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Questions and Answers
What is the ideal blood sugar level for diabetic patients before a meal imaging procedure?
What is the ideal blood sugar level for diabetic patients before a meal imaging procedure?
Which of the following medications should be discontinued two days before testing to avoid affecting gastric emptying?
Which of the following medications should be discontinued two days before testing to avoid affecting gastric emptying?
What is the quantity of liquid egg whites recommended in the standard meal preparation?
What is the quantity of liquid egg whites recommended in the standard meal preparation?
How long are initial imaging sessions conducted immediately after a meal ingestion?
How long are initial imaging sessions conducted immediately after a meal ingestion?
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What is the purpose of dynamic imaging in a gastric emptying study?
What is the purpose of dynamic imaging in a gastric emptying study?
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Where are the kidneys located in relation to the vertebrae?
Where are the kidneys located in relation to the vertebrae?
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Which of the following activities is recommended between imaging sessions during a gastric emptying study?
Which of the following activities is recommended between imaging sessions during a gastric emptying study?
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What is the characteristic position of the right kidney in relation to the left kidney?
What is the characteristic position of the right kidney in relation to the left kidney?
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What is the primary purpose of testicular imaging?
What is the primary purpose of testicular imaging?
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During testicular imaging, in which position should the patient be placed?
During testicular imaging, in which position should the patient be placed?
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What condition necessitates immediate treatment when diagnosed via testicular imaging?
What condition necessitates immediate treatment when diagnosed via testicular imaging?
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Which radiopharmaceutical is administered for testicular imaging?
Which radiopharmaceutical is administered for testicular imaging?
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What is the imaging procedure following the injection of 99mTc-pertechnetate for testicular imaging?
What is the imaging procedure following the injection of 99mTc-pertechnetate for testicular imaging?
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What symptom is associated with acute torsion of the spermatic cord?
What symptom is associated with acute torsion of the spermatic cord?
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Which radiopharmaceutical would be used for performing GFR measurements?
Which radiopharmaceutical would be used for performing GFR measurements?
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What is the significance of differentiating between ureteral reflux and other conditions during imaging?
What is the significance of differentiating between ureteral reflux and other conditions during imaging?
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Which cell type is primarily responsible for phagocytosis in the liver?
Which cell type is primarily responsible for phagocytosis in the liver?
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What is the primary function of the liver's blood supply from the hepatic portal vein?
What is the primary function of the liver's blood supply from the hepatic portal vein?
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What imaging priority should be adhered to when performing liver/spleen imaging?
What imaging priority should be adhered to when performing liver/spleen imaging?
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What is the recommended fasting period before administering a tracer for hepatobiliary imaging?
What is the recommended fasting period before administering a tracer for hepatobiliary imaging?
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What is the dose of Technetium-99m sulfur colloid used for liver/spleen imaging?
What is the dose of Technetium-99m sulfur colloid used for liver/spleen imaging?
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What imaging technique begins after a time frame of 10-15 minutes post-tracer localization?
What imaging technique begins after a time frame of 10-15 minutes post-tracer localization?
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What is the main purpose of using Sincalide in hepatobiliary imaging?
What is the main purpose of using Sincalide in hepatobiliary imaging?
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When should Sincalide not be administered during the procedure?
When should Sincalide not be administered during the procedure?
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What role do RE cells play in the biodistribution of Technetium-99m sulfur colloid?
What role do RE cells play in the biodistribution of Technetium-99m sulfur colloid?
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What is the typical time frame for gallbladder emptying after Sincalide administration?
What is the typical time frame for gallbladder emptying after Sincalide administration?
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Which of the following is NOT typically included in patient history for liver/spleen imaging?
Which of the following is NOT typically included in patient history for liver/spleen imaging?
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Which standard view is NOT a projection used in static liver/spleen imaging?
Which standard view is NOT a projection used in static liver/spleen imaging?
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What imaging acquisition method should be used initially after tracer administration?
