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NM By Myself > Brain Classic NM > Flashcards

Brain Classic NM Flashcards

(53 cards)

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1
Q

AD FDG

A

Bilateral posterior parieto - temporal cortex
Posterior cingulate gyrus
Frontal lobe (advanced)
FDG 100% vs SPECT 90% sensitivity in discriminating AD patients

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2
Q

DLB FDG

A

Medial occipital cortex

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3
Q

FTD FDG

A

Fronto - temporal regions

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4
Q

Amyloid plaques in cortical gray matter

A

AD 100%
DLB 50-70%
Normal elderly

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5
Q

Amyloid imaging tracers

A

DD AD vs FTD
Identify MCI who will convert to AD
Early diagnosis of AD
C11PiB - - more sensitive than FDG
NeuraCeq
Amyvid
Vizamyl

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6
Q

NeuraCeq

A

F-florbetaben
8 mCi 120 min

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7
Q

Amyvid

A

F-florbetapir
10 mCi 45 min
Binding similar to PiB

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8
Q

Vizamyl

A

F-flutemetamol
5 mCi 90 min
Clinically diagnosed AD vs MCI in healthy elderly

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9
Q

Amyloid imaging AD

A

Frontal, parietal, temporal cortex
No dd AD vs DLB - - DatScan - - bilateral striatum - - AD

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10
Q

Amyloid imaging DLB

A

AD-like atrophy in parahippocampal area,
Lateral temporal, parietal cortex
Reduced Dat uptake

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11
Q

Amyloid imaging FTD

A

No amyloid - - no uptake

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12
Q

Brain SPECT tracers AD

A

Tc-ECD
TC-HMPAO
Both are small, lipophilic, neutral molecules - - cross intact BBB
Fast washout from extra-cerebral tissue, high contrast grey/white
Reduced perfusion in temporoparietal and frontal areas

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13
Q

DatScan preparation and protocol

A

I123-FP-CIT - cocaine analog
Thyroid block - lugol 100 mg or potassium perchlorate 400 mg 30-60 min before tracer injection
FOV with radius <16 cm, total time 30-45 min, min 1.5 ml counts
Scan after 3-6h when striatal/occipital binding ratio is stable

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14
Q

Sertraline in DatScan

A

Increase uptake but not interfere with visual presentation

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15
Q

Reduce binding to presinaptic dopamine transporter Dat

A

Cocaine, amphetamine, methylphenidate, ephedrine, phentermine
Anti Parkinson drug do not interfere with binding!!

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16
Q

FDOPA PD

A

Presynaptic dopamine transporter imaging
5 mCi 60-90 min
Striatal activity due to activity of AADC (aromatic amino acid decarboxylase)
Transport into storage vesicle by VMAT2
Reduced striatal uptake - - PD
Biomarker for in vivo striatal dopamine level

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17
Q

Postsynaptic D2 dopaminergic imaging tracer PD

A

Dd PD (presynaptic) and Parkinson plus (postsynaptic)
C11-raclopride
I123 - iodobenzamide = IBZM
Increased binding to putamen contralateral to more affected body side
Degeneration of presynaptic (PD untreated) - - upregulation of postsynaptic

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18
Q

I123 MIBG PD

A

Myocardial uptake - - no PD
Degeneration of adrenergic post-ganglion pathways - - no cardiac uptake - - PD
Presence of LB - hallmark of PD
Marker of DLB

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19
Q

PD symptoms

A

Bradykinesia
Rest tremor
Rigidity
Gait abnormality

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20
Q

Vascular cause of PD

A

Poor response to L-dopa

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21
Q

DatScan normal

A

Comma shaped uptake with symmetric borders
Rule out PD and DLB - - AD

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22
Q

DatScan abnormal

Study These Flashcards
A

Reduced uptake in striatum, esp putamen, assymetrical (contralateral)
PD or DLB vs AD (normal)
One side caudate + putamen = infarct

23
Q

DatScan indication

Study These Flashcards
A

Dd DLB vs AD (normal)
DD PD vs essential tremor (normal)
Early diagnosis of PD
DD PD vs drug-induced parkinsonism or psychogenic parkinsonism
Not for disease progression and response to treatment

