2006 ORAL BOARD REVIEW: NucMed
Diagnosis Modality Information Other
Myocardial Infarction Cardiac Fixed defect. DDx: Hiber...
2006 ORAL BOARD REVIEW: NucMed
Bile leak HIDA Increasing radiotracer collection around the
liver ("turning the corner"). M...
2006 ORAL BOARD REVIEW: NucMed
RBC Labelling Artifact In-111
WBC
Blood pool = RBC labelling.
Vertebral
Osteomyelitis
In-11...
2006 ORAL BOARD REVIEW: NucMed
Liver Uptake - Diffuse MDP Colloid formation (Al), hepatic necrosis,
amyloid, Prior Scan
Li...
2006 ORAL BOARD REVIEW: NucMed
Soft Tissue Uptake -
Focal
MDP Dystrophic or Metastatic Calcification,
Tumoral Calcinosis, ...
2006 ORAL BOARD REVIEW: NucMed
Paraganglioma Octreotide Not just for Carcinoid. For any
neuroendocrine tumor.
Octreotide D...
2006 ORAL BOARD REVIEW: NucMed
Renal Artery Stenosis
(RAS)
Renal Scan MAG3 (tubular agent) -> Unilateral
Cortical Retentio...
2006 ORAL BOARD REVIEW: NucMed
GI Bleed Tagged
RBC
LUQ, RUQ, Cecal, SB = four patterns. Central rounded activity early = m...
2006 ORAL BOARD REVIEW: NucMed
Central Obstructing
Lesion
VQ Whole lung partial mismatch (global
decreased perfusion with ...
Upcoming SlideShare
Loading in …5
×

Diagnosis Modality Information Other Myocardial Infarction ...

1,044 views

Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Diagnosis Modality Information Other Myocardial Infarction ...

  1. 1. 2006 ORAL BOARD REVIEW: NucMed Diagnosis Modality Information Other Myocardial Infarction Cardiac Fixed defect. DDx: Hibernating Myocardium. May confirm with Thallium reinjection or FDG-PET. Myocardial Ischemia Cardiac Reversible defect in LAD distribution. Cardiac artifacts. Apical sparing implies artifact. Normal wall motion in area or defect. Repaired Transposition Cardiac Right ventricular uptake > Left. Pericardial Effusion Cardiac MUGA Photopenic Halo. MUGA is blood pool image. Utilize Tc99-RBCs. Two approaches: 1st pass (can be done with DTPA) in RAO immediately after injection. Equilibrium study: 20 minutes in 35 - 50 (45) degree LAO with cardiac gating. May do three views: AP, LAO, and steep LPO. Gallium Postives Gallium Scan Sarcoid, PCP, lymphoma, osteomyelitis (> In-111 for diskitis/osteomyelitis), amyloid. Diffuse lung uptake - Sarcoid, Infection (PCP, TB, MAI, CMV), lymphoma, Bleomycin, Amiodarone. Hemosiderosis / Hemochromatosis Gallium Scan No liver activity. Liver Ferritin is bound to Iron Gallium binds to Transferrin in blood, Lactoferrin in area of infection, and Ferritin in the liver. Lactation Gallium Scan Bilateral breast uptake. GaLLium: Lacrimal and Liver>spleen. Lymphoma Gallium Scan In this case: lymph node enlargement in chest and diffuse periotoneal uptake = Lymphomatosis Gallium: lacrimal glands are key, but may be suppressed by tumor. Generally, spleen is not very hot. Liver>Spleen Sarcoidosis Gallium Scan Lambda sign + Panda Sign Panda Sign DDx: Sjogren's, HIV, Sarcoid, Lymphoma, radiation. Thymic Rebound Gallium Scan Treated lymphoma with non-bulky anterior mediastinal uptake. Note LACRIMAL GLAND = GALLIUM. Fuzzy images are not Tc99m. Indium has no bowel activity. Early Gastroparesis Gastric Emptying Abnormal intragastric transit from fundus to antrum. Gastric Outlet Obstruction. Gastric Emptying No emptying. GOO may be functional (gastroparesis) vs. mechanical (obstructing mass). Hiatal Hernia Gastric Emptying Large thoracic collection > GER Tc99m Sulfur Colloid - cooked in egg or oatmeal. Tc99m added to milk/formula. Acute Cholecystitis HIDA No GB at one hour = "ABNORMAL" (no diagnosis yet). Give 0.04 mg/kg MSO4 (2-3 mg). At 4 hours: - GB = Acute cholecystitis . + GB at 4 hours = Chronic Choecystitis. Rim Sign - 20% association with Gangrenous Cholecystitis = increased risk of perforation. Morphine Dose = 0.04 mg/kg (2-3 mg) over 1 minute Sincalide Dose = 0.02 mcg/kg (1- 1.5 mcg) in 30 cc .9NS over 30 minutes NucMed 5/22/2007 2:49 PM 1 of 9
