NUC RAD SHARE

NUCLEAR MEDICINE CASES

 
case of the week

case of the week 2




Tc-MAG3 renal scan (posterior view)
Renal MRI (T1 FS post Gad and T2 FS)
Contour abnormalities bilateral kidneys
1. Right renal superior pole TCC (see arrow)
2. Multiple b9 left renal cysts (non-enhancing)

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NM CASES (ARCHIVE)

 
case1
case1b

F-18 FDG PET/CT
Parietal/temporal/frontal hypometabolism with preserved occipital and sensorimotor cortex metabolism
Alzheimers disease
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case2

Interictal F18-FDG PET/CT
Left mesial temporal cortex hypometabolism
Seizure focus
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case3
case3b

Tc-HMPAO Brain Death study
Flow and BP imaging show preserved hemi-cerebral intracranial flow and uptake
Not brain dead yet!
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case4
case4b

Tc-DTPA Brain Death study
Flow imaging: normal trident sign confirms intracranial perfusion
BP imaging: normal filling of venous sinuses (dont expect to see brain parenchyma as DTPA does not cross BBB)
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case5

Tc-pretechnetate thyroid scan
Lack of thyroid activity in patient with suppressed TSH 
Thyroiditis (pertechnetate is trapped but not organified so no uptake values are reported)
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case7

I-123 thyroid scan
Cold nodule ddx: 40% colloid cyst, 40% non-functioning adenoma, 20% thyroid CA
Non-functioning "cold" nodule in setting of Graves = Marine Lenhart Syndrome
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case8

I-131 WB post-therapy scan
Star artifact due to septal penetration (generally seen on post-therapy scan)
Diffuse hepatic activity is physiologic (metabolizes thyroid hormone)
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case9

I-131 WB surveillance scan
Focal uptake mediastinum consistent with recurrence
Thyroglobulin antigen >2 suggest recurrence
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case10

I-131 WB post therapy scan
Unexpected thyroid mets to lungs are seen as nodular uptake at lung bases
Patients with diffuse lung mets (miliary mets) are at high risk of lung fibrosis with high dose -131 therapy (dosimetric evaluation pre-therapy is prudent)
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case11
case11b

I-123 WB metascan and subsequent F-18 FDG PET/CT
Hx: TG antigen >2
Negative Metascan with elevated TG should prompt evaluation with FDG PET to exclude de-differentiated non-iodine avid tumor as in this case
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case12

Tc-mibi Parathyroid scan
Early and delayed imaging show rapid washout left inferior parathyroid adenoma
Note lack of normal thyroid uptake in this patient with prior thyroidectomy
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case13

Tc-mibi myocardial perfusion scan
Multi-vessel ischemia and TID at stress
TID=transient ischemic dilation at stress suggest multivessel disease, diffuse subendocardial ischemia or LV dysfunction
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case14

Tc-mibi myocardial perfusion scan
Reverse apex sign
Apical aneursym (gated images generally show dyskinetic apex)
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case15

Tc-mibi myocardial perfusion scan
Hypertrophic septum
Hypertrophic cardiomyopathy
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case16

Rest Tc-mibi vs FDG PET viability study
Inferior wall defect on rest MPS shows perfusion-metabolism mismatch with preserved metabolism
Viable "hybernating" myocardium
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case17

Tc-RBC MUGA or RN ventriculography
Overstimated EF of 97% due to incorrectly placed background ROI over spleen
EF = (EDV - ESV) / (EDV - background)
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case20
case18b

Tc-MAA Lung perfusion scan
Kidneys and thyroid uptake (ddx= Free Tc vs R to L shunt)
Lack of uptake within brain excludes shunt  and rules in Free Tc
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case19

Tc-choletec HIDA scan
Nubbin sign (cystic duct distal to obstruction) of acute cholecystitis
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case20

Tc-choletec HIDA scan
Rim sign of complicated acute cholecystitis
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case21
case21b

Tc-choletec HIDA scan
Lack of biliary activity (and hence bowel and GB activity) ddx= hepatic dysfunction (esp if sig residual BP activity within heart) vs high grade CBD obstruction
Follow up delayed imaging is the only option
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case22

Tc-choletec HIDA scan
Biloma in post-op patient
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case23
case23b

Tc-pertechnetate Meckels scan
No meckels diverticula identified
Right renal collecting system physiologic activity confirmed on lateral
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case25

Tc-SC RN VCUG
Bilateral VUR noted during filling phase
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case26

In-111 Octreoscan
Carcinoid mets to liver and intra-abdominal LN
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case27

In-Prostascint and Tc-RBC dual isotope imaging
Recurrent prostate CA idenitifed within intra-abdominal LN on Prostascint scan
Tc-RBC scan helps in identifying physiologic blood pool on Prostascint scan
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case29

Tc-HDP bone scan
Bilateral diffuse rib fxs at costochondral junctions after CPR
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case30

Tc-HDP bone scan
Honda sign of sacral insufficiency fracture
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case32

F18-FDG PET/CT
Diffuse splenic involvement (spleen uptake abnormally increased conpared to liver) with Lymphoma
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case34

F-18 FDG PET/CT
Intense uptake right paramediastinal after recent XRT therapy 
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case42

Daily extrinsic uniformity flood image
Can see individual PMT shadows (non-uniform image)
Service engineer notified
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case45

DEXA scan
Artifactually high spine BMD due to overlying metallic IVC filter
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case47

case47b

VQ scan with Tc-MAA and Tc-DTPA aerosol followed by perfusion SPECT/CT
Triple matched defect "mid" lung zone
Low probability for PE
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case 48

Brain PET/CT
Hx of SCCA of Head/Neck with headaches concerning for brain mets
Non-FDG avid subacute isodense right subdural hematoma 
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case46

Ga-67 WB scan
Mediastinal and hilar uptake (lambda sign)
Active Sarcoidosis
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case50

Tc-choletec HIDA scan
Heterogenous liver uptake with persistent blood pool and no significant biliary activity
Cirrhosis (poor hepatic extraction/excretion)--cannot assess GB pathology due to lack of biliary activity
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case51

In-111-WBC and Tc-SC (dual isotope imaging with subtraction)
Focal tibial uptake on In-WBC scan which is discordant with Tc-SC
Positive for osteomyelitis
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case3
case3b

Tc-HMPAO Brain Death study
Flow and BP imaging show preserved hemi-cerebral intracranial flow and uptake
Not brain dead yet!
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case52

F-18 FDG PET/CT
Enhancing lesion at base of tongue
Ectopic thyroid tissue (thyroid bed was empty--not shown
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case54

In-111 Prostascint and Tc-RBC (dual isotope)
Multifocal abnormal central abdominal uptake on Prostascint (not seen on RBC imaging)
Recurrent prostate CA within intra-abdominal lymph nodes 
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