gated heart pool scanning - breast uptake
Post on 24-Dec-2014
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Hunter Health Imaging Service
Getting to the heart of the matter!
Todd Charge Senior Technologist Nuclear Medicine and PET Centre Hunter Health Imaging Service
Hunter Health Imaging Service
Background • 29yr old female
• Benign cyst removed from Right breast 1995
• Fatty lump noted at time
• Regular follow up U/S
Hunter Health Imaging Service
Background U/S Dec 2002 abnormal right breast Mammogram widespread calcification Palpable axillary nodes U/S adbo, chest clear CXR normal FBC, biochem normal LFT, serum alkaline phosphatase normal
Hunter Health Imaging Service
Background CXR Jan 2003 abnormality R lung base CT normal 5 days later Right side mastectomy Axillary dissection Post op evacuation of
haematoma
Hunter Health Imaging Service
Background Invasive ductal carcinoma Measuring 10cm Grade 3 Pagets disease invol nipple Extensive lymphatic, vascular invasion 18/27 lymph nodes involved Extension up to 2mm beyond capsule
Hunter Health Imaging Service
Background Oestrogen, progesterone receptors neg. Her-2 marker strongly positive High risk of local recurrence Required radiation treatment and chemo 10yr survival 13% With chemotherapy inc. to 30%
Hunter Health Imaging Service
Background
Smoker (ceased six years) Social drinker Three children, unremarkable pregnancies No family history breast cancer 24 weeks pregnant
Hunter Health Imaging Service
Treatment Six cycles of AC chemotherapy Three weekly Plan to deliver at 37 weeks Post delivery commence radiation treatment Monthly foetal growth U/S No randomised studies Case studies suggest no detrimental effects
Hunter Health Imaging Service
Treatment Induced labour, normal vaginal delivery Normal, healthy 8.3pound female infant Breast feeding successfully on left breast Paused breastfeeding for 5 days to
complete sixth cycle of chemo Right chest wall irradiation with inclusion of
lymph node drainage areas
Hunter Health Imaging Service
Treatment No evidence of local recurrence or distant
disease Commence Herceptin trial Baseline LVEF
Hunter Health Imaging Service
Administration • 1ml Radpharm PYP IVI via left posterior
hand
• 1hr interval
• 900MBq Tc04- IVI via left cubital fossa
• Imaging commenced immediately
• 3 lead ECG gating
Hunter Health Imaging Service
Scanning • Anterior, LAO35, Left Lateral views • 10 mins per view • 24 bin gating • 75-85bpm heart rate • Normal sinus rhythm
Hunter Health Imaging Service
Images
PScope
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Images
LAO35 Static
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Images
Anterior Cine
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Images
LAO35 Cine
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Images
LtLat Cine
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Images
Gated SPECT
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Images
Zoomed Short Axis
Hunter Health Imaging Service
Outcome Normal wall motion No LVEF due to technical difficulties No evidence in literature search Highlights the need to consider uptake of
radiopharmaceuticals in lactating females as normal variant
Gated SPECT processed same as Sestamibi/Thallium cardiac to obtain LVEF after overcoming technical difficulties
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