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NM By Myself > Lung NM > Flashcards

Lung NM Flashcards

(73 cards)

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1
Q

FDG in lung

A

Sarcoidosis
TB
Occult infection
Autoimmune fibrosis
Pneumonia
Cystic fibrosis
Acute lung injury
Acute RDS

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2
Q

Ga67-citrate

A

Cells with increased metabolic rate
Fe analog - - binds to transferrin receptor
Highly sensitive for FUO, sarcoidosis, idiopathic pulmonary fibrosis, Pneumocystis carinii/jirovecii pneumonia, drug induced pulmonary toxicity

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3
Q

Lung perfusion imaging

A

TC-MAA 15-100 microm - - microembolization - - lung perfusion
95% bound to MAA - - free Tc pert in stomach, thyroid
Shake vial, repeatedly invert syringe
Withdraw blood back into syringe - - microemboli - - hot spots

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4
Q

Lung perfusion dose

A

Adult - - 2-5 mCi - - 200-700k particles
Pulmonary hypertension or right-to-left shunt - - 100-200k particles
Inhomogenous distribution <100k particles
Children - - 1.11 MBq/kg (min 14.8 MBq) without ventilation or 2.59 MBq/kg with ventilation - - <0.3% of capillary bed (particles)

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5
Q

Pulmonary hypertension diagnostic criterion

A

Physiologic gradient of lung perfusion from base to apex in upright position and from back to front in supine position is altered

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6
Q

Tc-MAA injection

A

Patient keeps position for 4-5 min before administration
Cough - - several deep breaths before injection
Inject slowly 30s during 3-5 respiratory cycles
Not distal port of Swan-Ganz catheter or indwelling line or port with filter
Large matrix
Min 500k counts per view

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7
Q

Lung perfusion pregnant

A

2 days protocol
First perfusion with reduced activity
If normal - - avoid ventilation

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8
Q

Upright better

A

Increase chest cavity size
Minimize diaphragmatic motion

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9
Q

Low dose CT

A

Data for attenuation correction
Not during deep breath holding but tidal breathing

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10
Q

Lung ventilation with radioaerosol tracers

A

Tc-DTPA (highest dose), Tc-colloid, Tc-technegas (superior quality than DTPA and Xe)
Through mouth piece, nose occluded - - tidal breathing
COPD - - prefer Technegas
Upright while inhaling, supine acceptable
Ventilation before perfusion - - smaller amounts 20-40 MBq

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11
Q

Lung ventilation with radioaerosol
Disadvantage

A

Substantial airway disease - - turbulent airflow in central airways - - central deposition - - aerosol in major bronchi - - limit evaluation of alveoli

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12
Q

Ventilation with Xe133
Advantage

A

T1/2 5.3 days, gamma, some beta, 10-20 mCi
Single breath, wash-in or equilibrium and washout images
More complete characterization
More sensitive for COPD
Liver uptake because it is fat soluble - - fatty liver

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13
Q

Lung ventilation with Xe133

A

Room should be equipped with appropriate exhaust/trapping system for radioactive gas
Patient upright or supine, facemask or mouthpiece connected via bacterial filter to Xe delivery system
Breath in closed system for 3-4 min - - equilibrium phase
Usually before perfusion
After perfusion - - background activity from down scatter of 140 keV Tc with energy window 80 keV
Washout phase - - posterior oblique
High radiation burden - - not recommended

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14
Q

Ventilation with Kr81m
Advantage

A

All view without interference from prior perfusion due to gamma 190 keV - - better quality

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15
Q

Ventilation with Kr81m
Disadvantage

A

Short T1/2 of parent Rb81 4.5h - - breath continously from generator - - T1/2 13s
Low availability, high overall cost
Collimator with low septal penetration

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16
Q

Ga67 citrate scintigraphy

A

WBS - - 1.5-2 mln counts or 25-35 min
Min scan speed 6-8 cm/min
Spot views of chest - - 250k-1 mln counts or 5-20 min
At 48h remain in liver, spleen, bone, bone marrow, nasopharynx, lacrimal glands, thymus, breast

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17
Q

Acute PE ECG

A

Inversion of T waves in V1-V4
QR pattern in V1
S1Q3T3 pattern
RBBB
40% sinus tachycardia - in mild cases

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18
Q

Normal perfusion scan

A

Excludes PE

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19
Q

Focal perfusion defect

A

Tumor
Granuloma
Emphysema
Interstitial fibrosis
Bronchiectasis
Pneumonia consolidation
Atelectasis

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20
Q

Perfusion defect in PE

A

Wedge-shaped
Base facing pleura
Apex toward hilum
Around - forced perfusion due to redistribution of blood flow

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21
Q

PIOPED 2 criteria

A

Normal or not segmental match - - no acute PE
High probability - - >2 segmental perfusion defects with mismatch
Non diagnostic - - not typical multiple abnormalities

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22
Q

Match pattern

A

Reduced oxygen - - reduced blood flow
Preexisting parenchymal condition affecting both perfusion and ventilation - - PE unlikely

