nuclear medicine contest

8/14/2019 Nuclear Medicine Contest

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NUCLEARNUCLEAR

MEDICINEMEDICINE

CONTESTCONTEST

Prepared by:

Dr Majid Al-Homiedan

Dr Yasser Al-Ghamdi


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Which radiopharmaceutical commonly used for cystography?

What is the advantage over MCUG?

What is the difference between direct and indirect cystography?How is reflux graded with radiopharmaceutical cystography?


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99mTc DTPA and 99mTc Sulfur colloid.

More sensitive in detection of VUR and 50 to 200times less radiation to the gonads.

Direct: cathetrization and instillation of tracer insidethe bladder, indirect: performed after routinerenography.

Mild reflux: confined to the ureter, moderate: reachesthe pelvicalyceal system, severe: distorted collectingsystem and dilated tortuous ureters.

Which radiopharmaceutical commonly used for cystography?

What is the advantage over MCUG?

What is the difference between direct and indirect cystography?

How is reflux graded with radiopharmaceutical cystography?


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2


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Describe the scintigraphic findings?

Give the diagnosis?

What treatment options are appropriate for this patient?

What would you expect the radioactive iodine uptake would be?


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Hot nodule in the right thyroid lobe withsupression of the remaining gland.

Toxic autonomous thyroid nodule.

Surgery and radioactive iodine 131I , therapywith PTU or methimazole sometimes is used as

initial treatment.

May be moderately elevated, but its often in thenormal range. Normal 24 hours uptake is 10%to 30%.

Describe the scintigraphic findings?

Give the diagnosis?

What treatment options are apropriate for this patient?

What would you expect the radioactive iodine uptake would


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3


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What is the radiopharmaceutical and mechanism of

distribution?What are the most common causes of acute testicularpain?

What is the mechanism of testicular torsion?

What are the imagining findings and diagnosis in thiscase?


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99mTc pertechnetate, initial blood flow and distributesin the extracellular fluid space.

Acute epidydimitis, testicular torsion, torsion of thetesticular appendage.

Developmental anomalies of testicular decent andattachment predisposes to spermatic cord torsion, themost common anomaly is the bell-clapper testis.

Decreased blood flow to the left testicle andphotopenic on delayed image consistent with acutetesticular torsion.

What is the radiopharmaceutical and mechanism of distribution?

What are the most common causes of acute testicular pain?

What is the mechanism of testicular torsion?

What are the imagining findings and diagnosis in this case?


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Describe the bone scan findings?

Name two non-osseous systems thatshould be evaluated on bone scan?

Describe any other finding?

What term can applied to this case?


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Increased radiotracer uptake in large majority ofvisualized bones, especially the appendicularskeleton with focal areas of increased uptake infemur and tibia bilaterally.

Soft tissues and genitourinary system.

Faint activity in the kidneys, little soft tissue

activity seen.

Superscan secondary to Osteomalacia.


Name two non-osseous systems that should be evaluated on bone sca

Describe any other finding?

What term can applied to this case?


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Describe the findings?

Provide the differential diagnosis?

What is the likely diagnosis in this case ?

Discuss the pathogenesis?


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Provide the differential diagnosis?

What are the phases of this disease?

The patient may experience clinical symptoms related to another organ system, discuss the mechanism?


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Abnormal high uptake in the left femur which appearswidened and bowed, increased uptake is seen in the pelvisand left first metatarsal are also seen.

Pagets disease, fibrous dysplasia, chronic osteomyelitis

and primary bone tumors in particular osteosarcoma.

Lytic, sclerotic and mixed.

High output congestive heart failure, once believed to be

sue to arteriovenous malformation in the bone lesion, nowhyperemia and increased blood flow to the lesion and notshunting.

Describe the bone scan findings?Provide the differential diagnosis?What are the phases of this disease?The patient may experience clinical symptoms related to another organ system,discuss the mechanism?


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Describe the findings?

What other imaging study should be ordered?

What is the diagnosis and most likely common cause for this scan?

Mention other causes of this condition?


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General increased activity in the long bones withpericorticalstriping along the medial and lateral aspects oflower extremities (railroad tracking) characteristic.

Chest x-ray

Hypertrophic pulmonary osteoarthropathy, bronchogeniccancer of the lung.

Mesothelioma, pulmonary mets, bronchiectasis, mediastinaldisease (hodgkins), lung abscess, asthma, cystic fibrosis,CCHD, bacterial endocarditis,r egional enteritis, UC andcongenital billiary atresia.

Describe the findings?What other imaging study should be ordered?What is the diagnosis and most likely common cause for this scan?Mention other causes of this condition?


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This is the chest x-ray of thepatient


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8


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Describe the difference between Graves disease and euthyroid scan appearance?

What is the appropriate therapy for Graves disease?

What are the usual administered doses of131

I uptake,123

I scan and Graves disease therapy?What are the short term and long term side effects of131I therapy?


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May be similar, with large goiter the scan often has plumper appearancewith convex borders, the pyramidal lobe maybe seen.

Surgery, seldom performed. PTU and methimazole sometimes used

initially particularly in patients with severe disease who require coolingdown, young children and pregnant patients. Most of the times treatedwith radioactive iodine after 6 to 12 months of antithyroid medication.Many patients are treated initially with 131I.

131I uptake (10 Ci), 123I scan and uptake (300 Ci), Graves diseasetherapy 131I (5 to 15 mCi).

Short term: exacerbation of hyperthyroidism, cardiac symptoms in elderly,very rare thyroid storm. Long term: hypothyroidism, there is no increasedincidence of secondary cancers, reduction in fertility or congenitaldefects.

Describe the difference between Graves disease and euthyroid scanappearance?

What is the appropriate therapy for Graves disease?

What are the usual administered doses of131I uptake, 123I scan and Gravesdisease therapy?

What are the short term and lon term side effects of131I thera ?


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If the EEG is flat line, why is another study indicated?

What are the clinical findings of brain death?

List 2 different types of tracers with different mechanism that could be used in this study?What are the scintigraphic findings and diagnosis?


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A flat EEG can be caused by barbiturates, depressivedrugs or hypothermia.

Deep coma, no brain stem reflexes or spontaneousrespiration, exclusion of reversible causes and thecause of the brain dysfunction must be diagnosed.

99mTc DTPA or Tc pertechnetate can be used as abrain flow study. However Tc HM-PAO and 99mTc ECD

have the advantage of irreversible cellular binding onthe first pass allowing for delayed images.

No blood flow to the cerebral cortex. Brain blood flowstudy consistent with brain death.

If the EEG is flat line, why is another study indicated?

What are the clinical findings of brain death?

List 2 different types of tracers with different mechanism that could be used in thisstudy?

What are the scintigraphic findings and diagnosis?


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Name the radiophamaceutical used?

List methods for preparation of this radiopharmaceutical?

Describe the methodologies of radiolabling?

List the advantage and disadvantage of the different radiolabling?


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THANKTHANK

YOUYOU

nuclear medicine contest

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