobes
  • Lewy body –> + occipital calcarine cortex
  • mult-infarct dementia –> mult asymm foci
  • Pick dz –> frontal lobes + ant temporal lobes
269
Q

brain tumor –> recurrence vs radiation necrosis –> nuclear imaging options? (2)

A
  • thallium-201

- dual phase F-18 FDG PET

270
Q

brain –> malig glioma –> thallium-201 study –> recurrence vs radiation necrosis –> appearance?

A
  • tumor –> uptake

- granulation tissue –> no uptake

271
Q

what is crossed cerebellar diaschisis?

A

supratentorial lesion –> ie. tumor, stroke, trauma –> disrupt corticopontine-cerebellar pathway –> contralat cerebellar hemisphere –> dec radiotracer uptake

272
Q

how to recognize MIBG scan?

A
  • no bones
  • liver > spleen
  • no kidney!
273
Q

high uptake in spleen & kidneys –> what study?

A

octreotide

274
Q

how to differentiate Tc-WBC scan from In-WBC scan?

A
  • Tc-WBC: kidney & GI uptake

- In-WBC: no kidney & GI uptake

275
Q

Tc-MDP –> how localize?

A

phosphate analog –> chemiabsorption –> bind w hydroxyapatite on bone surface

276
Q

F18-FDG –> how localize?

A

facilitated diffusion

277
Q

I-123 & I-131 –> how localize?

A

Na/I symporter (NIS) –> into cell –> incorporate into thyroid hormone

278
Q

thallium-201 –> how localize?

A

potassium analog –> Na/K ATP pump

279
Q

brain death study –> Tc99m HMPAO vs Tc99m ECD –> main difference?

A

Tc99m ECD –> more rapid clearance from blood pool

280
Q

bone scan –> abnormally low bone uptake –> ddx? (2) how to differentiate?

A
  • poor renal fx –> too much soft tissue noise

- air in vial/syringe –> poor labeling –> free Tc –> stomach uptake

281
Q

bone scan –> what is flare phenomenon?

A

bone mets –> ctx –> 2wk-3mo post –> look like inc size & number of lesions –> “pseudo-progression”

282
Q

bone scan –> liver uptake –> ddx? (4)

A
  • Al3+ contaminiation
  • cancer –> ie hepatoma, mets
  • amyloidosis
  • necrosis
283
Q

bone scan –> spleen uptake –> ddx? (1)

A

sickle cell –> auto-infarcted spleen

284
Q

elderly –> fx –> bone scan –> should be positive at what time point?

A

1wk

285
Q

bone scan –> tramline sign –> dx? next step?

A

hypertrophic osteoarthropathy –> CXR or CT chest –> look for lung cancer

286
Q

lytic bone mets –> imaging modality of choice?

A

skeletal survey

287
Q

blastic/sclerotic bone mets –> imaging modality of choice?

A

bone scan

288
Q

bone scan –> single lesion –> equivocal –> next step?

A

XR

289
Q

bone scan –> equivocal single lesion –> normal XR –> next step?

A

susp for bone met –> MRI

290
Q

vertebral osteomyelitis –> study of choice?

A
  • WBC scan + Gallium-67

- MRI

291
Q

infx –> when would use Tc-HMPAO WBC over In-WBC? (2)

A
  • peds: Tc99 –> lower absorbed dose, shorter imaging time

- small parts ie hands/feet

292
Q

In-WBC –> critical organ?

A

spleen

293
Q

Tc99m MAA –> particle size?

A

10-100 micrometer

294
Q

Tc99m MAA –> when use fewer particles? (5)

A
  • peds
  • only 1 lung
  • RtoL shunt
  • pHTN
  • preg
295
Q

gallium –> critical organ?

A

colon

296
Q

gallium scan –> panda sign –> ddx? (3)

A
  • sarcoid
  • sjogren
  • treated lymphoma
297
Q

differentiate: trapping vs organification?

A
  • trapping: iodine tracer transported into thyroid gland

- organification: iodine incorporated into tyrosyl moiety

298
Q

thyroid scan –> when would use Tc-99m over I-123/I-131?

A

recent thyroid blocker ie iodinated contrast

299
Q

Tc-99m thyroid scan –> when can resume breastfeed?

A

24hr

300
Q

I-123 thyroid scan –> when can resume breastfeed?

A

2-3 day

301
Q

Hashimoto thyroiditis –> potential comp?

A

1ary thyroid lymphoma

302
Q

I-131 radioiodine therapy –> dose for…

  • thyroid only
  • thyroid + nodes
  • distant mets
A
  • thyroid only: 100
  • thyroid + nodes: 150
  • distant mets: 200
303
Q

I-131 radioiodine therapy –> pt should be admitted to hospital when how much residual activity?

A

33 mCi

304
Q

hyperthyroid –> I-131 radioiodine therapy –> dose for…

  • Graves
  • MNG
A
  • Graves: 15 mCi

- MNG: 30 mCi

305
Q

parathyroid scan –> radiopharmaceutical?

A

Tc sestamibi

306
Q

brain –> shunt scan –> radiopharmaceutical?

A

Tc-DTPA

307
Q

brain –> sz scan –> finding?

A
  • ictal: hot focus

- interictal: cold

308
Q

Kaposi sarcoma –> uptake on…

  • gallium
  • thallium
A
  • gallium –> neg

- thallium –> pos

309
Q

HIDA scan –> CCK –> dose?

A

0.02 microgram/kg over 60min

310
Q

HIDA scan –> morphine –> dose?

A

0.02-0.04 mg/kg over 60min

311
Q

infant –> HIDA scan –> phenobarbitol –> dose?

A

5mg/kg for 5 days

312
Q

sulfur colloid liver scan –> cold or hot?

  • hepatic adenoma
  • FNH
  • cavernous hemangioma
  • HCC
  • cholangioCA
  • mets
  • abscess
  • focal fat
A
  • FNH –> hot

- rest are cold

313
Q

sulfur colloid scan –> diffuse lung uptake –> ddx? (1)

A

Al contaminiation

314
Q

sulfur colloid scan –> kidney uptake –> ddx? (2)

A
  • CHF

- renal tx –> rejection

315
Q

hemangioma scan –> radiopharmaceutical? findings?

A

Tc-RBC

  • flow phase: no uptake
  • pool: no uptake
  • delayed: hot
316
Q

which radiotracers are made by generator? (2)

A
  • Tc99

- rubidium

317
Q

hepatic adenoma

  • sulfur colloid
  • HIDA
  • gallium
A
  • sulfur colloid: photopenic
  • HIDA: hot
  • gallium: neg
318
Q

thyroid scan –> meds that interfere w thyroid uptake?

A
  • thyroid blockers
  • IV contrast
  • amiodarone
  • nitrates

CORE (33 decks)

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