  2. 2. 2006 ORAL BOARD REVIEW: NucMed Bile leak HIDA Increasing radiotracer collection around the liver ("turning the corner"). May be along dome, subcapsular, pericolic, intraperitoneal. Delayed views if not seen. Reappearing Liver: HIDA cleared, then liver "reappears" as leak tracks around it. Biliary Atresia HIDA Lack of clearance to bowel at 24 hours. DDx: Neonatal hepatitis or cholestasis - child. In adult = high grade CBD obstruction. Phenobarbital Dose: 5mg/kg/day x 5 days. CBD Obstruction (High Grade) HIDA No uptake in the CBD, secondary to hydrostatic pressure. Stone can be anywhere along the duct. Also: Can say NOTHING about the GB (can't exclude cholecystitis ). HIDA=Hepatic IminoDiacetic Acid. Say Hepatobiliary Scan instead. Agent=mebrofenin at our institution. Disofenin (DISIDA) also common. If Persistent Blood Pool (Heart): can say decreased uptake: cholestasis, hepatitis, biliary atresia. Cholecystitis with partial CBD obstruction HIDA Shows no GB uptake + delayed activity (CBD activity should peak at 45 minutes and drop by 60) Gall Stone Pacreatitis HIDA Small bowel obstruction with enterogastric reflux Liver Lesion HIDA Initial -> Delayed . FNH: Hot -> Hot. HCC: Cold -> Hot. Adenoma: Cold -> Cold. Brain Death HMPAO No cerebral perfusion on flow. No cortical uptake on delays. Hot nose sign = shunting to external carotid. Non-Brain Death: May still shows cerebellar activity due to retained posterior circulation patency. I-123/I-131 Pre-Therapy diagnostic scan (24h) and Post- Therapy Scan (5d). Gastric -> bowel, and bladder are normal. Residual Thyroid will light (may give star artifact). Esophageal Activity I-131 Whole body scan, 2 mCi, 6 wks post surgery (to increase TSH >50). Images at 24, 48, and 72 hours demonstrating subtle activity in the mediastinum. May give water to atttempt clearance. In general: 1-131 -> fuzzy, low-resolution whole body images with low counts. No solid organ activity. May see colon only at late scan time. CSF Leak In-111 Cistern Use Pledgets to capture fluid. Place in well counter and compare to activity in blood. NPH In-111 Cistern Study performed to differentiate from ex- vacuo hydrocephalus (atrophy). Dx: ventricular reflux that does NOT clear by 24 hours and delayed clearance of convexities. Flow into the ventricles is NOT normal. Gut Activity In-111 WBC Coughed then swallowed White Cells from PNA. DDx: Colitis, enteritits, IBD, GIBleed. Normal In-111 WBC distribution: Spleen>Liver, Marrow, Soft Tissues will show some activity. Hepatic Abscess In-111 WBC Focal uptake in liver. Malignancy does NOT show increased WBCs. Marrow distribution: Indium 111 vs. Sulfur Colloid. IN-111: Spleen>Liver, axial skeleton. Sulfur Colloid: Liver>Spleen - really hot>>>>axial skeletal marrow. NucMed 5/22/2007 2:49 PM 2 of 9
  3. 3. 2006 ORAL BOARD REVIEW: NucMed RBC Labelling Artifact In-111 WBC Blood pool = RBC labelling. Vertebral Osteomyelitis In-111 WBC Photopenic Defect in vertebral body = pus under pressure. Spinal Osteo is cold 50% of time. DDx: Mets. 0.5 mCi In-111 WBC : Spleen>Liver>Marrow. NO bowel, NO bladder. 