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Clinical History:
52 year old man, 1.8m, 90 kg. Previous removal of duodenal gastrinoma. Underwent 3 treatment courses with Lutetium DOTA Somatostatin for non-metastatic lymph node in the peritoneum.
Findings:
SPECT images acquired 24h post IV injection of 6mCi
In-111 Somatostatin. Results show increased uptake in the retro-peritoneum, anterior to previous surgical field, with enlarged lymph node in the corresponding location of the study.
Diagnosis:
Metastatic lymph node.
Courtesy of Tel-Aviv Sourasky Medical center
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Clinical History:
65-year old woman with a history of papillary thyroid carcinoma was referred for a red blood cell study (RBC). A liver ultrasound detected liver abnormalities suggestive of hemangiomas and cyst but could not definitely rule out liver metastases. Last WBS after 131I therapy was normal and TG was undetectable.
Findings:
SPECT images, CT images, and then SPECT/CT fused images confirmed the presence of 2 posterior liver lesions on CT (segment IV and V) with increased tracer uptake suggestive of hemangiomas. An anterior liver cyst with no tracer uptake was also clearly identified (segment III). Fused images helped to confidently rule out liver metastases.
Diagnosis:
Liver metastases
Courtesy of London Hospital, Ontario, Canada
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Clinical History:
Iodine 131 scintigraphy. A 67-year-old female after total thyroidectomy for thyroid cancer.
Findings:
Increased uptake of iodine in the neck corresponds in location to the thyroid bed, appears physiologic. Hawkeye ensures higher degree of confidence in ruling out malignancy.
Diagnosis:
Physiological uptake.
Courtesy of Tel-Aviv Sourasky Medical center
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Clinical History:
An obese 80 year old male with history of myocardial ischemia.
Findings:
Thallium stress images are shown. Due to obesitas there are important attenuation artifacts in the inferior, the septal antero-septal and apical areas.
Attenuation correction:
After attenuation correction there is only a decreased myocardial perfusion in the apical and antero-apical area.
Attenuation correction with a power of only 1.0 mA and by this with a lower radiation burden gives clinically the same results as with the full 2.5 mA power.
Courtesy of Clinic St jean, Brussels, Belgium
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Clinical History:
Man, aged 40.
Screening for renal function in an atrophic right kidney.
Findings:
An atrophic right kidney with a decreased uptake.
A hypertrophy left kidney with normal uptake.
On the hawkeye CT a focal dense spot in the under pole of the left kidney.
Diagnosis:
Atrophic but still functional right kidney.
A compensatory morphological and functional hypertrophy of the left kidney.
Discovery of a renal calculus in the best working left kidney.
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Clinical History:
A 24 year patient with primary hyperparathyroidism.
Findings:
3 foci in the upper, lower left lobe as well as the lower right lobe of the thyroid.
Diagnosis:
Focal uptake consistent with abnormal parathyroid glands either multiple adenomas or hyperplasic glands .
CourtesySouth Street Hospital - Dpt of Nuclear Medicine, Ontario, Canada
Drs. Tarik Belhocine, Albert Driedger, Dr. Irina Rachinsky , Anil Shastry, and Jean-Luc Urbain
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Clinical History:
A 75-year old man with a low pretest likelihood of CAD was explored by SPECT-CT MPI following dipyridamole and sub-maximal bicycle exercice. BMI = 30.4.
SPECT parameters :
non-Gated Rest (25 s/pr) and Gated Stress (20s/pr) - Scan time = 15 min
CT parameters : 2.5 mA - 140 kV - Helical mode.
Scan time = 2 min
Findings:
99mTc-MIBI SPECT alone showed decreased uptake in the inferior wall likely due to infra-diaphragmatic attenuation.
Diagnosis:
Attenuation corrected images showed complete recovery of infra-diaphragmatic attenuation suspected on the non corrected images.
SPECT-CT increased the confidence for interpretation from a probably normal to a definitely normal MPI study.
Courtesy from South Street Hospital - Dpt of Nuclear Medicine, Ontario, Canada, Drs. Tarik Belhocine, William Vezina, Cigdem Akincioglu, Albert Driedger, and Jean-Luc Urbain
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Clinical History:
A 68-year old man with an intermediate pretest likelihood of CAD was explored by SPECT-CT MPI following bicycle exercice. BMI = 25.8.
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SPECT parameters :
non-Gated Rest (25 s/pr) and Gated Stress (20s/pr) - Scan time = 15 min
CT parameters : 2.5 mA - 140 kV - Helical mode. Scan time = 2 min
Findings:
Non corrected images (NAC) show a large defect in the inferior and apical walls, which is moderately reversible at rest.
Diagnosis:
At stress, the defect in the inferior and apical walls is still detected on attenuation corrected images (AC), which confirms the presence of a true perfusion defect not related to any attenuation artifact.
At rest, a reversible ischemia is more obvious on AC than NAC.
Courtesy from South Street Hospital - Dpt of Nuclear Medicine, Ontario, Canada
Drs. Tarik Belhocine, William Vezina, Cigdem Akincioglu, Albert Driedger, and Jean-Luc Urbain
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Clinical History:
Previous splenectomy for a hematological disease with misunderstood incomplete therapeutic result.
Admitted for search of an infection of unknown origin.
The complete radiological workout was negative.
Labeled white blood cell scintigraphy.
Findings and diagnosis:
Acute diverticulitis in the lower abdomen. (not shown)
A focal high concentration of labeled white blood cells in the left hypochondrium. CT shows a corresponding small nodule in the splenic area.
Accessory spleen, finally explaining the incomplete therapeutic result after splenectomy.
Diagnostic contribution:
Adding the high sensitivity from scintigraphy to the high specificity from CT leads to a a fast and very accurate diagnosis.
Courtesy of Clinic St jean, Brussels, Belgium
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Clinical History:
26 years old woman. Previous history of surgery for:
- 1/ primary hyperparathyroidism, with local recurrence and second surgery,
- 2/ colorectal adenocarcinoma (sigmoid),
- 3/ pancreatic endocrine tumor.
Search for local recurrence.
Findings:
Focal uptake against a biliary-digestive catheter.
Diagnosis:
Local recurrence.
Courtesy of HEGP hospital, Paris, France
Drs C.Hignette and M.Faraggi
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