Liver and Spleen Imaging Overview
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Questions and Answers

What is the ideal blood sugar level for diabetic patients before a meal imaging procedure?

  • