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Gated heart pool scanning - breast uptake
1. Getting to the heart of the matter!
Todd Charge
Senior Technologist
Nuclear Medicine and PET Centre
Hunter Health Imaging Service
Hunter Health Imaging Service
2. Background
• 29yr old female
• Benign cyst removed from Right breast
1995
• Fatty lump noted at time
• Regular follow up U/S
Hunter Health Imaging Service
3. Background
U/S Dec 2002 abnormal right breast
Mammogram widespread calcification
Palpable axillary nodes
U/S adbo, chest clear
CXR normal
FBC, biochem normal
LFT, serum alkaline phosphatase normal
Hunter Health Imaging Service
4. Background
CXR Jan 2003 abnormality R lung base
CT normal
5 days later
Right side mastectomy
Axillary dissection Post op evacuation of
haematoma
Hunter Health Imaging Service
5. Background
Invasive ductal carcinoma
Measuring 10cm
Grade 3
Pagets disease invol nipple
Extensive lymphatic, vascular invasion
18/27 lymph nodes involved
Extension up to 2mm beyond capsule
Hunter Health Imaging Service
6. Background
Oestrogen, progesterone receptors neg.
Her-2 marker strongly positive
High risk of local recurrence
Required radiation treatment and chemo
10yr survival 13%
With chemotherapy inc. to 30%
Hunter Health Imaging Service
7. Background
Smoker (ceased six years)
Social drinker
Three children, unremarkable pregnancies
No family history breast cancer
24 weeks pregnant
Hunter Health Imaging Service
8. Treatment
Six cycles of AC chemotherapy
Three weekly
Plan to deliver at 37 weeks
Post delivery commence radiation treatment
Monthly foetal growth U/S
No randomised studies
Case studies suggest no detrimental effects
Hunter Health Imaging Service
9. Treatment
Induced labour, normal vaginal delivery
Normal, healthy 8.3pound female infant
Breast feeding successfully on left breast
Paused breastfeeding for 5 days to
complete sixth cycle of chemo
Right chest wall irradiation with inclusion of
lymph node drainage areas
Hunter Health Imaging Service
10. Treatment
No evidence of local recurrence or distant
disease
Commence Herceptin trial
Baseline LVEF
Hunter Health Imaging Service
11. Administration
• 1ml Radpharm PYP IVI via left posterior
hand
• 1hr interval
• 900MBq Tc04- IVI via left cubital fossa
• Imaging commenced immediately
• 3 lead ECG gating
Hunter Health Imaging Service
12. Scanning
• Anterior, LAO35, Left Lateral views
• 10 mins per view
• 24 bin gating
• 75-85bpm heart rate
• Normal sinus rhythm
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14. Images
LAO35 Static
Hunter Health Imaging Service
15. Images
Anterior Cine
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16. Images
LAO35 Cine
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17. Images
LtLat Cine
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18. Images
Gated SPECT
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19. Images
Zoomed Short Axis
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20. Outcome
Normal wall motion
No LVEF due to technical difficulties
No evidence in literature search
Highlights the need to consider uptake of
radiopharmaceuticals in lactating females
as normal variant
Gated SPECT processed same as
Sestamibi/Thallium cardiac to obtain LVEF
after overcoming technical difficulties
Hunter Health Imaging Service