NM By Myself > PET > Flashcards

PET Flashcards

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1
Q

Diffuse uptake in bone marrow

A

MTS
Lymphoma
After chemo, GCSF
Anemia
Chronic or acute infection

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2
Q

Diffuse homogenous uptake in spleen

A

Extramedullary cell proliferation
Indirect sign of infection

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3
Q

Steroids

A

Window - first 3 days

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4
Q

Metformin

A

Diffuse uptake in small and large bowel.
Stop for 2 days before

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5
Q

Ipilimumab

A

Treat melanoma
Monoclonal antibody
High uptake in bowel because of immune-mediated toxicity

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6
Q

PET spatial resolution

A

4-5 mm - - partial volume effect

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7
Q

Vasculitis uptake

A

Homogenous diffuse uptake in vessel wall
Intense uptake in large cervical and thoracic vessels

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8
Q

Atherosclerosis

A

Focal moderate uptake at plaque with calcification
Vessels in upper abd lower limbs

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9
Q

Diffuse homogenous uptake in whole prosthetic valve or graft

A

Chronic inflammation

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10
Q

Focal heterogenous uptake in valve or graft

A

Infection
Also in locoregional LN, vegetations, abscesses, hematoma, aneurysm, fistula.

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11
Q

WBC on vertebral infection

A

Physiological uptake in bone marrow - - infection as photopenic area due to encapsulation of infection and poor migration of WBC

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12
Q

Parotid uptake

A

Warthin tumor
Pleomorphic adenoma
LN
Sarcoidosis

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13
Q

Pulmonary nodule uptake

A

Pneumonia
Tuberculosis
Cryptococcosis
Histoplasmosis
Sarcoidosis
Radiation pneumonitis
Pleurodesis

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14
Q

Pleural plaques

A

Asbestos dd epithelioid type mesothelioma

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15
Q

Focal hepatic uptake

A

MTS
Abscess
Infarct

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16
Q

Adrenal

A

Hyperplasia
Adenoma
Angiomyolipoma
Oncocytoma
Pheo
Paraganglioma

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17
Q

What is the critical organ for Tc-MDP?

A

Urinary bladder wall

Tc-MDP is used primarily for bone scans.

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18
Q

Tc-DTPA?

A

Glomerular filtration
3-5% protein binding
Also liquid aerosol for lung ventilation
Particles 1-2 microm
900-1300 MBq - - 10% in lung <100 MBq
T1/2 in lung 55-108 min

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19
Q

Tc-MAG3

A

Tubular secretion in proximal tubules
Partial glomerular filtration
80% protein binding
60% first pass
Renal + hepatobiliary excretion

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20
Q

Tc-Nanocolloid?

A

5-100 nm - - 95% <80 nm
Phagocytosis by reticuloendothelial system
Liver, Spleen, bone marrow

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21
Q

Tc-SC filtered

A

100-220 nm
Hepatosplenic scan
Bone marrow scan
Gastric emptying
Lymphoscintigraphy .

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22
Q

I123

A

T1/2 13.2 h
lower radiation burden, better image quality
159 keV
No stunning

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23
Q

O15-water

A

100% extraction rate - - high blood pool
T1/2 2 min
Range 8.2 mm
Myocardial blood flow

