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ST2 Radiology > Nuclear Medicine > Flashcards

Nuclear Medicine Flashcards

1
Q

What is the most common parathyroid pathology

A

Parathyroid adenoma

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2
Q

What radiopharmaceutical is taken up by the parathyroids ?

A

Technetium - 99m MIBI
SestaMIBI

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3
Q

What may lead to a false positive study in detecting parathyroid adenoma?

A

Toxic thyroid adenoma and thyroid carcinoma

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4
Q

What is the most common reason for performing a parathyroid SestaMIBI?

A

Planning minimally invasive surgery and exclusion.of multiple or ectopic adenomas

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5
Q

What is the most common extracranial solid tumour in children

A

Neuroblastoma

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6
Q

Where do neuroblastomas occur?

A

Anywhere along the sympathetic chain, from the neck to the pelvis

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7
Q

What cells do neuroblastomas originate from ?

A

Primitive neural crest cells that normally from the sympathetic nervous system

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8
Q

What is the most common site of disease in neuroblastoma ?

A

Adrenal gland

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9
Q

How is MIBG taken into the cells

A

Mainly via active transport via the uptake-1 system. This uses the norepinephrine transporter found at sympathetic neuronal synapses and reponsible for sodium-facilitated uptake of norepinephrine and dopamine from the synapse. As an analogue of norepinephrine, MIBG is taken up by the transporter and accumulates in the cytoplasm and mitrochondrkia. Most neuroblastomas express norepinephrine transporter. Therefore 90% of neuroblastomas are MIBG avid.

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10
Q

What preparation do patients require before a MIBG scan?

A

They need oral potassium iodide, this prevents the physiological thyroid uptake of unbound radioiondine.

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11
Q

What scoring system is used in lymphoma response to treatment ?

A

Deaville scoring system.

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12
Q

What does a deaville score of 3 mean? And what is used for the reference range

A

The reference organs are the liver and the mediastinum, (aortic arch )
A score of 3 : means that uptake is more than the mediastinum but less than/equal to the liver.

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13
Q

What is the Honda sign?

A

Sacral insufficiency fracture

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14
Q

What is a non-oncological indication for PET scanning ?

A

Vasculitis , sarcoidosis, IGG4 disease

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15
Q

What does Metformin cause in PET scans ?

A

Increased active in the bowel as it increases glucose metabolism to lactate by the intestine

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16
Q

How long can post radiotherapy avidity last for ?

A

12 months

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17
Q

What is the characteristic features of a dysplastic cerebella gangliocytoma?

A

This is multiple harmatoma syndrome , or COWDENS disease.
Gyroform enlargement of the ipsilateral cerebella hemisphere

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18
Q

What are desmoplastic infantile astrocytomas?

A

WHO grade 1 brain tumour
Large cystic lesions with an enhancing mural nodule and variable calcification

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19
Q

Where are central neurocytomias lesions found?

A

They arise from the septum pellucidium adjacent to the foramen of Munro.

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20
Q

When should a pineal cyst be followed up and discussed at MDT?

A

A post contrast study of pineal cysts should be obtained and discussed at MDT if they are complex or >10mm.
if simple then 6-12 moths follow up

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21
Q

What is Parinaud syndrome?

A

The inability to move the eyes up and down.
Caused by compression of the vertical gaze centre at the roster interstitial nucleus of the medial longitudinal fascicles.
Dorsal midbrain syndrome, a vertical gaze disturbance caused by compression fo the recital plate, it causes upward gaze palsy manifesting as Diplopia.

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22
Q

What demographics do pineoblastomas occur?

A

Childhood normally <5 years.
Grade 4 tumour with widespread dissemination and subarachnoid seeding via the CSF.

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23
Q

What do pineoblastomas look like?

A

Explosion of hte normal pineal calcification.
Usually evidence of metastasis at presentation and obstructive hydrocephalus

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24
Q

how is FDG taken into the cells ?

