Duodenal Gastric Reflux on Hida scan

CLINICAL HISTORY

Recurrent RUQ pain.  US, CT and prior HIDA scan NAD.

FINDINGS
There is good extraction of tracer by both lobes of the liver with prompt intrahepatic excretion of tracer.  Tracer passes freely into the intestine and there is prompt visualisation on the gall bladder. 

Subsequently oral Ensure (CCK equivalent) was administered and images obtained 60 mins later.

The gall bladder ejection fraction is calculated at 87% (normal range greater than 35%).

Tracer accumulation is noted in the stomach in the 2 hour delayed images.

COMMENT

Normal gallbladder ejection fraction.  The tracer accumulation noted in the stomach is consistent with duodenal gastric reflux.

 

Pagets Disease involving the Mandible

 

CLINICAL HISTORY

Ca prostate.  ? Mets.

TECHNIQUE
Anterior and posterior whole body sweeps, spot views and tomographic views of the lumbar spine have been obtained.

FINDINGS
There is intense tracer uptake in the whole of the mandible, slightly less marked in the left ramus, consistent with Paget’s Disease.
There is a small focus of increased uptake in the left symphysis pubis, corresponding with the abnormality seen on CT.
There are arthritic changes in the shoulders, elbows, hips and knees. The focal uptake in the left humeral head is most likely due to a rotator cuff injury and the focus in the left greater trochanter has the appearance of trochaneric bursitis (which is also seen, to a lesser degree on the right side).
There is evidence of bilateral L4/5 facet joint arthritis.
Elsewhere the distribution of radiopharmaceutical is within normal limits. The kidneys demonstrate focal photopaenic areas consistent with cysts.

COMMENT

The focal uptake in the left symphysis pubis is worrying for metastasis. The focal abnormalities in the left shoulder and left greater trochanter are most likely explained by degenerative change, but radiographic correlation of these areas would be helpful.
The abnormality in the mandible is consistent with Paget’s Disease. There appear to be bilateral renal cysts.

CT confirmed sclerotic bony appearance in the Lt symphysis pubis.

 

Enlarged Lt kidney

A DTPA scan and CT of the Urinary tracts was requested to ascertain the size, location and function of an enlarged LT kidney.

The images and findings are as follows:

DTPA renal scan

TECHNIQUE:

Regional scintigraphy was performed following intravenous injection of tracer.

FINDINGS
There is normal perfusion to the right kidney in the flow phase of the study with photopaenia demonstrated in the left flank at the site of the known large left kidney.

Delayed images demonstrate good extraction, excretion and clearance on the right kidney with only small areas of extraction in the large left renal kidney.

Differential function left 15%: right 85%

COMMENT

There is normal perfusion and function by the right kidney with markedly reduced perfusion and function by the large left renal kidney. Due to the marked impairment of function by the large left kidney obstruction can be neither confirmed or excluded.

CT Urinary tracts

The post contrast study has been performed in the arterial and the delayed phases and correlated with the nuclear study.

REPORT:

There is an enlarged (18cm), grossly hydronephrotic left kidney which is shows a thin rim of enhancing nephrographic cortex. (3-4mm).

The left ureter is normal in calibre.

In the delayed series there is some excretion noted and it would be in order of 10-15% which would correlate very well with the nuclear medicine functional study.

There is a normal right kidney with a normal collecting system and ureter on that side and normal appearances of the bladder.

No other relevant findings on the study.

CONCLUSION:

Normal right kidney collecting system and bladder.

Chronic left PUJ obstruction with gross hydronephrosis and thinning of the renal cortex.

Pelvic Kidney on bone scan

 

CLINICAL HISTORY

Known pelvic kidney – LT.  Lower back and RT hip pain.  PHx LT THR.  ? Bony pathology.

TECHNIQUE

Whole body scintigraphy with SPECT was performed following intravenous injection of tracer.

FINDINGS

There is reduced vascularity in the right hip and at the known left pelvic kidney in the flow phase of the study.

In the delayed static images there is markedly increased tracer uptake in the superolateral aspect of the right hip with apparent mild photopenia of the right femoral head. A left hip prosthesis is noted. Markedly increased uptake is demonstrated in the medial compartment of the left knee, the right patellofemoral joint, both shoulders with generally nonuniform uptake of tracer throughout the spine and a focus of increased tracer uptake in the right approximate eighth rib posteriorly.

SPECT images of the spine demonstrate increased uptake in the S1 superior endplate and the L5 vertebral body with generally nonuniform uptake elsewhere.

