THREE PHASE BONE SCAN TO RULE OUT AVASCULAR NECROSIS

A PATIENT WITH RIGHT # NECK FEMUR 5 MONTHS AGO, FOR EVALUATION OF VASCULARITY OF THE FEMORAL HEAD.

Blood flow and Blood pool images show slightly increased vascularity in the region of the right hip with a cold area in the center (in the region of femoral head). 2.5 Hours delayed images show increased tracer uptake in the right acetabulum and in the right femoral trochanteric region with evidence of photopenic area in the right femoral head.

Three Phase Bone scan is highly suggestive of Avascular Necrosis of the Right Femoral Head.

   
Tc E.C.D. BRAIN SPECT STUDY

CLINICAL INDICATIONS:FOR EVALUATION OF BRAIN FUNCTION.

Impression:

Hypo-perfusion in the regions of the Brain are compatible with ischemic stroke. Rest of the cerebrum shows normal perfusion.
   
Tc E.C.D. BRAIN SPECT STUDY

CLINICAL INDICATIONS:

ACUTE ONSET, MOTOR APHASIA AND Rt SIDED WEAKNESS YESTERDAY, SUSPECTED CVA, FOR EVALUATION OF BRAIN FUNCTION

Impression:

Mild hypo-perfusion in the right temporal and posterior frontal regions of the Brain are compatible with ischemic stroke. Rest of the cerebrum shows normal perfusion.
   
BASELINE Tc 99m D.T.P.A RENOGRAM DYNAMIC IMAGE REVIEW

Clinical Details :

RECENTLY DIAGNOSED UNCONTROLLED HT, UNEQUAL SIZED KIDNEYS, RENAL DOPPLER-BOTH RENAL ARTERIES NOT IMAGED, FOR EVALUATION OF DIFFERENTIAL RENAL FUNCTION AND RENO-VASCULAR COMPONENT.

BASELINE STUDY

KIDNEY RELATIVE FUNCTION (%) GFR (ml/min)
LEFT 51.6 28.1
RIGHT 48.4 26.4

POST ACEI INHIBITOR STUDY

KIDNEY RELATIVE FUNCTION (%) GFR (ml/min)
LEFT 47.6 18.8
RIGHT 52.4 20.7
DELAY IN TIME TO PEAK AND FALL IN GFR OF BILATERAL KIDNEYS DURING POST ACE INHIBITOR STUDY ---- HIGHLY S/O ? BILATERAL RAS
 
STRESS AND REST MYOCARDIAL PERFUSION IMAGES

Impression:

The polar maps revealed perfusion defect (?non-viable) in the apico-anterior portion supplied by the LAD (Recent transmural MI) but there is evidence of reversibility in the rest of the anterior wall which suggests that the re-vascularisation procedure for distal LAD may be useful.
   
Clinical Details:
SUB MENTAL SWELLING NOTICED SINCE TWO YRS,OTHERWISE ASYMTOMATIC ,RECENTLY MORE PROMINENT, USG NECK NORMAL THYROID GLD NOT SEEN ,SUSPECTED ECTOPIC THYROID TISSUE ,FOR EVALUATION OF THYROID UPTAKE AND FUNCTION.

Ectopic thyroid tissue in the sub mental region with no normal thyroid gland in its normal position indicating the ectopic thyroid tissue is the only functioning thyroid .The total tracer uptake in this area is 3. 5% which is with in normal limits (normal 0. 3 % to 5 %)
   
Rt shoulder mass, histopath : Malignant round cell tumour, Rt superior orbital swelling , left leg pain, for skeletal surveyAbnormal tracer accumulation in the above mentioned multiple sites mainly in the appendicular skeleton is s/o malignant bony pathology (? metastatic Ewing’s sarcoma) and needs histopathological confirmation.
   
GALLIUM SCAN- 24 HRS DELAYED

Clinical Indications:

CA MANDIBLE,OPERATED , THR DONE 20 YRS AGOFOR RT HIP FOR RTA, NOW PAIN IN RT LOWER THIGH, BONE SCAN INCREASED TRACER UPTAKE IN THE MID & LOWER SHAFT, SUSPECTED CHRONIC OSTEOMYELITIS.

Shows focal abnormal increased tracer accumulation in the right femur as mentioned above is compatible with the clinical & bone scan suspicion of ?Chronic Osteomyelitis involving the right femur .
   
DTPA GE REFLUX (MILK SCAN)
Conclusion: The above milk scan revealed radioactivity going from the stomach to the lower half of the oesophagus twice during dynamic images obtained after radiolabeled feed suggests high possibility of Gastro-oesophageal reflux as a cause of aspiration in this patient. There is low possibility of TO fistula in the present study. Kindly correlate clinically.
   

Conclusion:

Above scan findings with abnormal tracer in the region of the right iliac fossa during 4 hours post injection images suggests the site of Gastro-intestinal bleeding is probably in the terminal ileum and the tracer is also seen to be going to the ascending colon. Present study is positive for GI bleed.



Conclusion:

Above scan findings with abnormal tracer in the region of the right iliac fossa during 4 hours post injection images suggests the site of Gastro-intestinal bleeding is probably in the terminal ileum and the tracer is also seen to be going to the ascending colon. Present study is positive for GI bleed.

Conclusion:

These scan findings with abnormal tracer accumulation at the bifurcation of the aorta in the illiac vessels which was seen in the initial images and was persistent till 3 hrs, 5 hrs, and 16 hrs post injection suggests a possibility of ? Arterio - venous malformation which may be the reason for recurrent bleeding P/R. Incidentally, Patient’s left kidney was not visualized in it’s normal position, hence sonography was asked for to rule out pelvic kidney. The sonography showed left kidney in the pelvis in the center. The pelvic kidney is probably superimposed by ? AV malformation in this study.
   