25
FTD FDG
26
AD Amyloid imaging
27
PD DatScan
28
PD FDOPA
29
MSA FDG
MSA = multiple system atrophy Putamen and cerebellum
30
PSP FDG
PSP = progressive supranuclear palsy Upper brain stem, medial prefrontal cortex, medial thalamus, caudate, anterior cingulate, superior frontal cortex
31
CBD FDG
CBD = corticobasal degeneration Assymetrical cortical and subcortical regions
32
DLB PD FDG
Visual hallucinations Bilateral occipital cortex
33
PSP and MSA postsynaptic dopaminergic imaging
Reduced striatal binding due to reduced D2 receptor binding Also in patients taking dopaminergic drugs
34
MSA MIBG
MSA - - orthostatic hypotension ass with parkinsonism Cardiac uptake of MIBG DD MSA vs orthostatic hypotension in PD treated by L-DOPA Also no Lewy Body in MSA vs PD and DLB
35
Brain perfusion SPECT
Multidetector gamma camera with LEHR or LEUHR or fan-beam collimator - - highest spatial resolution Stop benzodiazepine Stop dilantin No coffee, smoke, alco Sedation after tracer 10 min before and 5 min after injection silent and low light SPECT 20 min after tracer 30 min acquisition - - FBP or iterative algorithm with low pass filter (Butterworth 0.5 cycle/cm, order 6-8)
36
Benzodiazepine cause
Globul perfusion reduction
37
Dilantin cause
Cerebellar hypoperfusion
38
TC-HMPAO
15-30 mCi Stable for 30 min Cross intact BBB by simple diffusion Labeled autologous leukocytes More adequate to identify areas with hyperperfusion (epilepsy), but in vitro not stable If subacute stroke - - better cerebral perfusion
39
Tc-ECD
15-30 mCi Stable for 6-8 h Stereomer 1.1-ECD More rapid clearance from bloodstream - - better target-to-background ratio Cross intact BBB - - passive diffusion If subacute stroke - - better metabolic activity
40
Tc-DTPA
15-20 mCi Brain death (not cross BBB) Short T1/2 - - for children
41
Brain death
Coma+absence of brain stem reflexes +apnea - - at least two of them - - no need for test Dynamic - - frame/sec for 1 min - - late planar 20-30 min - - SPECT "hot nose" sign = rerouted blood flow
42
Epilepsy
Drug resistant - - surgery First day - interictal SPECT (between seizures) Second day - ictal SPECT under video-EEG (within 45 sec of seizure onset) - - hyperperfusion
43
Diamox
= acetazolamide Increase CO2 - - vasodilation - - increase blood flow 3-4 times 1g IV - - 20 min - - cerebral vascular reserve - - flow decreases if vascular disease and impaired reserve Indication: carotid occlusion - - define risk of stroke and select patients for revascularization
44
Reduced vascular reserve
45
Elipelsy
46
Brain death
47
Cysternography
IN111-DTPA, long T1/2 Intrathecal injection into subarachnoid space 0.5-1 mCi 1 ml (remove 1 ml CSF) Early image over lumbar region 1-2H - - check injection Planar image of skull 6, 24, 48 h
48
Normal cysternography
Basal cisterns after 4h Sylvian and interhemispheric cisterns Subarachnoid space at 6h Washout from basal cisterns at 24-48h
49
Hydrocephalus
Lateral ventricles at 6h - - persists 24-48h Reflux into ventricles
50
Evaluate shunt patency
Tc-DTPA into reservoir of catheter of device under skin - - transit into peritoneal cavity within 30-60 min No activity in peritoneal cavity - - distal obstruction Fails to reach ventricles - - proximal obstruction
51
CSF leakage
Rhinorrhea, otorrhea Fistula - - place pledget in nostril after Intrathecal administration
52
Cross compromised BBB
Tc-DTPA Tc-pert
53
Brain death tracers
Tc-DTPA Tc-HMPAO Tc--ECD

NM By Myself (25 decks)

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