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Nuclear Medicine/Molecular Imaging

Slattery J.M.; Hochberg E.P.; Hasserjian R.P.; Setty B.; Blake M.A.; Radiology, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA.

Address correspondence to J.M. Slattery (jslattery4{at}partners.org)

Objective: To determine if SUV as measured on PET/CT is predictive of pathological cellular proliferation in lymphoma patients as measured by ki-67.

Materials and Methods: A retrospective review of PET/CT imaging in pre-treatment lymphoma patients who had undergone either percutaneous image guided or open surgical biopsy was performed. The SUV, correct for body weight, of the biopsied region was recorded using a region of interest tool. This value was correlated to the ki-67 of the biopsy specimen which is a pathological marker of cellular proliferation and is recorded as a percentage. Linear regression analysis of these sets of data was performed.

Results: 37 patients (M/F = 20/17) were analyzed. There were 20 cases of diffuse large B cell lymphoma and the remaining 17 were a mixture of marginal zone and follicular lymphoma. Biopsies were performed from various regions throughout the body and pre-treatment PET/CT imaging was available for all patients. Linear regression analysis showed a correlation between the SUV of the biopsied region and the cellular proliferation as measured by ki-67.

Conclusion: SUV values are a useful predictor of cellular proliferation in lymphoma and may be used as a general predictor of lymphoma grade as well as directing PET/CT-guided or surgical biopsies to ensure accurate staging.

E311. Evaluation of the difference in lymphatic drainage between N0 and N1 patients with breast cancer using a 3-D volume-rendering SPECT/CT fused image of Tc-99m phytate lymphoscintigraphy

Shiraishi S.¹; Utsunomiya D.²; Ikeda O.¹; Tomiguchi S.¹; Yamashita Y.¹; 1. Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; 2. Diagnostic Radiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan.

Address correspondence to S. Shiraishi (shinya-rad{at}s9.kcn-tv.ne.jp)

Objective: We hypothesized that false sentinel lymph node (SLN) was detected on a lymphoscintigraphy because of change in lymphatic drainage when the original SLN was completely involved by tumor. To verify this hypothesis, we evaluated the difference in lymphatic drainage patterns between staged N0 and N1 patients with breast cancer using a 3D-volume-rendering multimodal fused image.

Materials and Methods: Twenty-seven patients with staged N0 and 22 patients with staged N1 breast cancer proven by surgical dissection underwent sentinel lymphoscintigraphy using a SPECT imaging. Thin-slice CT imaging was also performed in all patients. Both imaging was obtained with a SPECT/CT combined system, which was comprised of a two-detector SPECT system (Skylight) and 8-detector-low CT (Light-speed ultra) with the same platform. Image registration involved the use of a manual method based on an external fiducial marker. 3D-VRMFI was then made for the evaluation of accurate anatomical location of SLN demonstrated on the lymphoscintigraphy. To verify the change on lymphatic drainage in case of presence of completely involved SNL, we compared the anatomical location of SLN demonstrated on the 3D-fused images between staged N0 and N1 patients with breast cancer.

Results: In 27 patients with N0 breast cancer, 36 of 38 (95%) sentinel nodes were located in pectoral region and only 2 (5%) in other regions (one subscapular and one parasternal nodes), respectively. On the other hands, in 22 patients with N1 breast cancer, 26 of 36 (72%) sentinel nodes were located in pectoral region and 10 (28%) in other regions (3 apical, 3 parasternal, 2 brachial, one subscapular, and one infraclavicular nodes), respectively. In addition, we experienced two false negative SLNB cases proved by backup dissection. In both cases, sentinel nodes were located in the apical region.

Conclusion: Our data indicated that in cases to include sentinel nodes localized except pectoral region, lymphatic drainage pattern might be changed and false sentinel node be detected on breast lymphoscintigraphy.

E312. Role of PET/CT in the Evaluation of Tumor Recurrence

Setty B.N.¹; Blake M.A.¹; Holalkere N.¹; Sahani D.V.¹; Fischman A.J.²; 1. Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA; 2. Division of Nuclear Medicine, Massachusetts General Hospital, Boston, MA.

