Teaching Atlas of Nuclear Medicine PDF
Preview Teaching Atlas of Nuclear Medicine
Teaching Atlas of Nuclear Medicine Teaching Atlas of Nuclear Medicine edited by Kevin J. Donohoe, M.D. Division of Nuclear Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts and Annick D. Van denAbbeele, M.D. Division of Nuclear Medicine Dana-Farber Cancer Institute Boston, Massachusetts 2000 Thieme New York • Stuttgart ThiemeNewYork 333SeventhAvenue NewYork,NY10001 Editor:JaneE.Pennington EditorialDirector:Ave´ McCracken EditorialAssistant:ToddWarnock DevelopmentalManager:KathleenP.Lyons Director,ProductionandManufacturing:AnneVinnicombe ProductionEditor:JaniceG.Stangel MarketingDirector:PhyllisGold SalesManager:RossLumpkin ChiefFinancialOfficer:SethS.Fishman President:BrianD.Scanlan CoverDesigner:KevinKall Compositor:AlexanderGraphics,Inc.,andGraphicWorld,Inc. Printer:Maple-VailBookManufacturingGroup LibraryofCongressCataloging-in-PublicationData Teachingatlasofnuclearmedicine/editedbyKevinJ.Donohoe,AnnickVandenAbbeele. p. cm. Includesbibliographicalreferencesandindex. ISBN0-86577-775-6 1. Radioisotopescanning—Atlases. I. Donohoe,KevinJ. II. VandenAbbeele,Annick, 1953- [DNLM: 1. RadionuclideImaging—Atlases. 2. RadionuclideImaging—CaseReport. WN 17 T253 1999] RC78.7.R4 T43 1999 616.07'575 21—dc21 99-040822 Copyright©2000byThiemeMedicalPublishers,Inc.Thisbook,includingallpartsthereof,islegallyprotectedby copyright.Anyuse,exploitationorcommercializationoutsidethenarrowlimitssetbycopyrightlegislation,withoutthe publisher’sconsent,isillegalandliabletoprosecution.Thisappliesinparticulartophotostatreproduction,copying, mimeographingorduplicationofanykind,translating,preparationofmicrofilms,andelectronicdataprocessingandstorage. Importantnote:Medicalknowledgeisever-changing.Asnewresearchandclinicalexperiencebroadenourknowledge, changesintreatmentanddrugtherapymayberequired.Theauthorsandeditorsofthematerialhereinhaveconsulted sourcesbelievedtobereliableintheireffortstoprovideinformationthatiscompleteandinaccordwiththestandards acceptedatthetimeofpublication.However,inviewofthepossibilityofhumanerrorbytheauthors,editors,orpublisher oftheworkherein,orchangesinmedicalknowledge,neithertheauthors,editors,publisher,noranyotherpartywhohas beeninvolvedinthepreparationofthiswork,warrantsthattheinformationcontainedhereinisineveryrespectaccurateor complete,andtheyarenotresponsibleforanyerrorsoromissionsorfortheresultsobtainedfromuseofsuchinformation. Readersareencouragedtoconfirmtheinformationcontainedhereinwithothersources.Forexample,readersareadvisedto checktheproductinformationsheetincludedinthepackageofeachdrugtheyplantoadministertobecertainthatthe informationcontainedinthispublicationisaccurateandthatchangeshavenotbeenmadeintherecommendeddoseorin thecontraindicationsforadministration.Thisrecommendationisofparticularimportanceinconnectionwithnewor infrequentlyuseddrugs. Someoftheproductnames,patents,andregistereddesignsreferredtointhisbookareinfactregisteredtrademarksor proprietarynameseventhoughspecificreferencetothisfactisnotalwaysmadeinthetext.Therefore,theappearanceofa namewithoutdesignationasproprietaryisnottobeconstruedasarepresentationbythepublisherthatitisinthepublic domain. PrintedintheUnitedStatesofAmerica 5 4 3 2 1 TNYISBN0-86577-775-6 GTVISBN3-13-108611-4 To my mother and father, who have given me knowledge and a sense of humor. To my mentors Dennis Patton and Tim Woolfenden, who have shown me how to teach and explore. And to Mary, who has given me her love and support. Kevin J. Donohoe, M.D. To my parents Nelly and Karel Gerard Van den Abbeele, my sister Karyn, my brothers Eric and Michel, and their families, for giving me the roots as well as the wings, for inspiring the best, and for their endless encouragement, love, and support. Annick D. Van den Abbeele, M.D. CONTENTS Contributors .................................................................................................. xiii Foreword ......................................................................................................... xv Preface .......................................................................................................... xvii I. SKELETALSCINTIGRAPHY NayerNikpoorandKevinJ.Donohoe A. NeoplasticDisease Case1. NormalBoneScan ............................................................ 3 Case2. ProstateCancer .................................................................. 6 Case3. BreastCancer .................................................................... 