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CONTENTS
Contributors xiii
Foreword xv
Preface xvii
I. SKELETAL SCINTIGRAPHY
Nayer Nikpoor and Kevin J. Donohoe
A. Neoplastic Disease
Case 1. Normal Bone Scan 3
Case 2. Prostate Cancer 6
Case 3. Breast Cancer 8
Case 4. Lung Cancer 11
Case 5. Renal Cancer 14
Case 6. Superscan 16
Case 7. Colon Cancer 19
Case 8. Colon Cancer 21
Case 9. Soft Tissue Metastases (sarcoma)
24
Case 10. Lytic Lesion 27
Case 11. Ascites on Bone Scan 29
Case 12. Decreased Bony Activity Secondary
to External Beam Radiation 31
B. Non-neoplastic Disease
Case 13. Sickle Cell Disease 33
Case 14. Benign Infarction in Sickle Cell
Disease 36
Case 15. Paget's Disease 38
Case 16. Paget's Disease of the Upper
Extremity 41
Case 17. Nodal Tracer Uptake 43
Case 18. Etidronate Therapy 45
Case 19. Resuscitation Trauma 47
Case 20. Paget's Disease of the Spine 49
Case 21. Brain Abscess 52
Case 22. Osteomyelitis 54
Case 23. Shin Splint 57
Case 24. Stress Fracture 59
Case 25. Post-traumatic Fracture 61
Case 26. Stress Fracture Mimicking
Malignancy 63
Case 27. Fracture in Elderly Patient 65
Case 28. Osteonecrosis 67
Case 29. Insufficiency Fracture 69
Case 30. Bone Graft 71
Case 31. Secondary Hyperparathyroidism 73
Case 32. Prosthesis Loosening 76
Case 33. Osteomyelitis 78
Case 34. Spondylolysis
II. CARDIAC SCINTIGRAPHY
Kevin J. Donohoe and Alan J. Fischman
A. Myocardial Perfusion-Planar
Case 35. Normal 85
Case 36. Stress-induced Ischemia 88
Case 37. Fixed Defect 90
Case 38. Tracer Uptake in the Lungs 92
Case 39. Poor Visualization of Myocardium
Case 40. Prominent Right Ventricle
Case 41. Dilated Left Ventricle
Case 42. Pericardial Effusion
B. Myocardial Perfusion-SPECT
Case 43. Normal MIBI SPECT 103
Case 44. Inferior Wall Ischemia 107
Case 45. Moderate Anteroapical Ischemia 110
Case 46. Cardiomyopathy 112
Case 47. Cardiomyopathy with Left Bundle
Branch Block 114
Case 48. Severe Dilated Cardiomyopathy
116
Case 49. Motion Artifact 118
C. Myocardial Function (radionuclide
ventriculography)
Case 50. Normal 121
Case 51. LV Aneurysm 125
D. Myocardial Viability
Case 52. 18FDG/13N-ammonia PET 127
Case 53. 18FDG/99mTc-sestamibiSPECT-Via
ble Myocardium 129
Case 54. 18FDG/99mTc-sestamibi
SPECT-Non-viable Myocardium 131
III. PULMONARY SCINTIGRAPHY
Jac Scheiner
A. Pulmonary Embolism
Case 55. Normal 155
Case 56. Low Likelihood-Small Perfusion
Defect 142
Case 57. Low Likelihood-Matched Defect 144
Case 58. Intermediate Likelihood 151
Case 59. High Likelihood 149
Case 60. Intermediate Likelihood 151
Case 61. High Likelihood-Massive Clot
Burden 154
Case 62. Clumping of Tracer 157
Case 63. Pacemaker Artifact 159
B. Right to Left Shunt
Case 64. ASD-Right-to-Left Shunt 161
Case 65. Right-to-Left Intrapulmonary Shunt
Secondary to Pulmonary Embolism
163
IV ENDOCRINE SCINTIGRAPHY
Kevin J. Donohoe and Rachel Powsner
A. Thyroid
Case 66. Normal 167
Case 68. Autonomous Nodule 172
Case 69. Poor Tracer Uptake 174
Case 70. Star Artifact 176
Case 71. Suppression Scan 178
Case 72. Cancer 181
Case 73. Transmission Scan 184
Case 74. Follicular Thyroid Cancer 186
B. Parathyroid
Case 75. Parathyroid Adenoma 189
Case 76. Parathyroid Adenoma in Multinodular
Goiter 191
Case 77. Mediastinal Parathyroid Adenoma
193
Case 78. Normal Parathyroid Bed 195
V. SCINTIGRAPHY OF NEOPLASTIC DISEASE
A. Lymphoma
Annick D. Van den Abbeele
Case 79. Hodgkin's Disease 199
Case 80. Low/Non-Hodgkin's Grade
Lymphoma 206
Case 81. Aggressive Non-Hodgkin's
Lymphomas 210
B. Breast
Frank Bradley
Case 82. Evaluation of Breast Mass
217
Case 83. Patient with Implant 219
Case 84. Axillary Mass 222
C. Neuroendocrine
Christopher P. Fey and Annick D. Van den Abbeele
Case 85. Neuroblastoma 224
Case 86 Gastrinoma 229
Case 87. Carcinoid Tumor 232
D. Antibody Scintigraphy
Milos Janicek, Christopher P. Fey, and Annick D.
