Table Of ContentTeaching Atlas of Nuclear Medicine
Teaching Atlas of Nuclear Medicine
edited by
Kevin J. Donohoe, M.D.
Division of Nuclear Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts
and
Annick D. Van denAbbeele, M.D.
Division of Nuclear Medicine
Dana-Farber Cancer Institute
Boston, Massachusetts
2000
Thieme
New York • Stuttgart
ThiemeNewYork
333SeventhAvenue
NewYork,NY10001
Editor:JaneE.Pennington
EditorialDirector:Ave´ McCracken
EditorialAssistant:ToddWarnock
DevelopmentalManager:KathleenP.Lyons
Director,ProductionandManufacturing:AnneVinnicombe
ProductionEditor:JaniceG.Stangel
MarketingDirector:PhyllisGold
SalesManager:RossLumpkin
ChiefFinancialOfficer:SethS.Fishman
President:BrianD.Scanlan
CoverDesigner:KevinKall
Compositor:AlexanderGraphics,Inc.,andGraphicWorld,Inc.
Printer:Maple-VailBookManufacturingGroup
LibraryofCongressCataloging-in-PublicationData
Teachingatlasofnuclearmedicine/editedbyKevinJ.Donohoe,AnnickVandenAbbeele.
p. cm.
Includesbibliographicalreferencesandindex.
ISBN0-86577-775-6
1. Radioisotopescanning—Atlases. I. Donohoe,KevinJ. II. VandenAbbeele,Annick,
1953-
[DNLM: 1. RadionuclideImaging—Atlases. 2. RadionuclideImaging—CaseReport.
WN 17 T253 1999]
RC78.7.R4 T43 1999
616.07'575 21—dc21
99-040822
Copyright©2000byThiemeMedicalPublishers,Inc.Thisbook,includingallpartsthereof,islegallyprotectedby
copyright.Anyuse,exploitationorcommercializationoutsidethenarrowlimitssetbycopyrightlegislation,withoutthe
publisher’sconsent,isillegalandliabletoprosecution.Thisappliesinparticulartophotostatreproduction,copying,
mimeographingorduplicationofanykind,translating,preparationofmicrofilms,andelectronicdataprocessingandstorage.
Importantnote:Medicalknowledgeisever-changing.Asnewresearchandclinicalexperiencebroadenourknowledge,
changesintreatmentanddrugtherapymayberequired.Theauthorsandeditorsofthematerialhereinhaveconsulted
sourcesbelievedtobereliableintheireffortstoprovideinformationthatiscompleteandinaccordwiththestandards
acceptedatthetimeofpublication.However,inviewofthepossibilityofhumanerrorbytheauthors,editors,orpublisher
oftheworkherein,orchangesinmedicalknowledge,neithertheauthors,editors,publisher,noranyotherpartywhohas
beeninvolvedinthepreparationofthiswork,warrantsthattheinformationcontainedhereinisineveryrespectaccurateor
complete,andtheyarenotresponsibleforanyerrorsoromissionsorfortheresultsobtainedfromuseofsuchinformation.
Readersareencouragedtoconfirmtheinformationcontainedhereinwithothersources.Forexample,readersareadvisedto
checktheproductinformationsheetincludedinthepackageofeachdrugtheyplantoadministertobecertainthatthe
informationcontainedinthispublicationisaccurateandthatchangeshavenotbeenmadeintherecommendeddoseorin
thecontraindicationsforadministration.Thisrecommendationisofparticularimportanceinconnectionwithnewor
infrequentlyuseddrugs.
Someoftheproductnames,patents,andregistereddesignsreferredtointhisbookareinfactregisteredtrademarksor
proprietarynameseventhoughspecificreferencetothisfactisnotalwaysmadeinthetext.Therefore,theappearanceofa
namewithoutdesignationasproprietaryisnottobeconstruedasarepresentationbythepublisherthatitisinthepublic
domain.