A

GLUT 1 and 3 transporter

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25
Q

what is the half like of F18 FDG

A

110 minutes

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26
Q

how is SUV calculated ?

A

ROI activity * Body weight / administered activity

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27
Q

what SUV value may suggest a malignancy ?

A

2.5

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28
Q

what is the size threshold for a lesions in PET /

A

6mm

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29
Q

what effect might metformin have on a PET study ?

A

cause increased bowel uptake

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30
Q

what is the gold standard for lymph node staging in lung cancer ?

A

mediastinoscopy

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31
Q

what is the role of PET in colon cancer ?

A

evaluating metastatic disease

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32
Q

In colon cancer, how long do you usually wait post the initial treatment before the next PET CT /

A

2 months - due to the increased FDG uptake in the peritreatment period

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33
Q

in squamous cell carcinoma of the head and neck, how long do you usually wait post treatment for the next PET CT scan ?

A

4 months

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34
Q

which thyroid cancers might not take up radio iodine ?

A

medullary thyroid cancer and undifferentiated thyroid cancer. Used for patients with rising thyroglobulin levels with negative whole body radio iodine scans

35
Q

in the setting of lymphoma, what might cause a diffuse bone marrow uptake ?

A

granulocyte colony-stimulating factor stimulation, rebound effect from chemo, malignant marrow infiltration

36
Q

why is PET CT not good for HCC/

A

high levels of phosphatase dephosporylates FDG and it leaks out of the cells

37
Q

what is Galium 68-DOTATATE used to image ?

A

tumours with a high somatostatin receptor, neuroendocrine tumours, pheochromocytoma, paragnaglioma, neuroblastoma and meningioma

38
Q

In FDG imaging in Dementia - in Alzheimers which areas of affected ?

A

temporal and parental lobes - assymmetrically affected

39
Q

in PICks disease - which areas will have reduced FDG uptake in dementia imaging ?

A

the frontal lobe and the anterior portion of the temporal lobe

40
Q

where in Huntingtons disease will show decreased FDG uptake ?

A

the basal ganglia

41
Q

where in Parkinsons disease will show decreased uptake with a dopamine transporter such as a F18-DOPA

A

stratum ( caudate nucleus and putamen) - loss of the common shape

42
Q

what is interictal seizure imaging ?

A

imaging between seizures

43
Q

what is crossed cerebellar diaschisis ?

A

a phenomenon seen in with supratentorial lesions (tumours strike trauma) whereby the contralateral size to the lesion shows decreased radio tracer uptake

44
Q

what scan might you do to differentiate between brain tumour recurrence or radiation necrosis ?

A

thallium 201 - uptake in living cells with disrupted blood brain barrier.

45
Q

when might you prefer to use Tc99m pertechnetate over I-123 in thyroid imaging

A

inpatients who have recently had iodine contrast- as it blocks thyroid uptake of additional iodine. or when a quick study is required

46
Q

how long after iodinated contrast should a patient wait for a radioidoine imaging of the thyroid ?

A

1 month

47
Q

Is Iodine-131 safe to use in pregnancy

A

No, it crosses the placenta

48
Q

what should a breastfeeding mother do if they require ablative Iodine 131 treatment :

A

stop breastfeeding permanently

49
Q

what is a strums ovarii

A

a rare ovarian teratoma which contains mainly thyroid tissue

50
Q

what is a discordant thyroid nodule ?

A

hot on Tc99m and cold on 1-123

51
Q

what imaging agent is used for parathyroid ?

A

Tc-99m sestamibi

52
Q

what tissue takes up Tc-99m sestamibi ?

A

parathyroid adenoma, hyper plastic parathyroids, normal thyroid tissue and thyroid adenoma

53
Q

how will a thyroid adenoma and a parathyroid adenoma differ on imaging when using sestamibi ?

A

the parathyroid adenoma will show early enhancement but retain activity on delayed images. Whereas a thyroid adenoma will wash out.