I131 whole body scan shows residual thyroid tissue (? Local recurrence of malignancy) in the neck.

Suggestion:

Radio-iodine ablation.
   
COLLOID LIVER SCAN – MARKED HEPATIC DYSFUNCTION

CLINICAL DETAILS :

A 20 Yrs OLD BOY WITH NEPHROTIC SYNDROME, H/O ? JAUNDICE – LAST YEAR, SUSPECTED CHRONIC LIVER DISEASE WITH PHT ON SONOGRAPHY. FOR EVALUATION OF HEPATIC FUNCTION.

Impression:

The liver scan reveals moderately shrunken liver with markedly decreased tracer uptake in the hepatic parenchyma. The spleen is moderately enlarged in size and shows markedly increased tracer uptake. There is also tracer uptake in the vertebral marrow. The spleen to liver ratio is 10 which suggests almost total colloid shift. Above scan findings are consistent with marked hepatic dysfunction due chronic hepatic parenchymal disease with colloid (tracer) shift to the spleen and the vertebral marrow.
   
Tc M.D.P. BONE SCAN SPOT

Clinical Details :

VAGUE BONE PAINS &JOINT PAINS, MRI –DIFFUSE MARROW SIGNALS, ? INFILTRATIVE MARROW DISORDER ,FOR SKELETAL EVALUATION.

The bone scan findings are strongly suggestive of Metabolic Bone Disease

   

Clinical Details:

INV FOR GENERALIZED BONE PAINS , RT SIDED NECK SWELLING, ALK PO4 VERY HIGH, TO RULE OUT PARATHYROID ADENOMA/ HYPERPLASIA.
The subtraction image of TcO4 thyroid and Tc MIBI parathyroid showed evidence of focal tracer accumulation, which indicates high possibility of Parathyroid Adenoma ,and it also corresponds to the clinically palpable neck swelling .
   
I - MIBG WHOLE BODY SCINTIGRAPHY IMAGES AT 24 & 48 HOURS

CLINICAL INDICATIONS:

YOUNG HYPERTENSIVE , FOUND TO HAVE LEFT ADRENAL MASS ?PHEOCHROMOCYTOMA ON CT ABDOMEN., FOR EVALUATION.

Impression:

131 I MIBG scan shows focal tracer accumulation in the left side of the abdomen with no evidence of any abnormal tracer uptake in the rest of the body. The scan finding are compatible with the left adrenal tumour (?Pheochromocytoma) .
   

Clinical details:

RENAL TRANSPLANT DONE LAST WEEK, USG-SUPRA RENAL COLLECTION, SUSPECTED URINOMA , FOR EVALUATION The post void anterior and posterior views showed focal tracer accumulation in the supero-posterior aspect of the upper pole of the renal allograft, compatible with the clinical suspicion of ?Urinoma.
   
H/o pain and swelling left foot since four months, no obvious trauma or fall, x ray normal , for evaluation.

Impression:

III phase bone scan shows increased tracer uptake in the left foot during all 3 phases namely blood flow, blood pool and 2.5 hrs delayed bone images involving all its bones and joints suggesting high p/o ? Reflex sympathetic dystrophy syndrome and needs clinical correlation. Rest of the skeleton shows fairly normal tracer distribution.
   
Tc O4- SCINTI - ANGIOGRAPHY IMAGES

CLINICAL INDICATIONS:

K/C/O DM SINCE 20 YEARS, H/O BILATERAL LOWER LIMB PAIN AND SWELLING (LEFT >> RIGHT), FOR EVALUATION OF PERIPHERAL VASCULAR DISEASE.

Impression:

The Scinti-Angio shows increased tracer accumulation in the left foot during blood flow and blood pool images. Above scan findings are suggestive of increased vascularity in the symptomatic left foot due to ?infection or ?inflammation. There is evidence of decreased tracer uptake in the right foot, which suggests peripheral vascular disease. Please correlate clinically.
   
III PHASE IMAGES OF BILAT SHINS

Clinical Details:

H/O B/l LEG PAIN , X RAYS NORMAL , H/O HOPPING SEVERAL TIMES FROM A HEIGHT LAST WEEK .

Impression

III phase bone scan shows focal tracer uptake in the mid shafts of b/l tibiae during blood flow, blood pool & 2.5 hrs delayed images, suggesting stress injury to the tibial shafts (?early shin splints).
   
III PHASE IMGS OF THORAX

Clinical Details :

CABG IN JANUARY ’08, DIABETIC, INFECTEED WOUND OVER STERNUM , SUSPECTED OSTEOMYELITIS , FOR EVALUATION

Impression :

Focal abnormal tracer accumulation in the manubrium sternum , body of sternum , and in the left sided costal cartilages during all the three phases is compatible with the clinical suspicion of bony involvement due to Osteomyelitis .Rest of the skeleton is unremarkable.
   
THREE PHASE BONE SCAN TO RULE OUT HAIRLINE # NOT PICKED UP BY RADIOGRAPH

Impression:

The three phase bone scan shows increased tracer uptake in the proximal and distal ends of the second left metatarsal bone during blood flow, blood pool and 2.5 hours delayed images. Rest of the skeleton shows normal tracer distribution. Above scan findings are compatible with the clinical diagnosis of stress fracture of the left second metatarsal.

Impression:

The three phase bone scan shows increased tracer uptake in the trochanteric region of the right femur during blood flow, blood pool and 2.5 hours delayed images. Rest of the skeleton shows normal tracer distribution. Above scan findings are compatible with the clinical diagnosis of bony injury to the right femur in the trochanteric region (more likely ?fracture of the greater trochanter).