PrintedintheUnitedStatesofAmerica
5 4 3 2 1
TNYISBN0-86577-775-6
GTVISBN3-13-108611-4
To my mother and father, who have given me knowledge
and a sense of humor.
To my mentors Dennis Patton and Tim Woolfenden, who have
shown me how to teach and explore.
And to Mary, who has given me her love and support.
Kevin J. Donohoe, M.D.
To my parents Nelly and Karel Gerard Van den Abbeele,
my sister Karyn,
my brothers Eric and Michel,
and their families,
for giving me the roots as well as the wings,
for inspiring the best,
and for their endless encouragement, love, and support.
Annick D. Van den Abbeele, M.D.
CONTENTS
Contributors .................................................................................................. xiii
Foreword ......................................................................................................... xv
Preface .......................................................................................................... xvii
I. SKELETALSCINTIGRAPHY
NayerNikpoorandKevinJ.Donohoe
A. NeoplasticDisease
Case1. NormalBoneScan ............................................................ 3
Case2. ProstateCancer .................................................................. 6
Case3. BreastCancer .................................................................... 8
Case4. LungCancer .................................................................... 11
Case5. RenalCancer ................................................................... 14
Case6. Superscan ........................................................................ 16
Case7. ColonCancer ................................................................... 19
Case8. ColonCancer ................................................................... 21
Case9. SoftTissueMetastases(sarcoma) ................................... 24
Case10. LyticLesion ..................................................................... 27
Case11. AscitesonBoneScan ...................................................... 29
Case12. DecreasedBonyActivitySecondarytoExternal
BeamRadiation ............................................................... 31
B. Non-neoplasticDisease
Case13. SickleCellDisease .......................................................... 33
Case14. BenignInfarctioninSickleCellDisease ........................ 36
Case15. Paget’sDisease ................................................................ 38
Case16. Paget’sDiseaseoftheUpperExtremity ......................... 41
Case17. NodalTracerUptake ....................................................... 43
Case18. EtidronateTherapy .......................................................... 45
Case19. ResuscitationTrauma ...................................................... 47
Case20. Paget’sDiseaseoftheSpine ........................................... 49
Case21. BrainAbscess .................................................................. 52
Case22. Osteomyelitis ................................................................... 54
Case23. ShinSplint ....................................................................... 57
Case24. StressFracture ................................................................. 59
Case25. Post-traumaticFracture ................................................... 61
Case26. StressFractureMimickingMalignancy .......................... 63
Case27. FractureinElderlyPatient .............................................. 65
Case28. Osteonecrosis .................................................................. 67
Case29. InsufficiencyFracture ...................................................... 69
Case30. BoneGraft ....................................................................... 71
Case31. SecondaryHyperparathyroidism ..................................... 73
Case32. ProsthesisLoosening ....................................................... 76
Case33. Osteomyelitis ................................................................... 78
Case34. Spondylolysis .................................................................. 80
vii
CONTENTS
II. CARDIACSCINTIGRAPHY
KevinJ.DonohoeandAlanJ.Fischman
A. MyocardialPerfusion—Planar
Case35. Normal ............................................................................. 85
Case36. Stress-inducedIschemia .................................................. 88
Case37. FixedDefect .................................................................... 90
Case38. TracerUptakeintheLungs ............................................. 92
Case39. PoorVisualizationofMyocardium ................................. 94
Case40. ProminentRightVentricle ............................................... 96
Case41. DilatedLeftVentricle ...................................................... 98
Case42. PericardialEffusion ....................................................... 101
B. MyocardialPerfusion—SPECT
Case43. NormalMIBISPECT .................................................... 103
Case44. InferiorWallIschemia ................................................... 107
Case45. ModerateAnteroapicalIschemia ................................... 110
Case46. Cardiomyopathy ............................................................ 112