Address correspondence to B.N. Setty (bsetty{at}partners.org)

Background: Metabolic imaging is a novel approach in the detection of malignancies owing to increased metabolic activity in the tumor tissue. PET-CT is a new state of art in oncologic imaging for the management of various malignancies. Differentiating a tumor recurrence from postoperative changes often poses a challenge. Cross-sectional imaging modalities like CT and MRI rely on structural abnormalities for diagnosing recurrence and are relatively insensitive for early recurrence. Due to its inherent physiologic mechanism, PET/PET-CT is considered to possess superior sensitivity in detecting tumor recurrence in a variety of visceral malignancies such as lung, esophagus, pancreas and colorectum.

Key Issues: An emphasis on the technique of PET/CT will be done. Also, a comparison of the role of PET/CT, cross-sectional imaging and relevant tumor markers for various tumors of the body will be highlighted.

Format: In this exhibit, a pictorial review of the role of PET-CT in detection of various tumor recurrences will be outlined with case examples and an imaging algorithm.

Teaching Points: 1. To evaluate the role of PET-CT in detecting tumor recurrence in various malignancies. 2. To educate the readers with the added value of PET-CT over other cross-sectional modalities like CT and MR in the detection of tumor recurrence. 3. To discuss the optimal imaging window for imaging patients with PET-CT after surgery.

E313. F-18 FDG PET/CT Imaging of Urologic and Gynecologic Malignancies

Nguyen B.D.; Ram P.C.; Roarke M.C.; Radiology, Mayo Clinic, Scottsdale, AZ.

Address correspondence to B.D. Nguyen (nguyen.ba{at}mayo.edu)

Background: F-18 FDG PET/CT is a well-established imaging modality for the staging and post-therapeutic surveillance of lymphoma, melanoma, and cancer of the lung, esophagus, colon and breast. The imaging is based on uptake of glucose-analog radiotracer in highly metabolic tumors and related metastases. In this exhibit, the authors present the practical clinical applications of PET/CT in the evaluation of prostate cancer, urinary transitional cell carcinoma, renal cell carcinoma, and cancer of the testicle, ovary, uterus, cervix, vagina and vulva.

Key Issues: This exhibit discusses and emphasizes the impact of combined functional and anatomic PET/CT imaging of uro-gynecologic oncology from the detection of organ cancer to the disease staging with evaluation of local, regional and distant metastases and post-therapeutic recurrences.

Format: This exhibit is presented as a pictorial essay focusing on PET/CT imaging of each organ of the uro-genital system. It reviews common and infrequent imaging features of these neoplasms and emphasizes the important influence of PET/CT findings on the strategy and conduction of patient care.

Teaching Points: (1) To review the spectrum of localized and advanced disease of the uro-genital malignancies demonstrated by PET/CT in correlation and comparison with conventional cross-sectional imaging, and (2) To raise the viewer's awareness of PET/CT advantages, pitfalls and limitations in the imaging of these urologic and gynecologic neoplasms.

E314. Pictorial Review of PET-CT in Gynecological Pathology and Normal Variants

Viney Z.N.; Gangoli S.; Cheow H.K.; Barrington S.F.; Rankin S.C.; Radiology and Nuclear Medicine, Guy's and St Thomas' Hospitals, London, United Kingdom.

Address correspondence to Z.N. Viney (poliov{at}hotmail.com)

Background: The role of PET-CT in gynecological malignancy is not as well established as with other tumors, but it may provide additional information in recurrent and possibly primary disease. A variety of benign conditions and normal variants also show increased FDG uptake.

Key Issues: We show the use of PET-CT in staging gynecological malignancies (including lymphoma, ovarian, cervical and endometrial carcinoma), particularly in the detection of local recurrence and unsuspected distant disease. We also show how a variety of other benign conditions, such as fibroids, ovarian dermoids and endometriosis may show increased FDG uptake. Uptake may also be seen associated with the normal uterus, intrauterine contraceptive devices and functional ovarian cysts.