COMMENT

The study demonstrates severe degenerative change involving the right hip joint most marked supero laterally. Reduced vascularity and apparent relative photopenia in the delayed images of the right femoral head raises the possibility of antecedent AVN as a cause for the severe degenerative change. Severe end plate degenerative change of S1 and marked degenerative change of L5 are also noted and may contribute to the symptoms. Widespread degenerative change elsewhere in the above-mentioned joints are present.

Colonic Transit study

REASON FOR STUDY:     Long standing onstipation and bloating.

Regional planar scintigraphy of the abdomen and pelvis was performed up to 5 days after ingestion of radiogallium.

FINDINGS

Time              %Retained Max activity            Normal

24 hrs                 89 AC                                 <100%

48 hrs                100 DC                                <50%

72 hrs                80 DC                                  <15%

96 hrs                53 DC                                    <5%

(AC – ascending colon,  DC – Descending colon)

COMMENT

Scan findings are consistent with marked slow colonic transit.

Normal hepatobiliary study using ENSURE plus for gallbladder contraction.

We no longer use KINEVAC for our HIDA’s mostly due to cost and unreliable availability of the product here in Australia.  This study demonstrates the effectiveness of the ingestion of ENSURE plus to show gallbladder contraction.  It is well tolerated by patients and comes in chocolate and vanilla flavours.

The study was acquired with the patient in the supine position and drinking 237 ml (1 can) of ENSUREplus at  50 mins post IVI.

Excellent gallbladder contraction was demonstrated from 50 – 90 mins with the EF calculated at 69.7%.

 

Toxic multinodular goitre

This female patient presented with a large goitre and decreased serum TSH levels.

Technique: Thyroid scintigraphy was performed following intravenous injection of tracer.

Findings:  There us a markedly patchy tracer distribution throughout a markedly enlarged thyroid gland which extends retrosternally there are focal areas of increased uptake demonstrated in the upper pole if the left lobe and both lower poles with a number of areas of reduced uptake in the mid portions of both lobes.

The neck to thigh ratio is 10.6 (normal range less than 6).

Comment:  The study demonstrates a large toxic multinodular gotire with some retrosternal extension.

Pagets Disease

CLINICAL HISTORY:  Increased ALP.  Pelvic pain.? Pagets disease

TECHNIQUE

Whole body scintigraphy with SPECT was performed following intravenous injection of tracer.

FINDINGS

In the delayed static and SPECT images there is intense tracer uptake demonstrated throughout both sides of the pelvis, T 12 and T10 vertebral bodies.

degenerative changes in the shoulders, knees, right foot and spine are also present

COMMENT:

The study demonstrates Paget’s disease involving both sides of the pelvis. The changes in the T10 and T12 vertebral bodies are also suspicious for Paget’s disease however due to the degree of uptake in the pelvis the uptake in the lower thoracic vertebral bodies is only suggestive rather than confirmatory.

Widespread metastatic bone cancer – A “Super Scan”

This 46 yo male patient presented with widespread pain and weight loss.  There was no prior history of carcinoma of any kind.

He underwent a whole body bone scan , CXR and CT of the abdomen and pelvis.  The results are as follows:

In the delayed images there is exquisite skeletal uptake particularly in the axial skeleton with increased uptake in both proximal humeri and a number of foci of intense uptake in the shaft of the right humerus.

There is absent uptake of tracer by the kidneys and exquisite skeletal uptake  – a “super” scan . This is suggestive of diffuse metastatic bone cancer.

The CT revealed extensive sclerosis of the entire bony skeleton.  Metastatic lymph nodes pre aortic in the mid abdomen were identified.  The prostate was enlarged, quite heterogeneous and bulging in to the bladder base.

The scan appearances are suggestive of prostatic cancer however, PSA levels and  prostatic biopsy had not yet been performed.

Bilateral shin splints – Comparative study

 

LINKS —->  Shin Splints  ,  Stress Fractures  <—- LINKS

HISTORY

Runner.  RT leg pain.  No trauma.  ? shin splints.

TECHNIQUE

Regional scintigraphy was performed following intravenous injection of tracer.

FINDINGS
There is normal increased vascularity in the flow phase of the study.

In the delayed images there is markedly increased uptake in the postero medial aspect of both tibii with two focal regions of increased uptake in the mid-shaft of the right tibia and mild increased uptake in both ankles.

The study was compared with a previous study of November 2007 and the abnormalities in the tibii were not present, however the ankle abnormalities were noted at the time.

COMMENT

There is severe bilateral shin splints with two small grade 1 stress fractures in the midshaft of the right tibia. The chronic changes at the ankles are most likely due to repetitive trauma.