What imaging acquisition method should be used initially after tracer administration?
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Why might delayed imaging be required in hepatobiliary imaging?
Why might delayed imaging be required in hepatobiliary imaging?
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During imaging, which position should the patient be in for optimal visualization of involved organs?
During imaging, which position should the patient be in for optimal visualization of involved organs?
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What is the maximum duration for delayed imaging after initial acquisition?
What is the maximum duration for delayed imaging after initial acquisition?
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What is the primary purpose of SPECT Imaging in relation to liver and spleen abnormalities?
What is the primary purpose of SPECT Imaging in relation to liver and spleen abnormalities?
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What percentage of Tc99m-sulfur colloid is typically found in the liver?
What percentage of Tc99m-sulfur colloid is typically found in the liver?
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Which of the following is NOT a source of artifacts that can distort liver shape in imaging?
Which of the following is NOT a source of artifacts that can distort liver shape in imaging?
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What imaging finding typically indicates severe diffuse liver disease?
What imaging finding typically indicates severe diffuse liver disease?
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How can breast shadow artifacts be mitigated during SPECT imaging?
How can breast shadow artifacts be mitigated during SPECT imaging?
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Which condition is NOT known to cause liver displacement?
Which condition is NOT known to cause liver displacement?
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What is the result of imaging too soon after the injection of Tc99m-sulfur colloid?
What is the result of imaging too soon after the injection of Tc99m-sulfur colloid?
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Which imaging technique aids in differentiating artifacts from true defects?
Which imaging technique aids in differentiating artifacts from true defects?
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What is the primary method through which the kidneys drain blood from the body?
What is the primary method through which the kidneys drain blood from the body?
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What is the main function of the nephron?
What is the main function of the nephron?
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Which of the following imaging methods is used to evaluate renal trauma or abnormalities?
Which of the following imaging methods is used to evaluate renal trauma or abnormalities?
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What is a contraindication for performing a radionuclide renal study?
What is a contraindication for performing a radionuclide renal study?
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What is the primary purpose of Technetium-99m (99mTc)-Pentetate (DTPA) in renal imaging?
What is the primary purpose of Technetium-99m (99mTc)-Pentetate (DTPA) in renal imaging?
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Which radiopharmaceutical is used primarily for assessing effective renal plasma flow (ERPF)?
Which radiopharmaceutical is used primarily for assessing effective renal plasma flow (ERPF)?
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What should be the positioning of the patient during renal perfusion imaging?
What should be the positioning of the patient during renal perfusion imaging?
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What indicates poor renal function when assessing laboratory values?
What indicates poor renal function when assessing laboratory values?
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Study Notes
Liver and Spleen Imaging
- Located on the right side, underneath the ribs, and directly below the diaphragm
- Composed of two cell types: RE cells (Kupffer cells) and hepatocytes
- Largest solid organ in the body
- RE cells are responsible for phagocytosis, ingesting particulate matter like bacteria
- Primarily found in the liver (80%), with smaller amounts in the spleen, bone marrow, and lymph system
- Receives oxygenated blood from the hepatic artery and nutrient-rich blood from the hepatic portal vein
Clinical Indications
- Determining the size, configuration, and position of the liver or spleen
- Detecting tumors, hematomas, cysts, abscesses, and trauma
- Evaluating functional liver diseases, such as cirrhosis and hepatitis
Radiopharmaceutical
- Technetium-99m sulfur colloid is used for liver/spleen imaging
- Colloid is engulfed by RE cells, which distribute it uniformly throughout the liver
- Dose: 10 mCi
- Mechanism of action (MOA): IV; Phagocytosis
- Biodistribution:
Patient Preparation
- No special preparation required
Patient History
- Patient diagnosis
- Serum bilirubin level
- Liver enzyme levels (SGOT, SGPT)
- Serum alkaline phosphatase
- Total serum protein levels (including globulin and albumin)
- Urine bilirubin level
- Previous abdominal surgery
Imaging Priority
- Perform liver/spleen imaging before GI tract studies using barium or contrast agents
- Contrast agents can cause artifacts on nuclear medicine images
Flow Imaging
- Patient positioned under the camera before tracer administration
- Flow study demonstrates vascularity of defects visible on static images
Static Imaging
- Imaging time begins after 10-15 minutes for tracer localization
- Standard views include Anterior, posterior, right lateral, left lateral, right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique projections
- Additional images include Anterior image with a reference marker along the right costal margin for liver size and location assessment
SPECT Imaging
- To better assess the size, location, and depth of liver and/or spleen abnormalities
- Aids in assessing abnormalities, distinguishing between artifacts and true lesions, detecting lesions not visible on planar images
Imaging Findings
- Tc99m-Sulfur Colloid Distribution: Primarily localized in the liver (85%), followed by the spleen (10%), with minimal presence in the bone marrow.