Format: The poster is in the format of a didactic educational poster using PET, CT and fused PET-CT images to illustrate the above.

Teaching Points: We have shown the use of PET-CT in assessing gynecological malignancies and how to recognize the potential pitfalls of benign conditions which may also show FDG uptake.

E315. Intravenous Contrast Administration for Diagnostic Whole-Body 18F-FDG PET/CT: Does it Introduce Artifacts?

Gomes R.E.; Daniel M.M.; Camargo A.C.; Wagner J.; Cunha M.L.; Yamaga L.I.; Racy M.C.; Baroni R.H.; Rocha M.S.; Funari M.G.; Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.

Address correspondence to R.E. Gomes (rlegomes{at}uol.com.br)

Objective: A combined PET/CT examination, if performed with high standards to obtain a diagnostic image quality, is superior to the image quality of each examination alone. These standards include careful patient preparation according to stand-alone CT and PET and the application of CT contrast media. The purpose of this retrospective study was to look for contrast-introduced artifacts which could impair the quality of the examinations.

Materials and Methods: Whole-body PET/CT included a topogram and a multi spiral CT scan (8-row) without or with intravenous contrast, followed by an emission scan. The CT scan was used for attenuation correction of the emission data. This retrospective study included 19 patients (7 abdominal and 12 head and neck malignant tumors) who were referred for a combined PET/CT study with 18F-FDG. All patients signed an informed consent, which details the use of intravenous and oral CT contrast and rare potential side effects. The PET/CT acquisition protocol was performed in accordance with our hospital guidelines for diagnostic procedures. The CT transmission images were used for attenuation correction of the PET emission data. Three independent physician readers with at least 18 mo of PET/CT experience saw the examinations: two radiologists graded the diagnostic quality of the CT images and one nuclear medicine reviewed the attenuation-corrected PET images for potential artifacts from intravenous contrast agents without consulting the CT, for each single examination.

Results: PET acquisition itself is not significantly influenced by the presence of IV contrast medium. CT artifacts in the thoracic veins from injection of intravenous contrast or other types of artifacts were not found. The use of IV contrast agent improved the identification of the lesions and the diagnostic quality.

Conclusion: IV contrast agent can be used for PET/CT without changing the clinical diagnosis interpretation. It improves the overall perception and, subsequently, the diagnostic quality of the CT images compared with nonenhanced CT studies. No contrast-introduced artifacts were found.

E316. Utility of PET Scanning in the Pediatric Population: A Pictorial Essay

Barron B.J.^1,2,3; Sawaf M.Y.^1,3; McClain K.²; Joseph U.^1,3; Wan Q.D.¹; 1. Radiology, UT-Houston Medical School, Houston, TX; 2. Hematology-Oncology, Texas Children's Hospital, Houston, TX; 3. Radiology, Memorial Hermann Hospital, Houston, TX; 4. Nuclear Medicine, Greater Houston Imaging, Houston, TX.

Address correspondence to B.J. Barron (bruce.j.barron{at}uth.tmc.edu)

Background: PET and PET-CT has become an important diagnostic tool in diagnosing metabolic activity of various oncologic and neurologic conditions. Utility in the adult population has been well established and PET imaging has become routine in staging and evaluation of response. Due to reimbursement issues and lack of dedicated Pediatric PET centers, there have been limited applications in this population. Through a unique combination of a free-standing imaging center and Texas Children's Hospital, PET imaging has been added to the diagnostic evaluation in many patients.

Key Issues: F-18-FDG has become the standard PET imaging agent. There is increased metabolic uptake of fluorodeoxyglucose in many oncologic conditions. Increased metabolic uptake causes increased utilization of FDG. This will help determine the presence of active disease in tumors of the body and brain. Areas of decreased metabolism may reflect benign conditions or treated disease and in patients with epilepsy (interictal), may represent a focus of seizure activity. Various therapies may induce changes in the pattern of FDG uptake and these will be discussed.