20 mCi Tc99m HMPAO WBC - also show Bowel. ATN MAG-3 Increasing activity without obstruction. Aluminum Colloid Formation MDP Liver and Kidney Activity. Diffuse liver uptake. DDx: Severe hepatitis, CHF (look at heart. Liver=blood pool), Amyloid, miliary mets. QC for Aluminum: Dipstick Test = colorimetric spot test from reaction with aurin tricarboxylic acid. Arterial Injection MDP Increased tracer activity distal to injection sight. "Monkey Arm" AVN MDP Associated with Fracture of Femoral Neck. DDx of AVN: SSD, Caisson, Steroids, EtOh, Pancreatitis, Obesity. Cardiac Uptake - Diffuse MDP Amyloidosis, myocarditis, pericarditis Cardiac Uptake - Focal MDP Myocardial Infarction Cardiotoxicity MDP Left Ventricular uptake. Differentiate from Pericardial uptake. DDx: MI, metastatic calcification, myocarditis, contusion, myocardial necrosis, amyloidosis. Note: Hot Calvarium can be a normal variant, particularly in african-american population. Extravasation with Lymphatic and Nodal Uptake MDP SubQ infection becomes lymphoscintigraphy. Hyperparathyroid MDP Diffuse lung, stomach, and kidney uptake (sights of acid base metabolism) = metastatic calcification. Too unifrom to be metastatic (Osarc vs. Thyroid). Metastatic calcifications - any process with an elevated calcium-phosphate product - renal failure, hyperparathyroidism, sarcoidosis, milk-alkali syndrome. Dystrophic Calcification = calcification in damaged tissue (trauma, tumor, vascular, infective) Hypertrophic Pulmonary Osteoarthropathy (HPOA) MDP Tram-track distal periosteal uptake. Two forms: Primary HPOA (3-5%) = pachydermoperiostosis - rare, AD. Secondary HPOA : Pleural (fibroma, mesothelioma), Cardiac (R-L Shunt), Pulmonary (Bronchogenic CA, Infection, Sarcoid, Hodgkins, Mets), Foregut Path ology(Cirrhosis, IBD, infection, tumor), Other, infected grafts. Pathophysiology is unclear. DDx = stress fractures and shin splints DDx: Periostitis seen in Venous Stasis, Thyroid Acropachy, Vitamin A Toxicity, Child Abuse . Increased Renal Uptake MDP Obstruction, Chemotherapy, Nephrocalcinosis, Hypercalcemia, Radiation, ATN Intense Muscular Activity MDP Intense Muscular uptake may be seen following strenuous exercise. NucMed 5/22/2007 2:49 PM 3 of 9
  4. 4. 2006 ORAL BOARD REVIEW: NucMed Liver Uptake - Diffuse MDP Colloid formation (Al), hepatic necrosis, amyloid, Prior Scan Liver Uptake - Focal MDP Metastatic Tumor Lung Uptake - Diffuse MDP HPTH, hypercalcemia, pulmonary hemosiderosis. Lung Uptake - Focal MDP Lung Ca, metastatic osarc. Metastatic NB MDP Superscan in kid. CT shows calcified abdominal mass. Note: NB may be cold. Metastatic RCC MDP Cold Defects : Mets most common = MM, lymphoma, renal, thyroid , or NB. Primary Bone Lesions = SBC, ABC, EG. Vascular = AVN, infarct, radiation. Artifacts. Infection in a closed space (vertebra) secondary to increased pressure. Off Peak Image MDP Grainy Images. Osteochondromatosis MDP Abnormal uptake around joints with abnomal xray showing articular calcification/ossification. DDx: Metachondromatosis (enchondromas + osteochondromas). Paget's MDP Scoliosis with increased uptake = DDx: Paget's, FD, Mets. Multifocal uptake with large confluent area. Enlarged bone: just doesn't look like mets. Prior Radiotracer MDP Prior I-131 administration gives star artifact. Saturation effect produces loss of pereceived activity (fewer counts) Recent HIDA MDP Bowel Activity. DDx: Recent HIDA, Free Tc99 (must see thyroid, stomach!), brisk GIB, IBD (? Mechanism) RSD MDP Increased uptake on all three scans. Increased around all joints. Flow and pool may gradually decrease after 4-5 months. Sickle Cell Dz MDP Splenic MDP uptake - secondary to infarction. Pediatric Patient Skeletal Muscle Uptake MDP Rhabdomyolysis, Myositis Ossificans Soft Tissue Uptake - Diffuse MDP Renal Failure, CHF, Edema, Lymphedema, dermatomyositis, scleroderma NucMed 5/22/2007 2:49 PM 4 of 9