8 Case4. LungCancer .................................................................... 11 Case5. RenalCancer ................................................................... 14 Case6. Superscan ........................................................................ 16 Case7. ColonCancer ................................................................... 19 Case8. ColonCancer ................................................................... 21 Case9. SoftTissueMetastases(sarcoma) ................................... 24 Case10. LyticLesion ..................................................................... 27 Case11. AscitesonBoneScan ...................................................... 29 Case12. DecreasedBonyActivitySecondarytoExternal BeamRadiation ............................................................... 31 B. Non-neoplasticDisease Case13. SickleCellDisease .......................................................... 33 Case14. BenignInfarctioninSickleCellDisease ........................ 36 Case15. Paget’sDisease ................................................................ 38 Case16. Paget’sDiseaseoftheUpperExtremity ......................... 41 Case17. NodalTracerUptake ....................................................... 43 Case18. EtidronateTherapy .......................................................... 45 Case19. ResuscitationTrauma ...................................................... 47 Case20. Paget’sDiseaseoftheSpine ........................................... 49 Case21. BrainAbscess .................................................................. 52 Case22. Osteomyelitis ................................................................... 54 Case23. ShinSplint ....................................................................... 57 Case24. StressFracture ................................................................. 59 Case25. Post-traumaticFracture ................................................... 61 Case26. StressFractureMimickingMalignancy .......................... 63 Case27. FractureinElderlyPatient .............................................. 65 Case28. Osteonecrosis .................................................................. 67 Case29. InsufficiencyFracture ...................................................... 69 Case30. BoneGraft ....................................................................... 71 Case31. SecondaryHyperparathyroidism ..................................... 73 Case32. ProsthesisLoosening ....................................................... 76 Case33. Osteomyelitis ................................................................... 78 Case34. Spondylolysis .................................................................. 80 vii CONTENTS II. CARDIACSCINTIGRAPHY KevinJ.DonohoeandAlanJ.Fischman A. MyocardialPerfusion—Planar Case35. Normal ............................................................................. 85 Case36. Stress-inducedIschemia .................................................. 88 Case37. FixedDefect .................................................................... 90 Case38. TracerUptakeintheLungs ............................................. 92 Case39. PoorVisualizationofMyocardium ................................. 94 Case40. ProminentRightVentricle ............................................... 96 Case41. DilatedLeftVentricle ...................................................... 98 Case42. PericardialEffusion ....................................................... 101 B. MyocardialPerfusion—SPECT Case43. NormalMIBISPECT .................................................... 103 Case44. InferiorWallIschemia ................................................... 107 Case45. ModerateAnteroapicalIschemia ................................... 110 Case46. Cardiomyopathy ............................................................ 112 Case47. CardiomyopathywithLeftBundleBranchBlock ........ 114 Case48. SevereDilatedCardiomyopathy ................................... 116 Case49. MotionArtifact .............................................................. 118 C. MyocardialFunction(radionuclideventriculography) Case50. Normal ........................................................................... 121 Case51. LVAneurysm ................................................................ 125 D. MyocardialViability Case52. 18FDG/13N-ammoniaPET ............................................ 127 Case53. 18FDG/99mTc-sestamibiSPECT—Viable Myocardium .................................................................. 