Nuclear Medicine, 2nd Edition: Case Review Series

This new volume in the popular CASE REVIEW series is the ideal text to prepare for certification and CAQ exams and ensure an up-to-date mastery of the field. Approximately 200 case studies challenge the reader's understanding to the radiologic interpretation and diagnosis for nuclear medicine. Each case study is followed by 3 or 4 questions that mimic the format of the certification exams. Answers and rationales are also provided. Three different difficulty levels test fundamental, intermediate, and advanced skills. The result is a focused and effective way for readers to hone their knowledge.

• Features approximately 200 randomly organized cases which address topics such as scintigraphy, SPECT, and PET imaging · PET single pulmonary nodule · primary brain tumor · bullseye · and Alzheimer's.
• Provides 400 images for a realistic simulation of the challenges faced on the exams and in practice.
• Organizes the questions and images on one side of the page, answers for the questions along with rationales, references and cross references on the flip side.
• Cross Referenced to Thrall: Nuclear Medicine: The Requisites

Table of Contents
Opening Round
1: Skeletal system: Janus – two-headed Roman god
2: Skeletal system: Stress fractures
3: Skeletal system: Paget’s Disease
4: Skeletal system: Rib fractures and sternotomy
5: Skeletal system: Pedal osteomyelitis - three phase positive
6: Skeletal system: Abnormal breast uptake
7: Skeletal system: Neuroblastoma
8: Skeletal system: Extra-renal pelvis and mobile solitary right kidney
9: Skeletal system: Lymphedema
10: Skeletal system: Bone-abnormalities of renal position
11: Skeletal system: Metastatic prostate cancer
12: Skeletal system: Breast cancer
13: Skeletal system: Fibrous Dysplasia
14: Skeletal system: Radiopharmaceutical infiltration, scatter, and lymph node uptake
15: Skeletal system: Sacral insufficiency fracture
16: Skeletal system: Multiple insufficiency fractures
17: Cardiovascular system: LAD ischemia
18: Cardiovascular system: Apical infarct
19: Cardiovascular system: Dual isotope study - mild inferior ischemia
20: Cardiovascular system: Breast attenuation, wall thickening
21: Cardiovascular system: Emergency room chest pain
22: Cardiovascular: Planar thallium with increased lung activity
23: Cardiovascular system: Cardiomyopathy on RVG/MUGA
24: Pulmonary system: High probability for pulmonary embolus
25: Pulmonary system: Hot spots on lung scan
26: Pulmonary system: V/Q – Stripe sign, emphysema
27: Pulmonary system: Hampton’s hump-Intermediate probability
28: Infection and inflammation: Sarcoidosis
29: Infection and inflammation: Intra-abdominal abscess
30: Oncology: Bone/Gallium - Stage IV Hodgkin’s
31: Oncology: Ga-67 - non-Hodgkins lymphoma pre- and post-therapy
32: Oncology: FDG PET - Single pulmonary nodule
33: Primary brain tumor
34: Oncology – Scintimammography
35: Hepatobiliary system: Cholescintigraphy – Normal study
36: Hepatobiliary system: Acute cholecystitis
37: Hepatobiliary system: Morphine-augmented cholescintigraphy
38: Hepatobiliary system: Biliary Leak
39: Hepatobiliary system: Cavernous hemangioma of the liver
40: Gastrointestinal system: Tc-99m RBC colonic bleeds
41: Gastrointestinal system: Meckel’s diverticulum
42: Gastrointestinal system: Diabetic gastroparesis
43: Gastrointestinal system: "Milk" study – gastroesophageal reflux
44: Central nervous system: Brain death
45: Central nervous system: Cerebral infarct
46: Radionuclide cystography
47: Diuretic renography – unilateral obstruction
48: Renal radiopharmaceuticals
49: Genitourinary system: Diuretic renography-nonobstructed hydronephrosis
50: Genitourinary system: Transplant kidney urinary leak
51: Genitourinary system: Non-viable kidney post-transplantation
52: Genitourinary system: Renal transplant with acute tubular necrosis
53: Genitourinary system: Testicular torsion
54: Endocrine system: Cold thyroid nodule
55: Endocrine system: Hyperthyroidism – thyroiditis
56: Endocrine system: Graves’ disease
57: Endocrine system: I-131 star artifact
58: Endocrine system: Hyperparathyroidism
59: Endocrine system: Parathyroid adenoma

