DAT SCAN

DAT Scan is used to assess the pre-synaptic striatal uptake in the putamen and caudate of the brain. The different uptake patterns can differentiate between:

• Parkinsonian syndrom and an essential tremor

DaTSCAN has a dopamine transporter radioligand which allows it to be taken up by the dopamine receptors in the basal ganglia (putamen & caudate) of the brain.

Positioning the Patient:

Both detectors should be in lateral positions. Detector 1 should be in left lateral and detector 2 should be in right lateral.

 Patient should be laying supine with the head between both detectors. Patient should be on head rest. You should have 2 straps for chin and forehead. Check if the patient is straight by using their chin as a guide now the nose.

Attempt to align the ear of patient with middle of detector. Use a point source on ear to position the caudate and putamen in FOV. The caudate and putamen are always above the ears meaning you do not have to image the whole head. This is good for patients with short necks.

 Now you find the radius by mapping around the patient avoiding any collision between camera and detectors. Once you go around patient 180 degrees. Put detector 1 anterior and detector 2 posterior.

You can now begin acquisition.

Acquisition parameters:

Matrix size : 128 x 128

High resolution collimator

Dual head camera

     

60 projections per head

30 seconds per view

Imaging time : 45 min

Case Studies:

The following case studies were acquired at Holy Name Medical Center:

CASE #1

 Report Results:

Abnormal scan consistent with Parkinson's syndrome

CASE #2

 Report Results:

Scan is negative for Parkinson's disease

If you want additional information; go to the the following link:

DaTSCAN



IV

PET (F18FDG) - Atherosclerosis

Clinical history: multiple myeloma and temporal arteritis (inflammation and dammage to the  blood vessels that supply the head, particularly the large or medium arteries that branch from the neck and supply the temporal area), weight loss.

PET scan for temporal arteritis can produce detailed images of the blood vessels and highlight areas of inflammation. PET imaging for atherosclerosis of carotid and peripheral arteries have been documented in several studies see below.

The patient was injected with 15 mCi F18 FDG and imaged from brow to mid-thigh at 1.5 hours post injection, with CT for attenuation correction. blood glucose at the time of injection was 90 mg/dl. 

Findings - The images demonstrate diffuse metabolic activity in the carotid arteries suggesting active atherosclerosis or  inflammation. Diffuse activity is present in the aorta, large vessels of the thorax, pelvis, upper and lower extremities...

There was no evidence of metabolically active neoplasm.

Further reading

JNM June 2008: Atherosclerosis Inflammation imaging

July 20, 2012 UMDNJ Newark

Welcome to the Advisory Committee Meeting!!

Agenda

Update on Current Students

Review of Applicant Pool for 2013 Program

Update on Competencies and Required Program Content as per Accrediting Bodies

Documentation of Student Performance at Clinical Sites - New Evaluation Form

Program Status and Accreditation

Updates from Affiliates

Open Discussion 

Cutaneous Metastases

Breast cancer is known to metastasize to anywhere in the body, either by hematogenous or lymphatogenous routes. Cancers that have the highest tendency to metastasize to the skin include melanoma, breast, nasal sinuses, larynx and oral cavity.

Excluding melanoma, cutaneous metastases occur more often in breast cancer than in other diseases in women and is the most often encountered in clinical practice. In a recent study, that included 12146 patients with internal malignancies, the rate of CM associated with breast carcinoma was 2.42 percent.

PETCT - subcutaneous metastases - transverse image shows extent of disease located in the soft tissue at the upper lobe of the liver.

projection image

Another example of a female with a clinical history of breast cancer who presents with "nodular" cutaneous metastases. image includes PET WB coronal slice and comparative transverse PET and CT slices.  Localized nodules are the most common presentation, occurring in 10% of patients.

Reading:
Cutaneous metastases of breast carcinoma: a case report.

Cutaneous and subcutaneous metastases of adenocarcicoma of the colon and rectum

Lung Scan - renal uptake

Clinical history: 85 y-male arrived in nuclear department for a lung scan to rule out pulmonary embolism.

Technique: Patient received 20 mCi Xe133 ventilation, followed by 30 mCi Tc99m MAA for lung perfusion imaging.

There was renal uptake noted on the perfusion images which was an unexpected finding. Following investigation it was found that the patient had come into the medical center the previous night through the emergency room and a lung scan had been started. Due to equipment malfunction the perfusion portion of the scan was not completed, and was to be repeated the following morning. The uptake by the kidneys was determined to be most likely due to biological breakdown of the Tc99 MAA from the previous night, which was being removed from the body through the kidneys.
Thanks to Cheryl Casale, 2004.

Perfusion Lung Scan - Artifact

Perfusion lung scan - Tc99m MAA

Images obtained on two consecutive patients demonstrated mild uptake in the salivary glands, thyroid and stomach. This represents free technetium due to either poor kit preparation or kit breakdown.  According to the package insert no less than 90% of the pertechnetate added to a reaction vial is bound to aggregate at preparation time and remains bound throughout the 6-8 hour lifetime of the preparation (depending on the manufacturer).

Use of Tc MAA after 8 hours of kit preparation has been shown to have an increase in agglomeration. It is recommended  for preparation and use of Tc 99m MAA, that  a fresh dose should be used for imaging.

The lower image demonstrates mild uptake int he stomach. If the ventilation portion of the scan had used Tc99m DTPA aerosol the stomach uptake could be accounted for by swallowed radiopharmacuetical. However at this facility the ventilation portion of the study was acquired utilizing Xe133.