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24
Q

F-Fluripidaz

A

Pyridaben analog
Inhibitor of mitochondrial complex 1
Myocardial perfusion

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25
Tl201-Chloride?
K analog Redistribution - - viability T1/2 10 days Gamma 135 and 167 keV X ray 67-82 keV - - scatter - - poor quality Myocardial perfusion, glioma, PTA 48h no lact, no touch 96h frozen milk
26
MIBG
Analog of catecholamines taken up by chromaffin cells as Adrenalin - - VMAT1 and 2 stored in secretory vesicles - - ganglia, adrenal medulla, myocardium Not bind postsynaptic rec Not degraded by MAO, COMT Less renal uptake vs octreoscan, GIT 3% I123 - diagnostic only I131 - diagnostic + therapy 48h no Frozen 96h
27
Ga67-citrate
Similar to Fe 90% protein binding - - transferrin and lactoferrin Image 48h, 72h, 96h Infection, inflammation, sarcoidosis First 24h renal excretion - - then bowel >3 weeks no Frozen a month
28
Tc-HMPAO
Lipophilic - - cross BBB - - hydrophilic - - trapped Stable for 30 min Brain perfusion Brain death WBC
29
Tetrofosmin
Positively charged lipophilic - - bind to cytosol protein Renal, hepatobiliary excretion Similar to MIBI Myocardial perfusion
30
Tc-Tilmanocept
Particle 7 nm Not colloid - - bind to CD206 on surface of macrophages and dendritic cells in LN
31
In111-DTPA
Intrathecal - - cisternography. T1/2 2.8 days
32
Tc-PYP
Bone uptake and binding to microcalcification in amyloid plaque in heart ATTR Amyloidosis
33
PSMA
1.8-2.2 MBq/kg Type 2 integral membrane glycoprotein Involved in angiogenesis l Prostate Bladder, pancreas, lung, kidney F18 - - better spatial resolution, less renal excretion No touch 30 min
34
I123-FP-CIT
Cocaine analog DD essential tremor vs Parkinson's disease DAT scan - - antagonist DAT SPECT within 3-6h
35
What is K analog?
A substance taken up by myocardium through Na+/K+ ATPase-pump. Tl201-chloride Rb82-Chloride
36
Rb82-chloride
K analog T1/2 1.3 minutes. Range 8.6 mm
37
choline
Synthesis of phospholipids in cell membrane Phosphorylated by choline kinase - - trapped C11 - - prostate, brain tumor F18 - - higher renal excretion
38
Cell proliferation
C11-thymidine - - DNA synthesis during S phase of cell cycle - - rapid catabolism - - suboptimal F18-FLT - - more resistant to phosphorylase Taken up like thymidine - -phosphorylated by thymidine kinasa 1 Uptake correlate with Ki67
39
Amino acid transport
C11-methionine - - no uptake in normal brain - - brain tumor F18-FET --glioma F18-fluciclovine - - synthetic amino acid - - low renal excretion - - prostate
40
Amyloid imaging
C11-PiB - - suboptimal specificity F18-Flutemetamol = Vizamyl - - 90 min F18-Florbetapir = Amyvid - - 45-60 min F18-Florbetaben - - 120 min
41
Uptake correlate with Ki67
F18-FLT Cell proliferation
42
Tissue hypoxia
FMISO High blood pool - - suboptimal Preradiation regional hypoxia Head and neck, lung
43
GA-STTR lact
4h no Frozen 8h
44
F18-DOPA
precursor of catecholamines - - taken up by LAT1 - - turn to dopamine by AADC - - stored in secretory vesicles by VMAT - - degraded by MAO Carbidopa - - AADC inhibitor 185 MBq = 5 mCi 4h no Frozen 8h No touch 2h
45
N13 ammonia
Lipophilic - - trapped as glutamine T1/2 10 min Range 2.5 mm Rest-stress in same session Myocardial perfusion
46
I122-IBZM
D2 postsynaptic receptor 3% cross BBB DD Parkinson vs Parkinson+ Wilson and Hantington - - D2 block by neuroleptics Pituitary adenoma - - therapy strategy Melanoma?
47
Tc MAA
Heat denaturated human albumin particles - - microembolisation 15-100 microm Lung perfusion ROLL, TARE 12h no lact Frozen 24h
48
Tc ECD
Lipophilic - - cross BBB - - stereoisomer 1,1-ECD trapped Stable 8h Brain perfusion Brain death
49
Zr89-Bevacizumab
Anti VEGF antibody breast, ovarian cancer, NET, RCC, glioma.