Case47. CardiomyopathywithLeftBundleBranchBlock ........ 114
Case48. SevereDilatedCardiomyopathy ................................... 116
Case49. MotionArtifact .............................................................. 118
C. MyocardialFunction(radionuclideventriculography)
Case50. Normal ........................................................................... 121
Case51. LVAneurysm ................................................................ 125
D. MyocardialViability
Case52. 18FDG/13N-ammoniaPET ............................................ 127
Case53. 18FDG/99mTc-sestamibiSPECT—Viable
Myocardium .................................................................. 129
Case54. 18FDG/99mTc-sestamibiSPECT—Non-viable
Myocardium .................................................................. 131
III. PULMONARYSCINTIGRAPHY
JacScheiner
A. PulmonaryEmbolism
Case55. Normal ........................................................................... 137
Case56. LowLikelihood—SmallPerfusionDefect .................... 142
Case57. LowLikelihood—MatchedDefects .............................. 144
Case58. IntermediateLikelihood ................................................ 147
Case59. HighLikelihood ............................................................ 149
Case60. IntermediateLikelihood ................................................ 151
Case61. HighLikelihood—MassiveClotBurden ...................... 154
Case62. ClumpingofTracer ....................................................... 157
Case63. PacemakerArtifact ........................................................ 159
B. RighttoLeftShunt
Case64. ASD—Right-to-LeftShunt ........................................... 161
Case65. Right-to-LeftIntrapulmonaryShuntSecondaryto
PulmonaryEmbolism .................................................... 163
IV. ENDOCRINESCINTIGRAPHY
KevinJ.DonohoeandRachelPowsner
A. Thyroid
Case66. Normal ........................................................................... 167
Case67. ColdNodule .................................................................. 170
viii
CONTENTS
Case68. AutonomousNodule ..................................................... 172
Case69. PoorTracerUptake ....................................................... 174
Case70. StarArtifact ................................................................... 176
Case71. SuppressionScan .......................................................... 178
Case72. Cancer ........................................................................... 181
Case73. TransmissionScan ......................................................... 184
Case74. FollicularThyroidCancer ............................................. 186
B. Parathyroid
Case75. ParathyroidAdenoma .................................................... 189
Case76. ParathyroidAdenomainMultinodularGoiter .............. 191
Case77. MediastinalParathyroidAdenoma ................................ 193
Case78. NormalParathyroidBed ............................................... 195
V. SCINTIGRAPHYOFNEOPLASTICDISEASE
A. Lymphoma
AnnickD.VandenAbbeele
Case79. Hodgkin’sDisease ........................................................ 199
Case80. Low/Non-Hodgkin’sGradeLymphoma ....................... 206
Case81. AggressiveNon-Hodgkin’sLymphomas ...................... 210
B. Breast
FrankBradley
Case82. EvaluationofBreastMass ............................................ 217
Case83. PatientwithImplant ...................................................... 219
Case84. AxillaryMass ................................................................ 222
C. Neuroendocrine
ChristopherP.FeyandAnnickD.VandenAbbeele
Case85. Neuroblastoma .............................................................. 224
Case86. Gastrinoma .................................................................... 229
Case87. CarcinoidTumor ........................................................... 232
D. AntibodyScintigraphy
MilosJanicek,ChristopherP.Fey,andAnnickD.VanDenAbbeele
Case88. OncoScintt .................................................................... 235
Case89. CEA-Scant ................................................................... 239
Case90. ProstaScintt .................................................................. 244
E. PositronImagingofTumors
HosseinJadvarandAlanJ.Fischman
Case91. StagingofNon-smallCellLungCancer ....................... 247
Case92. PETMonitoringofLungCancer .................................. 249
Case93. PETImagingofEsophagealCancer ............................. 252
Case94. LungAdenocarcinoma .................................................. 256
Case95. RecurrentSmallCellLungCancer ............................... 258
Case96. EsophagealAdenocarcinoma ........................................ 260
Case97. PancreaticAdenocarcinoma .......................................... 262
Case98. LowerExtremitySarcoma(spindlecell) ...................... 264
VI. INFLAMMATIONIMAGING
KevinJ.Donohoe
A. SoftTissueInflammation
Case99. NormalIn-111WBC ..................................................... 269
Case100. PresacralAbscess .......................................................... 271
ix