Van Den Abbeele
Case 88. OncoScints 235
Case 89. CEA-Scan 239
Case 90. ProstaScint 244
E. Positron Imaging of Tumors
Hossein Jadvar and Alan J. Fischman
Case 91. Staging of Non-small Cell Lung
Cancer 247
Case 92. PET Monitoring of Lung Cancer
249
Case 93. PET Imaging of Esophageal Cancer
252
Case 94. Lung Adenocarcinoma 256
Case 95. Recurrent Small Cell Lung Cancer
258
Case 96. Esophageal Adenocarcinoma
260
Case 97. Pancreatic Adenocarcinoma 262
Case 98. Lower Extremity Sarcoma (spindle
cell) 264
VI. INFLAMMATION IMAGING
Kevin J. Donohoe
A. Soft Tissue Inflammation
Case 99. Normal In-111 WBC 269
Case 100. Presacral Abscess 271
Case 101. Splenic Abscess 273
Case 102. Peritoneal Metastases 276
Case 103. Inflammatory Bowel Disease
278
Case 104. Abdominal Abscesses-Gallium-67
280
Case 105. Brain Abscesses-Gallium-67 282
Case 106. Osteomyelitis 284
VII. IMAGING IN ACQUIRED
IMMUNODEFICIENCY SYNDROME
Nayer Nikpoor, Rachel Powsner, and Victor Lee
Case 107. Pulmonary Kaposi's 289
Case 108. Tuberculosis 293
Case 109. Lymphoma 296
Case 110. Nasopharyngeal B-cell
Non-Hodgkin's Lymphoma 299
Case 111. Skeletal B-cell Non-Hodgkin's
Lymphoma 301
Case 112. PCP-Gallium-67 303
Case 113. MAI-Gallium-67 305
Case 114. Gastric CMV 307
Case 115. Colitis-Radiolabeled WBC 309
Case 116. Septic Arthritis 311
Case 117. AIDS Dementia Complex 313
Case 118. Granulomatous Mycobacterial
Lymphadenitis 315
VIII. RENAL SCINTIGRAPHY
Finn Mannting
Case 119 Renal Perfusion 319
Case 120. Chronic Pyelonephritis 321
Case 121. Collecting System
Obstruction-Diuretic
Renography 324
Case 122. Chronic Obstruction 327
Case 123. Negative Captopril Renogram 331
Case 124. Parenchymal Renal Disease-Captopril
Renogram 336
Case 125. Renal Artery Stenosis-Captopril
Renogram 340
IX. BILIARY SCINTIGRAPHY
Kevin J. Donohoe
Case 126. Normal 349
Case 127. Gangrenous Cholecystitis 352
Case 128. Common Bile Duct Obstruction 354
Case 129. Gastric Reflux 356
Case 130. Hepatocellular Dysfunction 358
Case 131. Biliary Leak 361
Case 132. Hepatic Metastases 364
X. LYMPHOSCINTIGRAPHY
A. Lymphedema
Annick D. Van den Abbeele
Case 133. Upper Extremity 369
Case 134. Lower Extremity 372
B. Sentinel Node
Rachel Powsner
Case 135. Melanoma of the Trunk 375
Case 136. Melanoma of the Lower Back 378
XI. CENTRAL NERVOUS SYSTEM
SCINTIGRAPHY
A. Perfusion
Puneet Chandak and B. Leonard Holman
Case 137. Alzheimer's Disease 383
Case 138. Ictal and Interictal Seizure Imaging
386
B. Neoplastic Disease
Alan J. Fischman
Case 139. PET Monitoring of Astrocytoma 389
Case 140. Dual Isotope Tumor Recurrence 393
C. Brain Death
Rachel Powsner
Case 141. Brain Death 395
Case 142. Normal Brain Flow Study 398
Case 143. Normal HMPAO 402
Case 144. Isolated Mid-brain Tracer Uptake
405
XII. GASTROINTESTINAL SCINTIGRAPHY
Kevin J. Donohoe
Case 145. Gastric Motility-Normal 409
Case 146. Gastric Motility-Delayed Emptying
412
Case 147. Gastric Motility-Rapid Emptying 414
Case 148. Colon Transit-Functional Obstruction
416
