Nucs Flashcards
Whole body scan with bones and liver hotter then spleen. What are possible tracers?
More photons -> Tc99m Sulfur colloid
Less photons -> gallium
Whole body scan showing bones and spleen hotter than liver what is the tracer?
Indium 111-wbc
Whole body scan, no bones, no liver, no spleen. What are you options?
I-123 or I-131
Whole body scan, no bones, liver and spleen are lighting up. What is the tracer if the liver > spleen? What is the tracer if spleen > liver and renal uptake?
Liver > spleen I-131 MIBG
Spleen > liver + kidney I-131 MIBG
If there are bones and lacrimal gland uptake what are your options?
Free Tc if the bones are faint
Gallium but only if there is no spleen uptake
Hot spleen what should you think of?
Octreotide and WBC (sullfur colloid will have liver = spleen)
What does MIBG often look for?
Neuroblastoma
No bones + no liver + dark kidneys and spleen = ?
Octreotide. Higer count study the images should be cleaner
When do you image for Tc wbc scan?
4 adn 24 hours
How long can you see lung uptake in a Tc WBC scan?
4 hours
in WBC or Tc WBC which has no renal or GI take?
Indinum
What organ gets the highest dose of radiation with MDP? With F-18?
Bone for MDP
Bladder for F-18
What is normal distribution for Tc-MDP?
Bone Kidney (If not seen or faint = super scan) bladder breasts (in young females) soft tissues - low levels epiphyses in kids
If there is more then faint uptake in the skull what should you think of? ( Tc-MDP)
Renal osteodystrophy
If the renal cortex is hotter then lumbar spine ( Tc-MDP)
Hemochromatosis
If there is diffuse renal uptake ( Tc-MDP)
Seen in chemotherapy and urinary obstruction
What could abnormal liver uptake indicate? ( Tc-MDP)
Too much Al+3 contamination
Cancer mets or hepatoma
Amyloidosis
Liver Necrosis
Lung uptake in ( Tc-MDP) can be from what?
Heteroptic calcification (dystrophic or mets) Osteosarcoma Fibrothroax primary lung tumors radiation changes sarcoid berylliosis alveolar microlithiasis wegeners (etc)
What is flair phenomenon for ( Tc-MDP)?
Increase in activity 2 weeks to 3 months post treatment. X-rays should show lesions getting more sclerotic
Prostate ca mets are uncommon with a PSA below?
10
Prostate mets where?
Bone!
Lung cancer bone mets tend to be where?
appendicular skeleton
What bone related condition is assoicated with lung cancer?
Hypertrophic osteoarthropathy
Solitary sternal lesion on bone scan is concering for what?
Breast CA
Where does neuroblastoma frequently met?
Metaphysis of long bones
I-123 and 131 MIBG are superior for detection of bone mets in what condition?
neuroblastoma
How does osteopoikilosis look on bone scan?
Cold
What is hypertrophic osteoarthopathy assoicated with?
Chronic hypoxia (CF< Cyanotic heart disease, mesothelioma, pneumoconiosis) and LUNG CANCER!
Tram tracking on bone scan?
HPOA
What does AVN look like on bone scan?
Early and Late is cold, middle is hot from repair
What are HOT benign bone lesions on bone scan?
Fibrous dysplasia Giant cell tumor ABC Osteoblastoma OO
What is a benign COLD lesion on bone scan?
Bone cyst without fracture
What is variable on bone scan but benign?
Hemangioma
Multiple hereditary exostosis
How can RSD look on bone scan?
Hot on flow and pool with periarticular uptake on delayed phase
When do you use Tc HMPAO WBC over In-WBC?
Kids - Tc99 will have lower absorbed dose and shorter imaging times
Small parts - Tc99m does better in hands and feet
What cells are labeled by In-WBC?
Neutrophils
Normally what is the critical organ for In-WBC?
Spleen
In In-Wbc what happens to the distribution if the cells get fragmented?
Indium binds with transferrin and increased liver and bone marrow uptake
What is the dose used for ablating a thyroid remenent
30-75
What dose is used for treatment of recurrent diseasein the thyroid bed?
150
What dose is used for bone or distant thyroid mets?
200-250
