nm 4203 scanning & imaging
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NM 4203 Scanning & Imaging. Gastrointestinal System. Alimentary Canal. Mouth Pharynx Esophagus Stomach Small intestine Large intestine (colon). Accessory Organs. Salivary glands Pancreas Liver Gallbladder. Stomach Anatomy & Physiology. Three Regions: - PowerPoint PPT PresentationTRANSCRIPT
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NM 4203Scanning & Imaging
Gastrointestinal System
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Alimentary Canal
Mouth Pharynx Esophagus Stomach Small intestine Large intestine (colon)
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Accessory Organs
Salivary glands Pancreas Liver Gallbladder
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Stomach Anatomy & Physiology
Three Regions:– Fundus : controls liquid emptying– Corpus (body)– Antrum : controls solid emptying
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Gastric Emptying Study
Indications– Nausea, vomiting– Weight loss– Abdominal bloating
Mechanical causes– Ulcer, tumor, post-radiotherapy, pyloric stenosis,
post-surgical Nonmechanical causes
– Diabetes, hypo or hypertension, neuropathy, gastroparesis, anorexia, amyloidosis
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Gastric Emptying Study
Each lab must standardize meal type and size.
Solid phase could be meat, chicken liver, eggs, french toast, etc (99mTc Sulfur Colloid)
Liquid phase could be water, orange juice, apple juice. (111In DTPA)
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Gastric Emptying Study
Patient fasting for at least 8 hrs. Medium energy collimator (if doing
liquid phase with In111DTPA) Should eat meal within 5 minutes,
followed by liquid.
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Liver Anatomy & Physiology
Right upper quadrant of abdomen Right lobe generally larger than left Composed of:
– Kupffer cells– Hepatocytes
• Conversion of bilirubin to bile
Spleen: not part of the GI system
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Liver – Spleen imaging
99mTc Sulfur Colloid or 99mTc Albumin Colloid
Can do a flow (looking at vascularity of some defects)
No pt. prep Static images 15 min. after injection
– Anterior, RAO, Rt lat, RPO, posterior, LPO, Lt lat, LAO
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Liver – Spleen Colloid Image
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Liver Hemangioma
99mTc – Labeled Red Blood Cells No pt. prep Bolus 15 – 25 mCi with immediate flow
imaging Followed by pool images per facility
protocol SPECT usually 2-3 hours after injection.
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Liver Hemangioma
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Liver Hemangioma
Little or no blood flow to the lesion on early flow images
Delayed imaging usually shows increased uptake in hemangioma.
Other types of lesions will retain RBC’s, but only hemangiomas retain RBC’s for over 2 hrs.
Some consider this test to be 100% accurate for Hemangioma detection.
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Gallbladder Anatomy & Physiology Concentrates and stores bile Stimulated by fatty meal to contract and
release bile into the duodenum Bile is useful to breakdown fats during
digestion.
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Extrahepatic biliary anatomy
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Hepatobiliary Imaging
Radiopharmaceuticals– 99mTc HIDA, 99mTc DISIDA, 99mTc Mebrofenin
Pt. should fast at least 2 hrs. before study, no more than 24 hrs.
Pain medications (opium or morphine based) should not be taken prior to imaging.
Rt. Lateral image is helpful to separate Gb (Gallbladder should be anterior to other structures)
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Acute Cholecystitis
Usually due to cystic duct obstruction Visualization of GB with
radiopharmaceutical excludes diagnosis of acute cholecystitis
No GB visualized in 4 hrs, high probability of acute cholecystitis
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Acute Cholecystitis
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Gallbladder Imaging: other medications
Cholecystokinin (CCK)– Causes gb contraction– Relaxes the sphincter of Oddi– Used for GB Ejection Fraction– Peptide hormone, naturally secreted by duodenum
Morphine– Decreases peristalsis– Constricts the sphincter of Oddi– Used when Gb is not visualized to “force”
radiopharmaceutical into the gb.
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Biliary Leak
Usually requested after surgery or trauma
Subtle leaks that may accumulate in the pelvis
May mimic a gb ~ labeled bile in the gallbladder fossa
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Intestine anatomy & physiology
Small intestine– Duodenum, jejunum, and ileum– 20 feet long– Digestion and absorption of nutrients
Large intestine – Cecum, ascending colon, transverse colon,
descending colon,sigmoid colon, and rectum.– Resorption of water
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GI Bleed Imaging
Radiopharmaceutical– 99mTc Sulfur Colloid or 99mTc –labeled
RBC’s (each facility may have different labeling method)
Bolus injection with immediate flow imaging
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GI Bleed
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Causes of GI Bleeding
Diverticular disease Angiodysplasia Neoplasms Inflammatory bowel disease
Not uncommon to never find a reason
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Meckel’s Diverticulum
Common cause of GI bleeding in children.
Most are located
in the ileum 99mTc Pertechnetate
~ concentrates in
gastric mucosa
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Meckel’s Diverticulum
Painless rectal bleeding More common in children Some Meckel’s do not contain gastric
mucosa, won’t show on scan Glucagon – given i.v. 10 minutes after
Tc injection or Zantac given i.v. prior to Tc injection– Decrease small bowel activity
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Schilling Test
GI absorption of vitamin B12
57Co vitamin B12 given orally Followed by IM injection of non-labeled
vitamin B12 (saturates the liver) Urine collected for 24 hrs.