Fair Game
60: Skeletal system: L-5 pars articularis defect
61: Bone: Tibial osteomyelitis - three-phase positive bone scan
62: Skeletal system: Hepatoblastoma
63: Skeletal system: Sickle cell disease
64: Skeletal system: Osteosarcoma
65: Skeletal system: muscle injury
66: Skeletal system: Pleural uptake
67: Skeletal system: Hot kidneys, radiation nephritis and spinal photopenia
68: Skeletal system: Splenic uptake
69: Skeletal system: Heterotopic ossification
70: Skeletal system: Superscan secondary to metastatic prostate cancer
71: Skeletal system: Soft tissue uptake in lung mass
72: Skeletal system: prostate cancer bone metastases, axial distribution
73: Skeletal system: Hyperparathyroidism
74: Bone: Osteosarcoma metastatic to lung
75: Skeletal system: Reflex sympathetic dystrophy
76: Skeletal system: Spontaneous osteonecrosis of distal femur
77: Skeletal system: Metastases to bone and liver
78: Skeletal system: myocardial uptake
79: Skeletal metastases: Metastasis to clivus
80: Skeletal system: Cold spine defects
81: Skeletal system: Metastatic calcification in lungs and kidneys
82: Quality control: Gamma camera floods
83: Cardiovascular system: Inferior lateral wall infarction
84: Cardiovascular system: Dipyridimole-induced reversible inferior wall ischemia
85: Cardiovascular system: adenosine stress - apical infarct, anterior-lateral ischemia
86: Cardiovascular system: viability, fixed LAD defect
87: Cardiovascular system: Bullseye, reporting results
88: Cardiovascular system: Inadequate stress
89: Cardiac: Silent lateral wall ischemia
90: Cardiovascular system: LBBB
91: Cardiovascular system: RBC labeling for RVG/MUGA
92: Cardiac: Calculation of LVEF for RVG (MUGA)
93: Cardiovascular system: RVG/MUGA technique
94: Pulmonary system: Emphysema due to alpha-1 antitrypsin deficiency
95: Pulmonary system: Tc-99m DTPA ventilation study with aerosol clumping
96: Pulmonary system: Low probability ventilation perfusion scan
97: Pulmonary system: Intermediate probability and pregnancy
98: Infection and inflammation: Tc-99m HMPAO leukocytes and osteomyelitis
99: Infection and inflammation: Tc-99m HMPAO leukocytes – free Tc-99m pertechnetate
100: Infection and inflammation: Intra-abdominal abscess
101: Infection and inflammation: Pericarditis - Ga-67
102: Oncology: Neuroectodermal tumors
103: Oncology: Post-chemotherapy Ga-67 findings
104: Oncology: F-18 FDG PET – Lymphoma
105: Oncology: F-18 FDG PET – Lung cancer staging
106: Oncology: F-18 FDG PET - colorectal cancer metastatic to liver
107: Oncology: F-18 FDG PET - bronchogenic cancer metastatic to brain
108: Oncology: Thallium-201 - Intracranial lymphoma
109: Oncology: Melanoma lymphoscintigraphy
110: Oncology: Breast cancer lymphoscintigraphy
111: Hepatobiliary system: Delayed biliary-to-bowel transit
112: Hepatobiliary system: RIM sign
113: Hepatobiliary system: High-grade biliary obstruction
114: Hepatobiliary system: Hepatic dysfunction
115: Hepatobiliary system: Acute cholecystitis and biliary obstruction
116: Hepatobiliary system: Biliary Atresia
117: Hepatobiliary system: Cavernous hemangioma of the liver
118: Hepatobiliary system: Splenic remnant
119: Gastrointestinal system: gastrointestal bleed secondary to angiodysplasia
120: Gastrointestinal system: Tc-99m RBC Scan - Axillobifemoral graft
121: Gastrointestinal system: Tc-99m RBCs - free pertechnetate vs. gastric bleeding
122: Gastrointestinal system: Rectal bleeding
123: Central nervous system: Seizure disorder
124: Central nervous system: Alzheimer’s disease
125: Central nervous system: Pick’s Disease
126: Genitourinary system: Acute renal transplant rejection
127: Genitourinary system: Renal insufficiency – small kidneys, poor function
128: Genitourinary system: Captopril renography
129: Primary megaureter
130: Genitourinary system: Pyelonephritis and Tc-99m DMSA
131: Endocrine system: Hot thyroid nodule
132: Endocrine system: Lingual thyroid
133: Endocrine system: Thyroid left lobe agenesis – Graves’ disease
134: Endocrine system: mediastinal parathyroid adenoma
135: Endocrine system: MIBG – pheochromocytoma