  5. 5. 2006 ORAL BOARD REVIEW: NucMed Soft Tissue Uptake - Focal MDP Dystrophic or Metastatic Calcification, Tumoral Calcinosis, Sarcoma, Mets. Metastatic calcifications - any process with an elevated calcium-phosphate product - renal failure, hyperparathyroidism, sarcoidosis, milk-alkali syndrome. Dystrophic Calcification = calcification in damaged tissue (trauma, tumor, vascular, infective). Tumoral calcinosis - rare entity of unknown etiology. 50%- associated abnormalities in their renal labs. The calcifications are usually large, globular, and located in the soft tissues over joints. Solitary Metastatic Disease MDP Risk of met in patient with primary cancer and: Solitary Rib = 20%, Solitary Spine = 50%, Solitary Flat Bone = 80% MDP = methylene diphosphonate - binds to hydroxyapatite - osteoblast activity. Also reacts with mitrochondrial calcium - Infarction: myocardial, splenic, cerebral. Cardiac contusion, cardiac surgery, unstable angina, and myopathies. Spondylolysis MDP Back pain with negative planar. Must do SPECT. Stomach Uptake MDP Luminal: Free Tc99m. Parenchymal: Metastatic Calcification Stress Fracture MDP Focal bone uptake: Oblong, ovoid, may be multifocal. Mets are rounded and multifocal. DDx: Shin Splints - Elongated, linear and posteromedial. Superscan MDP No kidneys. DDx: Diffuse Mets (Axial Skeleton) vs. Myelofibrosis or Metabolic disease (Appendicular Skeleton) = Renal osteodystrophy, HPTH, Paget's, osteomalacia, hypervitaminosis D. No Kidneys + Soft Tissue Activity = Renal Failure. SVC Obstruction MDP Upper body trapping of MDP Ureter Uptake MDP Obstruction. Zipper Artifact MDP Large patient older camera. Patient is scanned in multiple segments and then "zipped." Artifact if the patient moves. Metastatic NB MIBG Any bone marrow on MIBG is abnormal. Pheo MIBG Adrenal Nodule with HTN. Heart not evident due to activity of the adrenal. Metaiodobenzylguanidine = analog of neurotransmitter precursor. Postive in any neuroendocrine transmitter: Pheo, paraganglioma, carcinoid, NB. MIBG Distribution = Sympathetic innervation. HEART, Salivary, liver, spleen, adrenal. Image at 1,2, 3 days. Octreotide Distribution : Spleen & Kidneys>> Liver & Lungs. No heart. Parathyroid Adenoma MIBI Heart and Thyroid on initial image. Loss of thyroid on delay. If uptake in the thyroid, cannot exclude thyroid pathology. Coexisting with Thyroid Abnormality: background activity with focal cold spot - Follicular Adenoma. Meningioma Octreotide Kidneys, Spleen > Liver. Any tumor with a somatostatin receptor Somatostatin Receptor Expressing Neoplasm: Carcinoid, Neuorendocrine, MTC, Other (Thymoma, astroctoma, meningioma, lymphoma, breast, pituitary). NucMed 5/22/2007 2:49 PM 5 of 9
  6. 6. 2006 ORAL BOARD REVIEW: NucMed Paraganglioma Octreotide Not just for Carcinoid. For any neuroendocrine tumor. Octreotide Distribution : Spleen & Kidneys>> Liver & Lungs. No heart. "Hottest Kidneys on Any Scan" Benign Adrenal Adenoma PET Benign adenomas can be hot. This case also demonstrated reactive LNs in chest which were also hot. Brown Fat PET Normal elevation: Brown Fat (make the patient warm to reduce), muscle activity, vocal cords, bowel activity (look for focality). Calvarial Hemangioma PET Hemangioma may be hot or cold. DDx: Met/Myeloma Cecal Adenocarcinoma PET Incidental FOCAL uptake in Cecum. 60- 70% show lesion on endoscopy. FDG extravasation PET Esophageal activity = esoph. CA, but right axillary activity = extravasated FDG. Hashimoto's PET Diffuse Thyroid Uptake Histoplasmosis PET Bilateral lung and hilar lymph node uptake. DDx = TB, sarcoid, and less likely malignancy (due to B) Incidental Thyroid CA PET PET for lymphoma shows focal uptake. Thyroid scan/US with Bx = papillary thyroid ca. Lung CA PET SPN. DDx: CA, TB, Histo. Bone lesion on PET. Can do follow-up bone scan. Vertebral Hemangioma PET Again, Hemangioma may be hot or cold. ATN Renal Scan Normal flow. Cortical Retention - No excretion on the renogram. Unilateral retention = RAS. Bilateral = ATN (no tubular secretion). Crossed fused ectopia Renal Scan Hyperacute Rejection Renal Scan Avascular Mass = photopenic defect in pelvis. Obstruction Renal Scan Normal Flow. Central accumulation of tracer in the collecting system. Give Lasix. T1/2 <10 - normal. T1/2 >20 - obstruction. NucMed 5/22/2007 2:49 PM 6 of 9
