F-18-FDG (FLUORODEOXYGLUCOSE) PET/CT (BODY), 1/29/07:
TECHNIQUE: Utilizing the Siemens Biograph-16 PET/CT imaging unit, PET, immediately preceded by transmission CT for attenuation correction and anatomic correlation, was obtained from the base of the skull to the mid thighs approximately 65 minutes after intravenous injection of 16.2 mCi of F-18-FDG.
FINDINGS: Previously demonstrated prevascular lesion is redemonstrated measuring 1.4 SUV max (previously 1.6 SUV). It is essentially stable.
In the aortopulmonary window there is a very tiny lymph node with no demonstrable hypermetabolism.
In the posterior medial portion of the liver there is artifactual small area of hypermetabolism. There is also nonspecific bowel activity. Hypermetabolism is also demonstrated in the nasopharynx and palatine tonsils. Clinical correlation is recommended. Mild increased activity in the salivary glands, likely inflammatory in nature.
Redemonstration of scarring versus atelectasis in the right upper lobe and to a lesser extent in the right middle lobe. No hypermetabolic lesions of note.
1. Redomonstration of stable mildly hypermetabolic prevascular lymph node.
2. Hypermetabolism demonstrated in nasopharynx and palatine tonsils, likely infectious/inflammatory in nature. Clinical correlation recommended.
BREAST LESION LYMPHOSCINTIGRAPHY
CLINICAL HISTORY: 56 y/o female with right breast cancer.
TECHNIQUE: Four intradermal injections, each containing 107 uCi Tc-99m filtered sulphur colloid, were made at the 3, 6, 9, and 12 o'clock positions 1-2 cm from the margins of the lesion located in the right breast. No images were obtained. This was done at 9:50 a.m., 11/27/06, by Dr. Farrar for later surgical lymph node exploration using a gamma probe.
IMPRESSION: Radiopharmaceutic injection for intraoperative gamma probe detection.
CARBON-14 UREA BREATH TEST
TECHNIQUE: The patient swallowed a capsule containing 0.799 uCi carbon-14 urea. Ten minutes later, the patient exhaled into a balloon and the balloon was analyzed for carbon-14 labelled carbon dioxide gas.
FINDINGS: Relative to background radiation, the quantity of carbon-14 in the exhaled sample was -3 dpm (less than 50 dpm is considered negative for H. pylori infection).
IMPRESSION: Negative H. pylori carbon-14 urea breath test.
CHOLESCINTIGRAPHY with EJECTION FRACTION
TECHNIQUE: Views of the abdomen were obtained intermittently over a 60-minute period, after intravenous injection of 6.0 mCi Tc-99m-DISIDA. The patient then received 1.14 mcg of cholecystokinin intravenously and a gallbladder ejection fraction was calculated.
FINDINGS: The liver demonstrates homogeneous intensity. There is visualization of extrahepatic bile ducts and gallbladder within 10 minutes and intestinal activity at 15 minutes.
Gallbladder ejection fraction calculated to be 18% (normal is greater than 40%).
1. Decreased gallbladder ejection fraction, consistent with chronic cholecystitis.
2. No evidence of biliary obstruction.
TECHNIQUE: Four intradermal injections of 107 uCi Tc99m filtered sulphur colloid in 0.1ml of normal saline each were made at the 3, 6, 9, and 12 o'clock positions 1-2 cm from the margins of the surgical site located on the patientís back. Images of the left axilla were obtained intermittently over a 60-minute period, and the sentinel nodes marked with indelible ink prior to sending the patient to surgery.
FINDINGS: The first lymph node was demonstrated by the radiotracer at 5 minutes and was located in the superior lateral aspect of the left axilla. The next two lymph nodes appeared at 10 minutes and were located approximately 3 cm and 6 cm inferior to the first lymph node, respectively.
IMPRESSION: Sentinel lymph node identification and marking for intraoperative detection.
DUAL WHOLE BODY BONE SCAN & INDIUM-111 WHITE BLOOD CELL SCINTIGRAPHY
TECHNIQUE: Multiple spot scintigraphs in various projections were obtained following IV injection of 10.9 mCi Tc-99m MDP and 0.50 mCi indium-111 labeled autologous white blood cells. Angiogram, blood pool, and three hour delayed images were obtained.
FINDINGS: The white blood cell scan demonstrates no foci of increased activity.
The bone scan demonstrates minimally increased general flow to the right foot relative to the left. On the blood pool phase and the delayed phase, the distal end of the left first metatarsal demonstrates increased activity. The right foot demonstrates no foci of increased activity on the blood pool or the delayed images.