Challenge
136: Skeletal system: Arterial injection, boot artifact, photopenic attenuation artifact
137: Skeletal system: Improved specificity with bone scan lumbar SPECT
138: Skeletal system: Pulmonary hypertrophic osteoarthropathy
139: Skeletal system: Gangrene of toes
140: Skeletal system: Avascular necrosis of metatarsal head (Frieberg’s disease)
141: Skeletal system: Neuroblastoma mimicking osteomyelitis
142: Skeletal system: Fibrous dysplasia, McCune Albright syndrome
143: Bone: Renal osteodystrophy
144: Skeletal system: Lumbar spinal fusion, renal transplant
145: Skeletal system: Metastases to bone (cold) and adrenal gland
146: Bone: Osteosarcoma and Tl-201
147: Skeletal system: Avascular necrosis of femoral heads
148: Musculoskeletal system: Lymphoscintigraphy of the lower extremities
149: Cardiovascular system: Dobutamine stress
150: Cardiovascular system: Patient movement artifact
151: Cardiovascular system: Breast attenuation
152: Cardiovascular system: Dipyridimode, inferior ischemia, overlying bowel activity
153: Cardiovascular system: Attenuation due to changing breast position
154: Cardiovascular system: Tl-201 viability study
155: Cardiovascular system: Planar thallium-201 with ischemia
156: Cardiovascular system: NH3/FDG cardiac viability study
157: Cardiovascular system: Doxorubicin toxicity
158: Cardiac: Pyrophosphate SPECT infarct
159: Cardiovascular system: Superior vena cava obstruction
160: Pulmonary system: High probability for pulmonary embolus
161: Pulmonary system: Stripe sign
162: Pulmonary system: Unilateral matched ventilation perfusion abnormality
163: Pulmonary system: Right to left shunt demonstrated by Tc-99m MAA
164: Throbophlebitis: AcutTect® (Tc-99m apcitide)
165: Infection and inflammation: In-111 oxine WBCs – right ileum osteomyelitis
166: Infection and inflammation: Osteomyelitis of the spine
167: Inflammation and infection: FDG PET – Paraspinal infection
168: Infection and inflammation: Knee arthoplasty – rule out infection
169: Oncology: FDG – Hodgkin’s disease and muscle tension artifact
170: Oncology: F-18 FDG – Melanoma
171: Oncology: Gamma camera FDG PET
172: Oncology: F-18 FDG – diabetic patient
173: Oncology: Brain lymphoma vs. infection in AIDS
174: Oncology: Tc-99m CEA colorectal carcinoma recurrence
175: Oncology: In-111 ProstaScint – Prostate cancer
176: Oncology: OctreoScan - Glomus tympanicum
177: Hepatobiliary system: Choledochal cyst
178: Hepatobiliary system: Chronic acalculous cholecystitis
179: Hepatobiliary system: Post-cholecystectomy syndrome
180: Hepatobiliary system: Cholecystojujunostomy
181: Hepatobiliary system: Focal nodular hyperplasia (FNH)
182: Hepatobiliary system: Hot spot Tc-99m SC imaging
183: Gastrointestinal system: Tc-99 RBCs - small bowel bleed
184: Gastrointestinal system: Peritoneal-pleural scan
185: Gastrointestinal system: Pulmonary aspiration
186: Gastrointestinal system: Peritoneal scan - Patent Denver shunt
187: Central nervous system: Gamma camera quality control
188: Central nervous system: Herpes encephalitis
189: Central nervous system: Normal pressure hydrocephalus
190: Central nervous system: Huntington’s Chorea
191: Central nervous system: Cerebrospinal fluid leak
192: Genitourinary system: Urinoma
193: Genitourinary system: Diuretic renography – bilateral obstruction
194: Genitourinary system: Torsion of testicular appendage, epidymitis, delayed torsion
195: Endocrine system: Therapy of toxic nodule
196: Endocrine system: Toxic nodular goiter and thyroid cancer
197: Endocrine system: Thyroid cancer whole body scan
198: Endocrine system: FDG-PET and thyroid cancer
199: Endocrine system: Adrenocortical scintigraphy
200: Endocrine system: Bone scan and I-131 MIBG - Neuroblastoma