Format: Case presentations of numerous disease states will be presented. PET images, CT or MRI images and coregistered images will also be displayed. Over 75 pediatric patients had PET scans in our facility. Numerous oncologic processes including nasopharyngial carcinoma, Langerhans cell histiocytosis (LCH), Burkitt's lymphoma, Hodgkin's lymphoma, B-cell lymphoma. Wilm's tumor, and brain tumors. The LCH patients include those with skeletal, lung, liver, spleen and soft-tissue involvement. In addition, numerous interictal studies will be presented with correlative imaging.

Teaching Points: 1. Patterns of normal FDG uptake in infants and children. 2. Patterns of uptake in new and treated cases of LCH, and lymphomas. 3. Utility of PET in various conditions. 4. Future potential applications. 5. Patterns of uptake related to therapy (brown fat and thymic activation).

E317. Spectrum of Disease Utilizing Positron Emission Scanning in the Pediatric Patient

Satti S.R.; Cerniglia C.; Makler P.T.; Radiology/Nuclear Medicine, Drexel University-Hahnemann Hospital, Philadelphia, PA.

Address correspondence to S.R. Satti (srs28{at}drexel.edu)

Background: Positron emission scanning is becoming the standard of care in the diagnosis and management of cancer in the adult population. PET allows whole body imaging and the ability to assess metastatic disease, while providing a reproducible method to quantitate treatment response. PET imaging is now becoming increasingly important in the pediatric patient.

Key Issues: There are distinct differences in the appearance of disease utilizing PET in the pediatric population when compared to adults. Differences in the imaging appearance are due to the normal change in physiology between children and adults, differences in types of tumors that affect each population, and in differences of the tumor response to FDG. Understanding and recognizing the normal appearance and spectrum of disease in the pediatric patient is critical in interpreting the studies correctly.

Format: In this didactic, more than 70 PET scans from a pediatric population, were reviewed. Cases demonstrating normal variations, typical and atypical manifestations of disease, and response to therapy are presented. The presentation is case based starting with brief clinical vignettes and includes dynamic mpeg movie displays and static tomographic images.

Teaching Points: Review the differences between the normal scan in the pediatric patient and adult patient. Normal: Pediatric specific uptake, such as the thymus and tonsils. Abnormal: Appearance of FDG scanning in tumors most commonly seen in the pediatric population. The reader should gain an appreciation of the usefulness of the positron emission scanning scans in the pediatric population and develop an improved ability to interpret normal from abnormal studies.

E318. Impact of Lowering CT Radiation Dose on the Ability to Co-register and Interpret Unenhanced PET/CT

Avila N.A.¹; Carrasquillo J.A.²; Le Meunier L.²; Dwyer A.J.¹; Bacharach S.L.²; 1. Diagnostic Radiology Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD; 2. Nuclear Medicine Department, Warren G. Magnuson Clinical Center, Bethesda, MD.

Address correspondence to N.A. Avila (navila{at}nih.gov)

Objective: The CT component of a PET/CT study (commonly performed at 140 KVp, and 30-60 mAs) is used for attenuation correction and co-registration of the FDG with the CT images; this later fusion of images allows for visual integration of the functional PET with the structural CT information and anatomic localization of the sites of FDG uptake. As with all radiologic procedures, radiation dose reduction is an important goal particularly when performing repeated follow-up studies or in a research setting. In this study we evaluate the feasibility of reducing the CT radiation dose by assessing the impact of reduction of mAs on the quality of anatomic depiction and the ability to anatomically localize sites of FDG uptake on the PET/CT images.

Materials and Methods: Eight patients had FDG-PET/CT scans with unenhanced CT (neither oral nor IV contrast) using a GE Genesis multislice scanner (140 KVp, 3 mm slice thickness, 0.5 seconds/rotation, and pitch 1.375) at 1/3 the usual mAs (12.7 vs. 41.8 mAs). These low dose CT images were reviewed and the quality of visualization with which the contours of thoracic, abdominal and pelvic organs were visualized was graded on a 4 point scale: not visualized, poor, good, and excellent. The FDG-PET/CT fused images were then reviewed: the sites of FDG uptake were identified and the degree of confidence with which their anatomic location could be determined was graded on a 4 point scale: no confidence, poor, good, excellent. Diagnostic CT's were available in 7/8 patients; these were reviewed and used as the gold standard to validate the anatomic findings on the low dose CT.