- Liver Location and Variations: Typically situated above the right costal margin, exhibiting diverse shapes, including the enlarged Reidel's lobe.
- Spleen Location and Visualization: Located in the left upper quadrant, best visualized on the posterior view.
- Artifact Sources: Heart, right kidney, porta hepatis, and gallbladder can distort the liver's shape.
- Liver Displacement Causes: Emphysema, subphrenic abscess, or an enlarged left hepatic lobe
- Tumor/Cyst/Abscess Appearance: Single or multiple areas of decreased or absent tracer uptake.
- Diffuse Liver Disease Appearance: Decreased or uneven tracer distribution throughout the liver.
- Severe Diffuse Liver Disease Appearance: Colloid shift, bone marrow visualization, and increased spleen tracer concentration
Technical Considerations
- Include details of imaging time, attenuation artifacts from barium, breast shadow artifact, skin fold artifacts, and respiration artifacts to ensure accurate imaging.
Anatomy and Physiology
- Provides information on the biliary tract components, bile flow, gallbladder function, bile function, bile production, and stimulation by cholecystokinin (CCK).
Clinical Indications
- Evaluation of patients experiencing upper abdominal pain is needed to rule out cystic duct obstruction (acute cholecystitis).
- Hepatobiliary imaging can help differentiate the cause of jaundice by ruling out obstruction of the biliary tract.
- Imaging can help to delineate bile drainage and reflux following surgery.
- Cold defects visualized on Tc99m-sulfur colloid images may be normal or abnormal variations of the biliary system.
Radiopharmaceuticals
- Commercially available Tc-labeled derivatives of iminodiacetic acids (IDA) used for hepatobiliary imaging
- Drug extraction from blood by hepatocytes and transported into the canaliculi with the bile
- Factors affecting tracer uptake: Chemical structure of the IDA compound, hepatic blood flow, hepatocyte viability, and bilirubin level
- Bilirubin elevation impact: Higher dosage may be required
Patient Preparation
- Fasting for 2-4 hours before tracer administration, but not more than 24 hours.
- Avoidance of narcotics, sedatives, and other drugs relaxing the sphincter of Oddi.
Imaging
- Imaging procedure starts after tracer administration using a scintillation camera with a low-energy collimator
- Patient positioning: Patient lies on their back, visualizing the liver, biliary tract, and small intestine
- Image acquisition: Sequential 5-minute images taken for 45-60 minutes
- Initial projections are Anterior oblique or right lateral projections after the first hour for bowel activity and organ visualization
- Delayed imaging: Obtain delayed images up to 24 hours if the gallbladder or bile ducts are not visualized initially
- Delayed Views for Intestinal Tracer: Obtain delayed views of the abdomen if the gallbladder and common bile duct are visualized but no tracer is seen in the small intestine
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Description
Explore the imaging techniques used for the liver and spleen, focusing on their anatomy and clinical indications. This quiz covers the roles of various cell types, the use of radiopharmaceuticals, and the evaluation of liver diseases. Test your understanding of the critical aspects of liver and spleen imaging.