129 Case54. 18FDG/99mTc-sestamibiSPECT—Non-viable Myocardium .................................................................. 131 III. PULMONARYSCINTIGRAPHY JacScheiner A. PulmonaryEmbolism Case55. Normal ........................................................................... 137 Case56. LowLikelihood—SmallPerfusionDefect .................... 142 Case57. LowLikelihood—MatchedDefects .............................. 144 Case58. IntermediateLikelihood ................................................ 147 Case59. HighLikelihood ............................................................ 149 Case60. IntermediateLikelihood ................................................ 151 Case61. HighLikelihood—MassiveClotBurden ...................... 154 Case62. ClumpingofTracer ....................................................... 157 Case63. PacemakerArtifact ........................................................ 159 B. RighttoLeftShunt Case64. ASD—Right-to-LeftShunt ........................................... 161 Case65. Right-to-LeftIntrapulmonaryShuntSecondaryto PulmonaryEmbolism .................................................... 163 IV. ENDOCRINESCINTIGRAPHY KevinJ.DonohoeandRachelPowsner A. Thyroid Case66. Normal ........................................................................... 167 Case67. ColdNodule .................................................................. 170 viii CONTENTS Case68. AutonomousNodule ..................................................... 172 Case69. PoorTracerUptake ....................................................... 174 Case70. StarArtifact ................................................................... 176 Case71. SuppressionScan .......................................................... 178 Case72. Cancer ........................................................................... 181 Case73. TransmissionScan ......................................................... 184 Case74. FollicularThyroidCancer ............................................. 186 B. Parathyroid Case75. ParathyroidAdenoma .................................................... 189 Case76. ParathyroidAdenomainMultinodularGoiter .............. 191 Case77. MediastinalParathyroidAdenoma ................................ 193 Case78. NormalParathyroidBed ............................................... 195 V. SCINTIGRAPHYOFNEOPLASTICDISEASE A. Lymphoma AnnickD.VandenAbbeele Case79. Hodgkin’sDisease ........................................................ 199 Case80. Low/Non-Hodgkin’sGradeLymphoma ....................... 206 Case81. AggressiveNon-Hodgkin’sLymphomas ...................... 210 B. Breast FrankBradley Case82. EvaluationofBreastMass ............................................ 217 Case83. PatientwithImplant ...................................................... 219 Case84. AxillaryMass ................................................................ 222 C. Neuroendocrine ChristopherP.FeyandAnnickD.VandenAbbeele Case85. Neuroblastoma .............................................................. 224 Case86. Gastrinoma .................................................................... 229 Case87. CarcinoidTumor ........................................................... 232 D. AntibodyScintigraphy MilosJanicek,ChristopherP.Fey,andAnnickD.VanDenAbbeele Case88. OncoScintt .................................................................... 235 Case89. CEA-Scant ................................................................... 239 Case90. ProstaScintt .................................................................. 244 E. PositronImagingofTumors HosseinJadvarandAlanJ.Fischman Case91. StagingofNon-smallCellLungCancer ....................... 247 Case92. PETMonitoringofLungCancer .................................. 249 Case93. PETImagingofEsophagealCancer ............................. 252 Case94. LungAdenocarcinoma .................................................. 256 Case95. RecurrentSmallCellLungCancer ............................... 258 Case96. EsophagealAdenocarcinoma ........................................ 260 Case97. PancreaticAdenocarcinoma .......................................... 262 Case98. LowerExtremitySarcoma(spindlecell) ...................... 264 VI. INFLAMMATIONIMAGING KevinJ.Donohoe A. SoftTissueInflammation Case99. NormalIn-111WBC ..................................................... 269 Case100. PresacralAbscess .......................................................... 271 ix
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