Nuclear Imaging

Question 1

Bone Scan - Symmetric Tram-track cortical uptake

Answer 1

Hypertrophic osteoarthropathy
Shin/quadriceps Splints (medial tibial stress syndrome)
Chronic venous stasis

Question 2

Lung Perfusion Scan - Extra pulmonary activity

Answer 2

Right-to-left Shunt - MAA particles bypass the lungs and localises in the systemic capillary beds ; cerebral cortical activity distinguishes shunting from other causes of extrapulmonary uptake

Question 3

Bone Scan - Superscan - Decrease/ Absent renal and soft tissue activity

Answer 3

Metastatic disease (most common) - inhomogeneous, centred within axial and proximal appendicular skeletal
Metabolic disease - renal osteodystrophy, hyperparathyroidism, osteomalacia ; uniform distribution - inv of appendicular skeleton and disproportionate calvarial uptake
Paget’s disease
Myeloproliferative / marrow infiltrative disorder

Question 4

Bone Scan - Inc activity and osseous expansion in the pelvis

Answer 4

Paget Disease
Metastasis
Ewing sarcoma
Lymphoma
Fibrous dysplasia

Question 5

Three-phase positive bone scan (Flow, blood pool, delayed imaging)

Answer 5

Trauma
Osteomyelitis
Bone tumour (Osteoid osteomalacia -> target sign on delayed image)
Complex regional pain syndrome -> periarticular osteopenia

NB: Cellulitis is hot on flow and blood pool but not on delayed

Question 6

Hepatobiliary Imaging - Non visualisation of GB (Normally visualised within 1h)

Answer 6

Acute cholecystitis - Non visualisation of the gallbladder with normal visualisation of the biliary and bowel activity
<RIM SIGN : complicated/advanced cholecystitis>
Chronic Cholecystitis - Delayed visualisation of the gallbladder between 1-4hours
Severe hepatocellular disease
High -grade biliary obstruction

Question 7

Pertechnetate imaging - Focal intra-abdominal uptake

Answer 7

Meckel Diverticulum
Focal intra-abdominal /inflammatory process

Question 8

Hepatobiliary Imaging - Neonate - Persistent hepatogram

Answer 8

Biliary Atresia - Good hepatic uptake, poor hepatic clearance
Neonatal Hepatitits - Poor hepatic uptake, delayed/decreased clearance (but present bowel activity within 24h, confirming biliary patency)
Intrahepatic cholestasis from severe parenchyma disease

Question 9

Delayed sestamibi imaging - Persistent focal cervical uptake

Answer 9

Parathyroid adenoma
Thyroid adenoma / carcinoma
Metastatic lymphadenopathy

Question 10

Tc99m RBC scan

Answer 10

Active GI bleed - focus of activity conforming to bowel anatomy, increases in activity over time, demonstrates peristalsis
Neoplasm/ inflammatory bowel disease
GU activity

Question 11

VQ Scan - Perfusion is worse than Ventilation

Answer 11

External compression - tumour, fibrosing mediastinitis
Pulmonary artery anomalies / corrected congenital heart disease
Massive unilateral PE

Question 12

VQ Scan - Ventilation is worse than Perfusion

Answer 12

Mucus Plug
Endobronchial Lesion
Unilateral diffuse parenchymal disease

Question 13

MAG 3 - wrosening renal function following captopril administration

Answer 13

Renal artery stenosis
Unilateral urinary obstruction

Question 14

I-123 - Cold Nodule

Answer 14

Thyroid Ca
Colloid cysts
Non functioning adenoma

Question 15

OctreoScan

Answer 15

Neuroendocrine tumour
Metastatic disease - lymphoma, meningioma, astrocytoma, breast ca
Granulomatous Disease