50
Tc MIBI
Positively charged lipophilic - - accumulate in mitochondria Myocardium, PTA, muscles, liver, kidney, salivary gland, thyroid, tumor Hepatobiliary + renal excretion Scintimammography
51
Tc HIDA
Mebrofenin Disofenin Analog of lidocaine - - bilirubin receptor Hepatobiliary and renal excretion
52
Y90 treatments
T1/2 64h Zevalin = Ibritumomab tiuxetan - - anti CD20 Microspheres - - resin and glass - - TARE, SIRT DOTA-TOC - - PRRT .
53
Lu177 in cancer treatment
T1/2 6.7 days DOTA-TATE--PRRT EDTMP - - bone MTS PSMA .
54
Re188?
T1/2 16.9h Lipiodol - - HCC HEDP - - bone MTS
55
alpha radiation
Single/double-strand DNA breaks Energy 5-9 MeV LET 80-100 keV/microm Range 40-100 microm
56
Sr89-chloride
Ca analog Bone MTS T1/2 50.5 days .
57
Ra223-Chloride
Similar to Sr89Cl2 Ca analog Bone MTS + benefit in survival T1/2 11.4 days Fecal excretion .
58
Retroperitoneal fibrosis
Soft tissue, encase ureter - - Hydronephrosis Enhanced on CT Biopsy Immunosuppresive therapy, tamoxifen Surgery for decompression
59
lipomatous hypertrophy of interatrial septum brown fat
60
Bowel uptake on bone scan
Day before MIBI MPI Introduce air - - incomplete labeling Necrotizing enterocolitis Inflammation GI bleeding Systemic Amyloidosis Protein loosing enteropathy
61
Bone scan after MUGA
Uptake in heart, liver, spleen
62
Bone scan increased renal uptake
Dehydration Hypercalcemia Post chemo Post radio Nephrocalcinosis Sickle cell disease Acute tubular necrosis (early) Glomerulonephritis
63
osteitis condensans ilii benign bilateral sclerosis of iliac side of SIJ triangular
64
FDG
AFib
65
Erdheim Chester disease non Langerhans histiocytosis --> fibrosis and osteosclerosis
66
67
lead pipe = ulcerative collitis hypertrophy of muscularis mucosa
68
polymyositis
69
70
ischiopubic synchondrosis
71
PERCIST = PET response criteria for solid tumor
CR - - no uptake > liver or blood pool PR - - reduction 30% SULpeak in target with absolute drop in SUL at least 0.8 SD - - not any PD - - increase 30% SULpeak, 0.8 increase in tumor vs baseline or visible increase or new lesions
72
Immune therapy
Anti-CTLA-4 - - ipilimumab ANTI-PD-1 - - pembrolizumab, nivolumab
73
Immunotherapy pseudo progression
Transient increase in tumor burden or appearance of new lesions Within first 4–6 weeks -- up to several months. Most common in metastatic melanoma treated with anti-CTLA-4. Re-evaluate 4-8 weeks later
74
Pseudoprogression mechanism
delayed activation of immune response, local edema due to inflammatory processes and infiltration of immune cells within tumor lesions.
75
Immunotherapy side effects
anti-CTLA-4 -- colitis anti-PD-1 -- pneumonitis increased BM activity and spleen>liver check pituitary
76
a - pseudo progression b - hyper progression
77
Obstruction of left bronchus Air trapping in left lung - - hyperinflation Mediastinum to the right
78
Pericardial tamponada
79
Bowel Perforation etiology
80
Ischemic colitis Air in the wall of small bowel
81
Melanoma
Pneumonitis
82
83
Lymphangitic spread
84
GFR 30-45
Worsening within 3 months Or risk factors for AKI (dehydration, hypovolemia, DM, proteinuria, MM) -- consultation with sending doctor
85
AKI
Within 48h from Nephrotoxic event : Creatinine increase >0.3 Urine output <0.5 ml/kg/min over 6h -- consultation with sending doctor
86
GFR <30 or chronic dialysis
Consultation with nephrolog Give saline 3 ml/kg 1h before and 1.55 ml/kg/min for 3h after Hospitalized - - 1 ml/kg/h 6-12h before and after Emergent abd no heart failure - - bolus 300-500 ml Heart failure - - consultation with doctor
87
Transplant kidney
Not a Contra Consultation with nephrolog
88
Dialysis + anuria
Report to dialysis department about iodine
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