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NUCLEAR MEDICINE

Tc99mMAA:

need to use a ratio of 10:1 for Tc based agents. Need to decrease the number of particles for the perfusion part of the imaging in pulm htn, pediatric patients, pregnancy, but not in prior PE

ERYTHROMYCIN:

this compound increases the rate of gastric emptying

201Tl:

this is an excellent tumor marker in addition to a myocardial perfusion agent. However, it does not label infectious and inflammatory processes

NUCS IN SPINAL INFECTIONS:

67Ga is good for intervertebral disc infection

111In WBC is good for spinal infection s/p instrumentation

RENAL IMAGING AGENTS:

IOIP: 20%  filtered. tubular is 80%. this is best for erpf

DTPA: almost all is filtered. Best for GFR

GH, DMSA: best for renal parenchyma; GH shows collecting system on early images.

with GH, 15% is retained in the kidney and with DMSA, 42% is retained in the kidney.

MAG3 has no significant filtration, ie almost all is by tubular secretion

TcDMSA gives the highest radiation dose to the kidney

67GA IN ANTIBIOTIC TREATED INFECTION:

it is useful for following antibiotic treated osteomyelitis as Indium WBC give a false negative result in this situation

SOURCES FOR EXTRINSIC CAMERA FLOOD:

57Co sheet source flush with the camera or 99Tc point source 3 m away form the camera

PIOPED CRITERIA:

high: 80% from 2 or more large segmental defects without CXR abnormalities

low: <20% non segmental perfusion defects

intemediate: one large, 2 moderate, 3 moderate, 1 large 1 moderate or triple match

MORE PIOPED CRITERIA:

PIOPED: high probability is 2 or more large vq mismatches. A small perfusion defect comprises <25% of a lung segment and large defect comprises > 75% of a lung segment

GUIDELINES FOR 131I TOTAL BODY IMAGING:

need to be off T4 for 6-8w and off T3 for 3w. Need to be off PTU for 2 w. No  H2O soluble contrast for 4-8w

IN NUCS:

stripe sign rules out PE, can be seen in COPD

NUCS AGENT FOR CARCINOID:

Indium 111-octreaotide is preferred for carcinoids

MORPHINE AND PANCREATITIS:

morphine administration can worsen pancreatitis

MORE ON RENAL IMAGING AGENTS IN NUCS:

both dmsa and GH bind to tubules and GH is only 15% bound so both of these are cortical agents. DTPA is excreted almost all by GF. MAG3 and OIH are handled by tubular secretion and glomerular filtration in different proportions and can be used for plasma flow rate determination

GA67 UPTAKE IN THE LUNGS:

lung uptake in IPF, PCP, mycobacteria infection, and bleomycin. In the UMDNJ notes 2000, it says that adriamycin does not cause increased gallium 67 uptake by the lungs

18F FDG UPTAKE IN ICTUS:

decreased interically and increased intrainctally

18F FDG UPTAKE IN ALZHEIMERS:

bilateral parietal and posterior temporal decreased perfusion and decreased FDG utilization in these areas. There is sparing of the sensory, motor cortex, BG and thalami

18F FDG IN PARKINSONS:

normal

18F FDG IN HUNTINGTONS:

decreased metabolism and uptake in the BG

18F FDG IN SCHIZOPHRENIA:

decreased metabolism in the frontal lobes

WARTHINS:

shows increased uptake of 99mTcO4. Note that the superficial parotid lobe is bigger than the deep lobe

DOSIMETRY:

Ga: bowel, DISIDA: bowel, 99m Tc pertechnetate: stomach, oral 99mTc SC: gut, IV 99mTc SC: liver and spleen, 99mTc disofenin: liver, damaged 99mTc RBC: spleen, 111 In WBC: spleen, 201Thallium: kidney, 99mTc sestamibi: bowel, 111In-octreatide: kidney, 123I IMP: lung, 99mTcRBC: heart wall, 99mTcHMPAO: lachrymal glands

with 99mTc SC, smaller particles tend to localize in the bone marrow, while larger ones tend to localize in the liver. Heat damaged 99mTcRBC specifically label spleen with minimal liver uptake

HARDWARE LOOSENING:

scintigraphic finding of loosening of femoral component is focal skeletal phase uptake at the tip of the hardware. Scintigraphic finding of infected femoral component is intense flow and uptake around the prosthesis stem

CROSSED CEREBELLAR DIASCHISIS:

in nucs, this is increase in the cerebellar uptake contralateral to a cerebral infarct. This is due to loss of suppressive neural activity from the contralateral infarcted cortex

201TL UPTAKE IN MALIG BRAIN TUMORS:

it is proportional to the malignant grade of the tumors

SVC VS BUDD CHIARI:

TcSC scanning shows hot quadrate with SVC obstruction and hot caudate with Budd Chiari

QUALITY CONTROL IN NUCS:

mnemonic: CLAG

C: constancy qd

L: linearity qw

A: accuracy qy

G: geometric efficiency q repair

SCANNING IN AIDS:

KS: gal - and thallium +

lymphoma: gal + and thallium +

infection: gal + and thal -

JUST TO RECAP:

GH: 20% cort, 80% glom

DTPA: 100% glom

DMSA: 50% cortical

IOH: 80% PCT, 20% glom

MAG3: 95% PCT, < 5% glom

PARATHYROID ADENOMA:

the combo of 99mTc and 201Tl with subtraction is useful for identifying parathyroid adenoma

SOME HALF LIVES:

"ITG"

111In: 67h

201Tl: 73h

67Ga: 78h

ARTEFACTS IN CARDIAC IMAGING:

breast attenuation: fixed lateral heart border

diaphragm: inferior and posterolateral

apex (thin): may mimic an infarct

LBBB: reversible septal defect

CARDIAC NUCS:

inferior wall: L lateral

LA: LAO

RV: shallow LAO

VENTILATION SCANNING:

with 99mTcDTAA, particle size > 0.5 micometer behaves more like a gas so it is desirable for ventilation