Portal Scintigraphy Flashcards

1
Q

What is the transit time for a trans-splenic portal scintigraphy? Per-rectal?

A

7 sec - Trans-splenic

12 sec - Per-rectal

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2
Q

What is the main advantages of trans-splenic portal scintigraphy vs per-rectal?

A

Less activity (1-2 mCi vs 10-20 mCi)

High counts

Morphology

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3
Q

What does 99mTc - MAA do?

A

Plugs up the first capillary bed

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4
Q

Goals of trans-splenic portal scintigraphy?

A

Multiple or single shunt

Where does it drain to

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5
Q

Can trans-splenic portal scintigraphy differentiate between intra and extra hepatic shunts?

A

No

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6
Q

What allows you to diagnose acquired vs congenital shunting?

A
  1. Acquired are usually slow transit due to portal hypertension
  2. Blush of activity behind the kidneys
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7
Q

What is the difference between the transit time in a congential shunt vs normal?

A

Congenital shunts have faster transit times

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8
Q

What is the only way to get a false positive on trans-splenic scinitigraphy?

A

Microvascular dysplasia

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9
Q

If you mess up the injection on a trans-splenic (ie intraperitoneum) what should you do?

A

Re-inject with a new dose

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10
Q

What sedation should you use when doing trans-splenic scintigraphy?

A

Ace to make the spleen bigger.

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11
Q

Dogs with left division shunts?

A

Irish wolfhounds

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12
Q

A left divisional intrahepatic shunt is asscoicated with what anatomic structure?

A

Patent ductus venosus

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13
Q

Why can’t 99mTc-sulfur colloid be used in cats and horses when looking for a PSS?

A

Because 99mTc-sulfur works by mononuclear phagocytic uptake in the reticuloendothelial system (liver, splee and bone marrow)…however, in cats and horse they have a resident population of mononuclear phagocytes in the Lungs and therefore it will stay there after first pass.

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14
Q

What type of collimator is used in trans spenic portal scin?

A

LEAP - cause it is 99mTc04-

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15
Q

What is the dose for Trans Splenic Portal scint?

A

0.5 - 2mCi

in 0.2 - 0.5 mL

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16
Q

What sedation could be used in trans splenic PS?

A

Ace….gets the spleen big

17
Q

Is this normal?

A

Yes.. Injection site.. splenic vein… liver and lastly heart

From left to right

18
Q

Is this normal?

A

Yes.. this is 99mTc Mebrofenin.. where, in a normal study, all the Tc goes to the liver and stays there.

19
Q

What are the three main patterns of TSPS?

A
  1. Portoazygos
  2. Single portocaval/splenocaval
  3. Internal thoracic

Multiple acquire acquired shunts

20
Q

Is this normal?

A

Portoazygos - look for the J-shape curve of coming to the cranial aspect of the heart

Transit time to the heart is 3 sec rather than 7

21
Q

What type of shunt is this?

A

Portocaval/Splenocaval — no J-shape… just straight to the heart

22
Q

What is the the disadvantage of TSPS?

A

Cannot tell the difference between intrahepatic vs extrahepatic.

23
Q

what shunt does this dog have?

A

Internal thoracic along with top with multiple acquired shunts

24
Q

What type of shunt is this?

A

Multiple acquired

25
What is happening in these three pictures?
Variation in uptake of mebrofeinin with right liver is dorsal, ventral is right.
26
What is normal transit time for TSPS?
7s in a normal dog
27
Normal shunt fraction of Mebrofenin and pertechnetate?
Mebrofenin - 0-2% Pertechnetate 1-4% This doesn't give you any other information besides... yes its a shunt.