Case 149. Lower GI Bleeding 418
Case 150. Upper GI Bleed 420
Case 151. Normal Liver-Spleen Scan 422
Case 152. Cirrhosis on Liver-Spleen Scan
424
XIII. VASCULAR SCINTIGRAPHY
A. SVC Imaging
Annick D. Van den Abbeele and Christopher
P. Fey
Case 153. Normal 429
Case 154. SVC Syndrome 432
Case 155. Fibrin Sheath 435
Case 156. Brachiocephalic Obstruction 437
B. Liver Blood Pool Scintigraphy
Kevin J. Donohoe
Case 157. Normal Liver Blood Pool 440
Case 158. Hepatic Cavernous Hemangioma 443
Case 159. Hepatic Metastases 445
Case 160. Hemangioma Positive only on SPECT
447
Case 161. Hepatic Cyst and Cavernous
Hemangioma 450
XIV. PEDIATRIC SCINTIGRAPHY
Laura Drubach, Leonard Connolly, and S. Ted
Treves
Case 162. Urinary Tract Infection 455
Case 163. Testicular Torsion 459
Case 164. Biliary Atresia 463
Case 165. Epilepsy 466
Case 166. Neuroblastoma 469
Case 167. Osteomyelitis 472
Case 168. Osteosarcoma 476
Case 169. Renal Collecting System Obstruction
480
Index 485
CONTRIBUTORS
Frank Bradley, M.D.
Department of Radiology
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Puneet Chandak, M.D.
Division of Nuclear Medicine
Department of Radiology
Brigham and Women's Hospital
Boston, Massachusetts
Leonard Connolly, M.D.
Associate Director, Resident/Fellow Training
Joint Program in Nuclear Medicine
Division of Nuclear Medicine
Children's Hospital
Boston, Massachusetts
Kevin J. Donohoe, M.D.
Division of Nuclear Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Laura Drubach
Division of Nuclear Medicine
Children's Hospital
Boston, Massachusetts
Christopher P Fey, M.D.
Clinical Fellow
Division of Nuclear Medicine
Brigham and Women's Hospital
Boston, Massachusetts
Alan Fischman, M.D., Ph.D.
Director
Division of Nuclear Medicine
Massachusetts General Hospital
Boston, Massachusetts
B. Leonard Holman, M.D., Ph.D. (deceased)
Chairman, Department of Radiology
Brigham and Women's Hospital
Boston, Massachusetts
Hossein Jadvar, M.D., Ph.D.
Clinical Fellow
Joint Program in Nuclear Medicine
Harvard Medical School
Boston, Massachusetts
Milos Janicek, M.D., Ph.D.
Division of Nuclear Medicine
Dana-Farber Cancer Institute
Boston, Massachusetts
Victor Lee, M.D.
Division of Nuclear Medicine
Boston Medical Center
Boston, Massachusetts
Finn Mannting, M.D., Ph.D.
Director
Division of Nuclear Medicine
Brigham and Women's Hospital
Boston, Massachusetts
Nayer Nikpoor, M.D.
Division of Nuclear Medicine
Brigham and Women's Hospital
Boston, Massachusetts
Rachel Powsner, M.D.
Acting Director
Division of Nuclear Medicine
Boston Medical Center
Boston, Massachusetts
Jac D. Schemer, M.D.
Clinical Assistant Professor
Department of Diagnostic Imaging
Brown University School of Medicine
Providence, Rhode Island
Annick D. Van den Abbeele, M.D. Director Division of
Nuclear Medicine Dana-Farber Cancer Institute Boston,
Massachusetts
S. Ted Treves, M.D.
Director, Resident/Fellow Training
Joint Program in Nuclear Medicine
Chief, Division of Nuclear Medicine
Children's Hospital
Boston, Massachusetts
