SCANS

Dr. Padmesh. V

Diuretic Renal scans:

Diuretic Renal scans:

• These are primarily done to rule out obstruction at Pelvi-ureteric or Vesico-ureteric junction in a child with hydronephrosis.

• Additionally, information about the function of each kidney can be gathered.

• There are 3 agents which can be used for a diuretic renal scan- DTPA or MAG3 or LLEC.

• All three are good but LLEC is supposed to be the best as the image quality is the best.

DTPA / MAG 3 Scan

• Involves an injection of either DTPA (99mTc-diethylene triamine pentaacetic acid) or MAG3 followed by immediate images of the kidneys as the injection enters the body.

• In doing this, we can get information on

– renal blood flow,

– GFR,

– tubular function and

– urinary excretion.

DTPA / MAG 3 Scan

• Clinical Indications:• Assessment of GFR

• Differential renal function

• Acute renal failure

• Chronic renal failure

• Acute & chronic rejection

• Screening of patients with suspected renal hypertension

• Obstruction

• Hydronephrosis

DTPA / MAG 3 Scan

DTPA / MAG 3 Scan

DTPA scan showing retention of isotope in Left kidney, right kidney has cleared off well.

DMSA Scan

DMSA Scan

• Technetium99m DMSA (Di mercapto succinic acid)is the radiotracer that is injected intravenously into the patient in order to visualise the renal cortex of the kidneys.

• This injection will take 3 hours to be bound to the kidneys before any imaging can commence.

DMSA Scan

• Clinical Indications:• Assessment of Renal Scarring

• Urinary Tract Infection

• Pyelonephritis

• Renal infarct

• Horseshoe kidney

• Ectopic kidney

DMSA Scan

DMSA Scan

• Horse-shoe kidney

DMSA Scan

• Right pelvic kidney on Tc99m-DMSA scan.

• Ectopic kidney

Bone Scan

Bone Scan

• A Bone scan is a two part test involving an intravenous radioactive injection (Technetium99m HDP) followed by images of the blood flow and blood pool to the area of interest.

• The HDP takes 2-3 hours to be absorbed by the bones, so a delay is required in order to visualise the bone structures.

Bone Scan• Clinical Indications:• Metastatic Disease

• Primary Malignant Bone Tumours

• Benign Primary Tumours

• Osteomyelitis

• Septic Arthritis

• Fractures - Traumatic, Stress, Insufficiency

• Paget’s Disease

• Avascular Necrosis

• Legg-Calve Perthes Disease

• Arthritides - Degenerative Joint Disease, Rheumatoid Arthritis, Pseudoarthritis.

Bone Scan

Bone Scan• POSITIVE BONE SCANS OBSERVED IN A VARIETY OF TUMOR

TYPES;

• BONE METASTASIS:

HIDA SCAN

HIDA SCAN

• Patients will be injected with Technetium99m Hepatolite (HIDA) .

• Hydroxy imino diacetic acid (HIDA).• Images will be taken of the liver and gallbladder for about 60 minutes.

• After this time, we will determine if the patient requires a CCK infusion or a morphine injection.

• The CCK infusion simulates the patient eating a fatty meal, so if the gallbladder is visualised, we should expect it to empty after the CCK infusion.

• However, if the gallbladder is not seen after 60 minutes and infusion of morphine may be given to contract the sphincter of Oddi, which increases biliary pressure, in order to help visualise the gallbladder.

HIDA SCAN

• Clinical Indications:

• Biliary atresia

• Neonatal hepatitis (Parenchymal liver dis)

• Abnormal biliary leakage

• Acute Cholecystitis

• Chronic Cholecystitis

HIDA SCAN

• Interpretation• A normal result means that the gallbladder is visualized within 1 hour

of the injection and the tracer is in the small intestine.• GB not visualized: If the gallbladder is not visualized within 4 hours

after the injection it indicates that there is either cholecystitis or cystic duct obstruction.

• Tracer not visualized in intestines means common bile duct obstruction. If the radioactive tracer moves through bile ducts very slowly, this may indicate a blockage or obstruction. Or it may indicate a problem in liver. .

• If the radioactive tracer is found outside of biliary system it indicates a leak.

• Uptake is poor in parenchymal liver disease, such as neonatal hepatitis, but excretion into the bile and intestine eventually ensues.

HIDA SCAN• Imaging results are best when scanning is preceded by a 5-7 day

period of treatment with phenobarbital to stimulate bile flow.

• After intravenous injection, the isotope is normally detected in the bowel within 1-2 hr.

• In the presence of extrahepatic obstruction, excretion of the isotope is delayed; accordingly, serial scans should be made for up to 24 hr after injection.

• Early in the course of biliary atresia, hepatocyte function is usually good; uptake (clearance) occurs rapidly, but excretion into the intestine is absent. Visualization of bowel excludes biliary atresia.

• In contrast, uptake is poor in parenchymal liver disease, such as neonatal hepatitis, but excretion into the bile and intestine eventually ensues. Visualization of bowel by 4-24 hrs more typical of neonatal hepatitis.

HIDA SCAN

HIDA SCAN

HIDA SCAN

• BILIARY ATRESIA:• The dye acts like bilirubin. If

the baby has biliary atresia, the liver will take up the dye but it will not be able to flow through the damaged biliarysystem into the small intestine. Rather, the tracer enters the circulation and collects in the bladder.

• 24 hour monitoring may be done.

Visualization of bowel excludes biliary atresia

HIDA SCAN

• Poor uptake of isotope by liver

Lung Scan (V/Q)

Lung Scan (V/Q)

• For this study, patients are required to inhale some radioactive gas in order to visualise the ventilation to the lungs.

• This ventilation image is then acquired prior to an injection into the vein in order to visualise the Perfusion to the lungs.

• Once the Perfusion image is finished, we are able to compare the two images and look for any mismatches in the perfusion image.

Lung Scan (V/Q)

• Clinical Indications:• Pulmonary Embolism

• Assessment prior to lung reduction surgery

Lung Scan (V/Q)

Lung Scan (V/Q)• 3-year-old boy with pulmonary embolism.

• A, Perfusion scan demonstrates no significant perfusion to the right lung.

• B, Ventilation scan demonstrates normal ventilation to both lungs.

Lung Scan (V/Q)• Almost absence of perfusion of right lung in the perfusion scan with normal

ventilation.

Thyroid Scan

Thyroid Scan

• A thyroid scan involves an intravenous injection of Technetium Pertechnetate.

• Enables us to determine the function of the thyroid gland with or without the presence of nodules.

• It also determines the presence and site of the thyroid tissue such as in thyroid bed of a completely excised gland or in other locations (ie sublingual). (ectopic)

Thyroid Scan

• Clinical Indications:• Hyperthyroidism - determine cause

• Nodules - Assess activity

• Find ectopic thyroid site

• This scan has no role in the evaluation of hypothyroidism without the presence of nodules

Thyroid Scan

Thyroid Scan

• Multiple nodules

in thyroid COLD NODULE HOT NODULE

Thyroid Scan

Thank you!

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