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23
Q

Mismatch pattern

A

Ventilation preserved area of reduced perfusion
Acute PE

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24
Q

Untreated or poorly treated acute PE

A

Chronic thromboembolic pulmonary hypertension

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25
Recurring PE
>30% death within 2 years
26
PE time line
Baseline scan - immediately (within 24h) Soon after - at 1 and 4 weeks At 3, 6, 12 months
27
Diffuse non segmental mismatch
Perfusion redistribution towards upper lung regions (ventilation less) Left heart failure
28
Reverse mismatch
Ventilation worse than perfusion Stripe sign Pneumonia
29
Obstructive lung disease
inhomogenous Ventilation more informative, but poor compliance Convective ventilation from upper airways to bronchioles Diffuse ventilation - - all remaining lung Obstruction - - both components of ventilation are impaired
30
Asthma
Central deposition
31
Chronic bronchitis and Emphysema
Inhomogenous deposition Spotty distribution
32
Central deposition Asthma
33
Spotty deposition Emphysema
34
Inhomogenous deposition Normal
35
Mixed deposition
36
COPD
37
Chronic PE or interstitial lung disease
38
Ventricular septal defect
39
Tumor
40
תסנין דלקתי
41
Chronic PE
42
Interstitial lung disease
Inflammation, scarring, edema - - thickening of interstitium Sarcoidosis - - bilateral pulmonary hilar and mediastinal lymphadenopathy Ga67 citrate - - lambda sign, panda sign (lacrimal and parotid glands)
43
Ga67 citrate limitations
Time consuming - - 48-72h after IV Variability of image interpretation Sensitivity and specificity variable High radiation exposure
44
Ga67 citrate vs FDG Sarcoidosis
45
Lambda sign Panda sign
46
Solitary pulmonary nodule
Round diameter <3 cm No lymphadenopathy No Atelectasis No Pleural effusion
47
Benign pulmonary nodule
Mass stable for 2 years Peripheral subpleural Polygonal, smooth margins Diffuse, central, laminated, popcorn calcification Pure solid or ground glass <15 HU
48
Malignant pulmonary nodule
>3 cm, growing mass Lobulated margin Corona radiata = thin spiculated edge Any other calcification Mixed solid and ground glass Air bronchogram sign >15 HU
49
Granulomatous disease
TB Aspergillosis Histoplasmosis Sarcoidosis
50
Benign tumor
Hamartoma Pulmonary pseudotumor
51
Malignant tumor
Peripheral bronchial carcinoma Bronchoalveolar carcinoma Multiple MTS Carcinoid Kaposi sarcoma Lymphoma
52
Other conditions. Solitary Pulmonary nodule
Septic embolism Intra pulmonary LN Arteriovenous malformation Round atelectasis
53
Air bronchogram Bacterial pneumonia
54
Central calcification
55
1 - Pleural lesion 2 - pulmonary lesion 3 - Pleural effusion 4 - extrapleural lesion 5 - Pleural and chest wall involvement
56
Anterior mediastinum 54% 5 Ts
Thymic mass Thyroid or parathyroid Terrible lymphoma Teratoma Thoracic aneurism
57
Thymic mass
Thymoma 50% Max transverse diameter 15 mm Benign - - well define round mass with soft tissue enhancement Invasive Thymic cysts after chemo or radio - - from - 15 to +80 HU due to bleeding
58
Lymphoma
Hodgkins - - single enlarged LN or large conglomerated mass, calcification after treatment Non Hodgkin - - advanced disease
59
Extra gonadal germ cell tumor
Dermoid cysts - round, capsule, hydric or cystic density Teratoma - - calcification of ossification foci Seminoma
60
Thoracic aneurism
Ascending aorta >4 cm Descending aorta >3 cm
61
Middle mediastinum 20%
Lymphadenopathy - - normal size <10 mm in short transverse diameter - - subcarinal <15 mm Vascular malformations Congenital mediastinal cysts
62
Congenital mediastinal cysts
Bronchogenic - - paratracheal or carinal location Enteric Esophageal duplication cyst - - not communicate with esophagus lumen Pericardial cyst - - right cardiophrenic angle, water density
63
Posterior mediastinum 26%
Neurogenic tumor - - schwannoma, neurofibroma paravertebral - - neuroblastoma, benign ganglioneuroma next to aortic arch or posterior pericardium Foregut duplication cyst Lymphoma Lymphadenopathy Extramedullary hematopoesis - - thalassemia, sickle cell anemia paravertebral, ass with splenomegaly
64
Lymphoma
65
Interstitial pneumonia
66
Uptake in spleen and kidney, no stomach - - right-to-left shunt Next step - - planar of brain
67
Acute PE
Within minutes to few hours - - local bronchoconstriction + hypocapnia Within 18-24h - - reduced production of surfactant distal to embolization - - shrinkage of alveolar space 40% normal saturation 20% normal alveolar-arterial oxygen gradient
68
Modified PIOPED II
69
Acute PE
70
Perfusion defect persist 3 months
Less likely to resolve
71
Count rate of second imaging
3-4 times count rate of first imaging
72
DTPA vs Xe
Better photon flux Acquisition of multiple projections Xe is more sensitive in COPD
73
How many capillaries blocked when perfusion scan with Tc MAA
<0.1% 1 in 1000 capillaries

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