Results: In general the quality of organ visualization by low dose CT was fairly uniform within each patient; the per-patient results were as follows: not visualized (1); poor (3); good (3); excellent (1). Patients with poorer visualization had higher body mass indices. PET/CT confidence levels were as follows: no confidence (1); poor (1); good (5); excellent (1). The "no confidence" reading was in a patient with high BMI, who had FDG uptake in retroperitoneal adenopathy and in an inflamed bladder that were only confidently diagnosed and differentiated from the surrounding structures on the enhanced diagnostic CT.

Conclusion: Except in patients with high BMI, the dose of the CT component of an un-enhanced PET/CT study can be reduced significantly without compromising the ability to anatomically locate sites of FDG uptake.

E319. Different Scintigraphic Patterns of Superscan

Han R.; Nikpoor N.; Department of Radiology, Tufts-New England Medical Center, Boston, MA.

Address correspondence to R. Han (rhan{at}tufts-nemc.org)

Background: A superscan is defined as markedly increased Technetium-99m HDP or MDP uptake in the skeleton with significantly diminished soft tissue and renal activity. The presence of a very high target to background ratio and very little if any renal activity in a good clinical setting tends to result in the correct interpretation of superscan. There are 3 main categories of conditions that lead to 3 different patterns of superscans: metastatic disease, metabolic disease and myeloproliferative disease. Metastatic disease that results in a superscan is typically from prostate, lung, and breast cancers. Prostate cancer is the most common metastatic cause of superscan. Metabolic causes include renal osteodystrophy, hyperparathyroidism, osteomalacia, and Paget's disease. Myeloproliferative disease as a cause of superscan include lymphoma, leukemia, and mast cell tumor.

Key Issues: The key observation in superscan is significantly increased uptake in the skeleton and decreased or absent renal activity. However, the different causes of superscan may demonstrate different patterns of activity. A superscan due to metastatic disease such as prostate will mainly involve the axial skeleton including the proximal one-third of long bones where red marrow exists, areas favored for metastatic deposit. The pattern of skeletal uptake is multiple scattered heterogeneous lesions throughout the skeleton. A superscan from proliferative bone marrow involvement like lymphoma, leukemia, or mast cell tumor usually manifests as uniform and homogeneous radiotracer uptake including the axial as well as appendicular skeleton. The third type of superscan, seen in metabolic disease such as hyperthyroidism, may present as a normal bone scan without renal uptake. If the osseous involvement with metastasis is uniform enough, the bone scan may appear deceptively normal. In athletic young patients, there may be faint visualization of the kidneys, which may mimic superscan.

Format: This educational exhibit in PowerPoint format discusses etiologies and scan findings of different types of `superscan' in Tc-99m bone scans. Illustrative images are included with relevant findings and discussion.

Teaching Points: Key imaging findings of the different types of superscan in Technetium-99m bone scan imaging related to different patterns of disease affecting the skeleton are discussed with illustrative images.

E320. Imaging Patterns of Hepatic Hemangioma on Nuclear Scintigraphy, CT Scan, Ultrasound and MRI; Imaging Pitfalls and Pearls

Bagga S.; Radiology, Tufts-New England Medical Center, Boston, MA.

Background: Hepatic hemangiomas are the most common benign liver masses. However they can cause diagnostic dilemma with atypical presentations. Their imaging appearances on competing modalities can be both typical and atypical, causing considerable diagnostic difficulties and usage of multiple competing radiological imaging techniques. This exhibit aims to discuss the typical and atypical imaging patterns of hepatic hemangioma as seen on competing imaging modalities.

Key Issues: This exhibit will discuss the typical and atypical imaging patterns of hepatic hemangioma as seen on competing imaging modalities. Illustrative imaging examples of hepatic hemangiomas as seen on CT, MRI, Ultrasound and Nuclear scintigraphy will be provided, with pitfalls and imaging pearls.