1. No evidence of osteomyelitis.
2. Right foot demonstrates subtle increase in flow relative to left foot. Clinical correlation recommended.
3. Increased activity at the distal end of the left first metatarsal, which may represent postoperative or degenerative change.
GASTRIC EMPTYING NUCLEAR MEDICINE STUDY, 11/20/06:
COMPARISON EXAMINATION: None.
CLINICAL HISTORY: 61-year-old female with diabetes mellitus. Complains of fullness and loss of appetite.
TECHNIQUE: Following ingestion of 1.00 mCi of Tc-99m Chelex resin in one ounce of unsweetened instant oatmeal and reconstituted to a total volume of six fluid ounces with water, serial images with the images in supine position utilizing the posterior projection were obtained over a 45-minute period. The half-life of gastric emptying was calculated.
FINDINGS: The calculated half-life of gastric emptying was 31 minutes (normal range 24-48 minutes).
Some radiotracer is observed in the distal esophagus. This likely represents esophageal dysmotility, although gastroesophageal reflux is a possibility. A barium swallow is recommended to further evaluate this.
1. Normal gastric emptying.
2. Esophageal dysmotility or gastroesophageal reflux.
e.g. Focal esophageal retention of radiotracer is seen for the majority of the study. Esophageal functional or structural pathology such as dysmotility or diverticulum are possible explanations.
I personally viewed and interpreted these images and I have reviewed and approved this report
IODINE-131 ADMINISTRATION FOR THYROID CANCER, 11/29/06
COMPARISON EXAM: Iodine-131 whole-body scintigraphy 11/29/06.
CLINICAL HISTORY: 22-year-old female status-post thyroidectomy for thyroid cancer.
TECHNIQUE: The patient received 50.4 mCi sodium iodide solution orally as therapy for thyroid cancer. The radiopharmaceutical was administered under the supervision of Laura Ryan, M.D. No images were obtained.
IMPRESSION: Radioiodine-131 administration for thyroid cancer.
TECHNIQUE: Utilizing 8.8 mCi Tc-99m DTPA IV, the callibrated gamma camera, Gate's technique, and computer-derived renal depths; split renal function and GFR were determined.
FINDINGS: Total GFR was 28 ml/min. Normalized GFR was 27 ml/min.
Split renal function revealed that the right kidney provided 48% and the left kidney provided 52% of total GFR.
GI HEMORRHAGE LOCALIZATION STUDY
TECHNIQUE: Cine and intermittent images of the abdomen and pelvis were obtained over a 2 hour period following the intravenous injection of 25.0 mCi of technetium-99m in vitro labeled autologous red blood cells.
FINDINGS: No evidence of abnormal activity collection within the abdomen and pelvis to suggest active GI bleeding. Splenomegaly is present. Collateral vessels are present in the abdomen and pelvis.
IMPRESSION: No evidence of GI bleeding during the time course of the study.
INDIUM-111 WHITE BLOOD CELL SCINTIGRAPHY
TECHNIQUE: Whole body scintigraphs were obtained 24 hours after IV injection of 509 microcuries of indium-111 labeled autologous white cells.
FINDINGS: There is an area of focal white blood cell accumulation in the left mid chest seen more prominent on the posterior view and probably within the lung. This is suspicious for a focus of infection in the left lung.
The spleen is diffusely enlarged. The liver is prominent.
There is bone marrow expansion in the distal femurs, proximal tibia, pelvis, and proximal humeri. Of note is asymmetry in the proximal humeri, with the right humerus being more intense than the left, uncertain significance and clinical correlation is recommended.
1. Focal white blood cell accumulation in the left mid chest region seen more prominent on posterior view , suspicious for lung infection when correlating with chest CT findings.
3. Diffuse bone marrow expansion. Slightly assymetric bone marrow distribution in proximal humeri, is of uncertain significance. Clinical correlation recommended.
IODINE-131 WHOLE BODY SCINTIGRAPHY
TECHNIQUE: 48 hours after ingestion of 2.06 mCi of I-131 sodium iodide, whole body scintigraphs, spot views of the neck and chest, pinhole view of the neck plus radioactive iodine neck uptake determinations were performed.
FINDINGS: Uptake is present in the thyroid bed bilaterally; however, the images are compromised by patient motion. Uptake in the remaining parts of the body are physiologic.
At 48 hours, there is 0.23% retention in the neck and 9.5% total body retention.