  7. 7. 2006 ORAL BOARD REVIEW: NucMed Renal Artery Stenosis (RAS) Renal Scan MAG3 (tubular agent) -> Unilateral Cortical Retention of Tracer (due to decreased urine flow from decreased filtration. Tubular secretion does NOT change) following ACE administration compared to normal baseline. DTPA (filtration agent) -> Unilateral decreased cortical uptake [absolute or relative] with captopril compared to baseline. 25 mg Captopril PO 1 hour before study. (0.5mg/kg in peds). If normal study - renovascular HTN is excluded. If not, do normal renal scan. If normal = RAS. RVT Renal Scan Poor flow, poor function, delayed excretion in a BIG kidney. DDx: Infiltrative disease, Pyelonephritis, If large collecting system - obstruction. Transplant ATN Renal Scan Normal Flow (peak within 2-4 seconds of contralateral iliac). No excretion on renogram. ATN: Good flow, good function, poor excretion. Transplant Rejection Renal Scan Poor Flow, poor function, and delayed excretion DDx: RVT - large kidney. Hyperacute (in OR = complete thrombosis). Acclerated Acute = 3 days. Acute = 3 weeks. Chronic = 3 weeks. Accelerated, Acute, and Chronic all look the same on Renal Scan. Accessory Spleen Sulfur Colloid Liver spleen scan (Liver>Spleen). Study will show accessory splenic tissue. Aluminum Colloid Formation Sulfur Colloid Lung Activity: trapped in vascular bed. Budd Chiari Sulfur Colloid Hot Caudate Lobe Colloid Shift Sulfur Colloid Cirrhosis/Portal Hypertension cause shift of activity. Spleen>Liver. Sulfur Colloid: Alternative Name = Liver, Spleen Scan. Liver>Spleen>>Marrow. Don't see much else. FNH Sulfur Colloid Hot lesion. Cannot excrete into biliary tree. All other hepatic lesions are cold on Sulfur Colloid. Hepatic hemangioma Sulfur Colloid Liver/spleen scan shows defect in liver. Correlate with CT. DDx = cyst, hemangioma, or adenoma. FNH shows tracer activity. Confirm hemangioma with RBC scan. Regenerating Nodules Sulfur Colloid DDx: FNH, Regenerating Nodules, Budd- Chiari (Caudate) and SVC Obstruction (Quadrate Lobe) SC accumulation is secondary to increased blood flow or increased density of Kupfer Cells. Duodenal Bleed Tagged RBC LUQ bleed with antero and retrograde flow. Note: Study is often divided into two 30 minute portions. Free tech will be excreted into urine and taken up in normal distribution. NucMed 5/22/2007 2:49 PM 7 of 9
  8. 8. 2006 ORAL BOARD REVIEW: NucMed GI Bleed Tagged RBC LUQ, RUQ, Cecal, SB = four patterns. Central rounded activity early = mesenteric blood pool. Hemangioma Tagged RBC Peripheral pooling early with centripetal filling on delayed images. May see second lesion In Vitro Tagging (ultratag). In Vivo. Modified In Vivo Tagging. Negative GI Bleed Tagged RBC RLQ nonmoving activity = meckels. DDx kidney or ureter. Post-Partum Transient Thyrotoxicosis Tc Thyroid Diffuse low uptake in Thyroid. DDx: Sub- acute Thryroiditis (painful), Hypothyroidism, thyroidectomy, Thyroid hormone administration, Silent (viral) thyroiditis, Recent IV contrast, Drugs (Amiodarone), Ectopic thyroid (struma ovarii). Late phase of Hasmioto's Delayed Torsion Testicular Scan Central photopenia with hot rim (from pudendal flow). Trx: surgery to remove auto- immune phenomenom and contralateral orchiopexy. 