Format: The poster will be in a power point format with images of hepatic hemangiomas as seen on CT, MRI, Ultrasound and Scintigraphic examination.

Teaching Points: This exhibit aims to discuss the typical and atypical imaging patterns of hepatic hemangiomas as seen on competing imaging modalities with imaging pearls and pitfalls as seen on each competing imaging modality.

E321. Computer Based Tutorial for the Interpretation of Renal Radionuclide Imaging in Patients with Two Kidneys and Patients with Renal Transplants

Satti S.R.; Cerniglia C.; Makler P.T.; Diagnostic Radiology and Nuclear Medicine, Drexel University-Hahnemann Hospital, Philadelphia, PA.

Address correspondence to S.R. Satti (reddyny{at}hotmail.com)

Background: Radionuclide imaging of the kidneys is a common and important functional imaging tool. The study allows for the non-invasive diagnosis of a broad range of functional renal pathology from abnormalities at the cellular level to physical obstruction. Radionuclide imaging is an important alternative in evaluation patient's with radiographic contrast sensitivity. Nuclear renal imaging can be used to evaluate the arterial blood flow, glomerular function, tubular function, and excretion. Although a commonly performed study, understanding renal physiology and the interaction of radiotracers for a given clinical situation is more challenging for residents. Radionuclide imaging is complicated because there are multiple radiotracers to choose from, each with advantages and disadvantages. Furthermore, there is the opportunity to tailor the study with pharmacological intervention with lasix or captopril.

Key Issues: 1. Review the current available radiotracers, their normal uptake, routes of excretion and consider different clinical scenarios where each could be used. 2. Review the components of a typical renal scan including the flow study, static planar images, function graphs, and pharmaceutical intervention. 3. Demonstrate patterns of tracer kinetics in a two kidney system of a healthy individual and in various disease states. 4. Demonstrate patterns of tracer kinetics in a patient with a renal transplant and provide examples of common disorders.

Format: The goal of this tutorial is to provide residents a systematic approach to renal radionuclide imaging and to expose residents to pathology they might not see at their own institution, such as renal transplants. The didactic is structured around real clinical cases and concludes with a self-assessment test of key concepts and unknown cases.

Teaching Points: 1. Understand when to use different radiopharmaceuticals. 2. Understand how normal physiology and then how pathophysiology can be evaluated using radionuclide imaging of the kidney. 3. Review cases of common pathology seen in patients with 2 kidneys and renal transplant patients. 4. Conclude with a series of unknown cases with discussion for self-evaluation.

E322. Phase-Contrast X-Ray Imaging in Tissues of Normal Kidney and Renal Tumors

Sung D.J.¹; Kim Y.H.¹; Cho S.B.¹; Je J.H.²; Yoon C.Y.³; Lee J.W.⁴; Oh C.W.⁵; 1. Radiology, Korea University Hospital, Seoul, South Korea; 2. Materials Science and Engineering, Pohang University of Science and Technology, Pohang, South Korea; 3. Urology, Korea University Hospital, Seoul, South Korea; 4. Pathology, Korea University Hospital, Seoul, South Korea; 5. Research Institute for Skin Image, Korea University Hospital, Seoul, South Korea.

Address correspondence to D.J. Sung (urorad{at}korea.ac.kr)

Objective: To report our experience about imaging of specimens of normal kidney and various kidney tumors with phase contrast x-ray with synchrotron radiation in comparison with optical microscopic images.

Materials and Methods: Unmonochromatized x-ray beams from the 7B2 beamline of the Pohang Synchrotron Light Source were used to illuminate the tissue specimen. The paraffin fixed specimens, consisted of the normal cortex (n = 2), normal medulla (n = 2), conventional renal cell carcinoma (n = 2), chromophobe renal cell carcinoma (n = 2), collecting duct carcinoma (n = 1), renal lymphoma (n = 1) and renal angiomyolipoma (n =2), were prepared in 3 mm thickness and 10 x 10 mm square for phase contrast x-ray imaging. The adjacent sections of each specimen were cut parallel to the specimens with a thickness of 4 m thickness and stained with hematoxylin-eosin for optical microscopic images. The phase contrast x-ray images were compared with the corresponding histopathologic microscopic images.