IMPRESSION: Bilateral thyroid bed uptake. No evidence of metastatic disease in lateral neck compartments or distant sites.
QUANTITATIVE PULMONARY PERFUSION STUDY
TECHNIQUE: Utilizing 5.0 mCi Tc-99m MAA intravenously, dividing the lungs into thirds in a craniocaudad direction, utilizing simultaneous anterior and posterior projections (750,000 counts per posterior projection), and a geometric mean method; relative perfusion to various regions of the lungs were calculated.
Right upper lung: 15%
Right middle lung: 33%
Right lower lung: 14%
Total right lung lung: 61%
Left upper lung: 11%
Left middle lung: 20%
Left lower lung: 8%
Total left lung lung: 39%
RENAL TRANSPLANT SCAN
TECHNIQUE: Dynamic perfusion and functional images of the transplanted kidney were obtained for 20 minutes following IV bolus injection of 10.9 mCi Tc 99m MAG3.
FINDINGS: There is normal perfsuion of the transplanted kidney in the right pelvis. Persistent cortical retention of tracer is noted without any observed excretion into the bladder. Collecting system is obscured by intense parenchymal activity. However, some activity is noted in the urinary collection bag indicating some excretion.
A photopenic area is observed superior to the transplanted kidney. This may represent a hematoma, urinoma, lymphocele, seroma, or other postoperative fluid collection. See ultrasound study done 11/20/06.
1. Normal perfusion with significant parenchymal retention of activity and mild excretory function , suggestive of acute tubular necrosis of transplanted kidney.
2. Photopenic area superior to transplanted kidney likely consistent with postoperative fluid collection.
THYROID UPTAKE & SCAN
TECHNIQUE: Radioactive iodine thyroid uptake (RAIU) determinations were performed at approximately 6 hours and 24 hours post ingestion of 242 mC of I-123 in capsule form. Thyroid scintigraphs were then obtained.
FINDINGS: The thyroid scintigraphs demonstrate diffuse enlargement of the thyroid gland and diffusely increased activity. There is a photopenic area at the medial base of the right lobe. This is likely a colloid cyst or thyroid nodule (see previous ultrasound scan report).
Mean uptake at 6 hours was 46.9% (normal range is 5-12%). Mean uptake at 24 hours was 58.3% (normal range is 7-33%).
TRIPLE PHASE BONE SCINTIGRAPHY of DISTAL UPPER EXTREMITIES
TECHNIQUE: A radionuclide angiogram followed by blood pool images and three-hour delayed static views of the distal upper extremities in various projections were performed following intravenous administration of 25.4 mCi of technetium-99m MDP.
VENTILATION / PERFUSION SCAN
TECHNIQUE: A ventilation study was performed utilizing Tc-99m DTPA aerosol (42 mCi in nebulizer) followed by pulmonary perfusion study utilizing 5.22 mCi Tc-99m MAA intravenously. Chest radiograph was done within 30 minutes of the V/Q study and was available for correlation.
FINDINGS: Small matched defects are present in the right lung base anteriorly, right anterior upper lung, left anterolateral lung base. Soft-tissue attenuation likely accounts for much of these findings (the patient weighs approximately 300 pounds).
IMPRESSION: Low probability for pulmonary embolism.
WHOLE BODY BONE SCAN, 11/20/2006:
COMPARISON EXAM: CT abdomen with contrast, 11/20/2006; CT chest with contrast, 11/20/2006; whole body bone scan 4/3/2006.
CLINICAL HISTORY: 57-year-old female with history of metastatic breast cancer.
TECHNIQUE: Whole body scintigraphs were obtained approximately 3 hours post intravenous injection of 25.0 mCi of technetium 99m-MDP.
FINDINGS: Stable diffuse increased activity is observed within the skull. Increased activity is also present in L1 and L5, with L5 being more prominent than on the previous study. However, a contrast enhanced CT done the same day indicates that the lesions are stable.
Increased activity is noted involving the right mandible, which is likely secondary to dental pathology. There is also increased activity at the left sternoclavicular joint, angle of the sternum, and xiphoid process, which are likely due to degenerative disease. This is confirmed on the contrast enhanced chest CT done the same day. Stable degenerative changes are also noted in the shoulders and knees bilaterally and in the right first metatarsophalangeal joint.
Diffuse increased activity is observed in the skull, which is stable and is likely a normal variant
1. Stable metastases involving L1 and L5.
2. Diffuse increased activity in skull, which is stable and is likely a normal variant.
3. Stable degenerative changes at multiple locations.