54
Q

where are reticuloendothelial cells found.

A

liver, spleen and bone marrow

55
Q

what radio tracer is used in liver-spleen imaging ?

A

Sulfur colloid

56
Q

what might colloid shift indicate in sulphur colloid imaging of the GI tract ?

A

liver dysfunction causing increased uptake in the spleen

57
Q

what is the normal residual activity in the stomach at 4 hours post gastric emptying study

A

< 10%

58
Q

what radio tracer is used to identify meckles diverticulum ?

A

technetium99m - pertechnetate

59
Q

what radio tracer is used for imaging the biliary system ?

A

HIDA san

60
Q

what is the flare phenomenon ?>

A

3 months after starting treatment the healing bone lesions demonstrate increased uptake.

61
Q

how often is a sternal lesion in breast cancer going to be malignant ?

A

80% of the time

62
Q

which tumours produce predominantly osteolytic lytic lesions and are therefore not well seen on nuclear scanning ?

A

multiple myeloma
renal cell carcinoma
thyroid carcinoma
agressive anaplasie tumour
neuroblastoma

63
Q

which cancer most commonly causes a superscan ?

A

metastatic prostate cancer

64
Q

what causes a superscan

A

metastatic prostate cancer
breast cancer
lymphoma
metabolic bone disease in hyperparathyroidism
renal osteodystrophy

65
Q

what are the 3 phases of a bone scan ?

A
  1. Arterial - evaluates blood flow with images taken every few seconds - increased blood flow indicates hyperaemia
  2. Blood pool - evaluates the extracellular distribution immediately following the blood pool phase
  3. Standard delayed phase - performed 3 hours after injection
66
Q

what stage of scanning will osteomyelitis be positive on ?

A

all three phases

67
Q

what is pagets disease ?

A

idiopathic disturbance of osteoclasts and osteoblasts. Three phases ; lytic, mixed and sclerotic

68
Q

what is a complication of pagets disease ?

A

osteosarcoma

69
Q

what is a renal DTPA scan used for ?

A

to measure GFR.
Scan at 60s, then every 5 minutes for 25 minutes.

70
Q

what is a renal MAG3 scan used for ?

A

renal plasma flow and evaluate renal perfusion

71
Q

what is a renal DSMA scan used for ?

A

static imaging- looking at the renal cortex

72
Q

what does the 20 minute to peak ratio look at ?

A

describes the percentage of maximum cortical activity at 20 minutes. normal is <0.3

73
Q

what is 1-123 MIBG used to scan for ?

A

adults - phaeochromocytoma
Children - neuroblastoma

74
Q

what is the normal distribution of MIBG ?

A

salivary glands, heart, thyroid, liver, kidney and bladder

75
Q

what is Indium-111 Pentetreotide (otreoscan) used to look for ?

A

detect tumours with somatostatin receptors, including carcinoid or islet cell tumours - gastinoma.

76
Q

what is the normal distribution of Indium 111 ?

A

intense renal and splenic uptake

77
Q

what is the normal distribution of indium 111 labelled WBCs

A

Spleen > liver > bone marrow

78
Q

what condition is the panda sign seen in ?

A

sarcoidosis - most common
sjogrens
aids

79
Q

what does the panda sign represent ?

A

increased uptake in the nasopharynx, parotid glands and lacrimal glands due to inflammation

80
Q

what is the first line application of a gallium scan ?

A

spinal discovertebral osteomyelitis

81
Q

which cancers metastasise first to regional lymph nodes ?

A

malignant melanoma and breast cancer

82
Q

what would be the indications of a MIBG scan in ?phaeochromocytoma

A

when there is abdnormal labs but the CT doesn’t show an adrenal abnormality

83
Q

when should a nuclear medicine scan be done in the menstrual cycle ?

A

the first week, as the ovaries can appear hot otherwise

ST2 Radiology (13 decks)

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