Results: Phase contrast x-ray imaging demonstrated glomeruli, tubules and collecting ducts clearly as optical microscopic images in specimens of normal kidney. It also revealed structural alterations in specimens of various kidney tumors. Typical internal structure and cells were demonstrated in renal angiomyolipoma and renal lymphoma. The structural alterations were nonspecific in different subtypes of renal cell carcinoma.

Conclusion: Phase contrast x-ray imaging revealed internal structures in specimens of normal kidney and various kidney tumors at the cellular level and could show the possibility of clinical applications. Further research studies are required on the source of X-rays other than synchrotron radiation, the safety aspect and automated system of tomography to practically apply this technique in the medical imaging field.

E323. Imaging Findings in Inflammatory Bowel Disease

Mattern M.; Clark P.; Kirkjian J.; Morton K.; Department of Radiology, Wake Forest University Health Sciences, Winston Salem, NC.

Address correspondence to M. Mattern (mmattern{at}wfubmc.edu)

Background: White blood cell scintigraphy is valuable in the diagnostic work-up and monitoring of inflammatory bowel disease (IBD). Historically, indium-111 labeled leukocytes were used for the purpose of locating sites of inflammation within the abdomen. More recently, technetium-99m labeled leukocytes have come into favor due to better imaging quality, shorter time to acquisition, and less radiation to the patient.

Key Issues: In this education exhibit, a brief review of key pathophysiologic features of IBD will be presented. This exhibit will describe and compare imaging findings of In-111 labeled WBC and Tc-99m HMPAO labeled WBC scintigraphy in IBD. Technical pros and cons of each radiopharmaceutical will be discussed in a didactic format. Correlative CT, small bowel follow-through, barium enema, colonoscopy and histologic features will be provided with nuclear imaging in case presentations. Differential diagnosis will also be discussed, with accompanying nuclear and radiologic images.

Format: The beginning of the presentation will feature didactic slides of pathophysiology of IBD, indications for WBC scintigraphy, as well as technical and imaging issues related to white blood cell imaging with In-111 and Tc-HMPAO. Case presentations illustrating imaging findings and differential diagnoses, including vasculitis and gastrointestinal bleeding, will be presented in a quiz format. Nuclear and radiologic correlation will be provided. A discussion of differential diagnoses, including how to distinguish between them, will follow.

Teaching Points: The teaching points conveyed will include: brief overview of IBD pathophysiology, pros and cons of In-111 vs. Tc-HMPAO WBC scintigraphy, application of WBC scintigraphy and its indications in IBD, physiologic and anatomic imaging features of IBD, and a differential diagnosis of labeled leukocyte activity in the bowel.

E324. Nuclear Cisternography Technique: Imaging Patterns, Pearls, and Pitfalls

Bagga S.; Radiology, Tufts New England Medical Center, Boston, MA.

Background: Radionuclide imaging of cerebrospinal fluid (CSF) is performed to diagnose and evaluate CSF leaks, shunt patency and communicating hydrocephalus. The technique is safe and provides valuable information to the treating Neurosurgeon.

Key Issues: This educational exhibit aims to discuss the technique of Nuclear cisternography, typical imaging patterns in the diagnosis of CSF leaks, shunt patency and communicating hydrocephalus. The typical Nuclear imaging patterns will be shown along with correlative anatomical images such as CT scan and MRI examination. Imaging pitfalls and pearls will be discussed.

Format: The exhibit will be in a power point format with illustrative examples of shunt patency and dysfunction, CSF leak, and communicating hydrocephalus.

Teaching Points: The reader will learn about the technique of Nuclear cisternography, typical imaging patterns of CSF leaks, shunt patency and dysfunction and communicating hydrocephalus. along with imaging pitfalls and pearls.

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