24 hour delay. Epididymitis Testicular Scan + Flow (should be normal) and mildly increased activity on delay -- may be crescentic = epididymis. Torsion = normal Flow with photopenia on delay. +Flow & -Delay = infection. -Flow & - Delay = Torsion. Varicocele Testicular Scan Flow study gets hot late - venous phase. Testicular agent = Tc99m pertechnetate. Cold Nodule Thyroid Risk of cancer: 10-20%. Rx: Biopsy. Trx: Sugery followed by total body Scan at 4-6 weeks 2 mCi I-131 (to avoid stunning). Hashimoto's Thyroid Graves vs. Hashimoto's. Patient has +TPO antimbody but, patient is euthyroid (normal TSH), therefore not Graves. Ectopic thyroid activity ddx: ectopic thyroid, metastatic thyroid ca, swallowed tracer, contamination, reflux, zenker's barretts. Parathyroid MIBI: shows increased uptake in the parotids (key for differentiation). I-131 Therapy for Cancer Thyroid Residual thyroid: 30-100 mCi. Residual Tumor: 150 mCi. Metastatic Disease: 200 mCi. Follow with Thyroglobulin and retreat - up to 1 Ci. Contraindications: Pregnancy and Brain Mets. If Pulmonary mets (follicular) radiation fibrosis ensues. Radiation precautions should involve the physicist. Multinodular Goiter Thyroid Mulfocal hot and cold spots. Cancer risk = 5%. Therapy is medical, but if use I-131 -> 30 mCi. Thyroid Adenoma Thyroid Solitary Hot Nodule with suppression of rest of gland. Focal photopenia = necrosis. Overall: 1% risk of cancer. Plummer's Disease Graves Disease Thyroid - Tc99 Large, uniformly hot with increased uptake I-131 therapy dose (10-20 mci): 100-200 mcCi x gland weight (normal = 20g)/uptake percentage (nl = 10-30%). Treat with NSAIDs and B-blockade. Will feel better in a matter of weeks with hypothyroidism to follow. NucMed 5/22/2007 2:49 PM 8 of 9
  9. 9. 2006 ORAL BOARD REVIEW: NucMed Central Obstructing Lesion VQ Whole lung partial mismatch (global decreased perfusion with normal ventilation) = central obstruction to flow. DDx: Central tumor, saddle embolus, pulm artery hypoplasia, unilateral radiation. Swyer-James gives matched defects with air- trapping on Delayed Xenon study. Clot from injection VQ Spotty deposition on Perfusion images COPD VQ Central Deposition of inhaled tracer.. Combination of turbulent flow and mucus plugging/secretions. V: Nebulized 50 mCi of Tc99m-DTPA - 250k counts. Q: 5 mCi Tc99m-MAA. Endobronchial obstruction VQ Reverse Mismatch. Malignancy vs. Mucus plug Fissure Sign VQ Fluid in the fissure Intermediate Probability VQ Single large (>50%) mismatch = intermediate probability. LOW PROB : Small (<25%) defect(s) = low prob. Matched defects = low prob. Triple match in upper/middle lobes = low prob. Two large (or equivalent) mismatches = HIGH PROB . Everything else is INTERMEDIATE. Large PE VQ No perfusion to right lung. DDx: occlusion of the pulmonary artery. Off Peak Image VQ Fuzzy images. Particularly noticeable when in only some of the images taken on a multi- head camera. PE VQ 5 mci MAA (Q) 50 mci DTPA (V), DDx = Pulm Vasculitis, chronic PE, Post radiation, stenosis, other emboli Pneumothorax VQ Matched (or Reverse Mismatch) Defects: Mucus Plugging, Central Airway obstuciton, Endobronchial lesion, Aplasia, hypoplasia, pleural effusion, radiation. Pulmonary Hypertension VQ Non-uniform distribution. DDx: Tumor or fat emboli. Rx: in PULM HTN: don't reduce radiation, reduce number of particles from 300K to 50K. Right-to-Left Shunt VQ Activity in liver, thyroid, spleen, stomach, and brain. Free Tc99m does NOT go to brain. Brain activity = R-L shunt. May have to ask if see extraplural perfusion agent activity. Triple Match VQ Triple match = intermediate probability unless Q defect >> V defect = high probability (non-PIOPED) NucMed 5/22/2007 2:49 PM 9 of 9

×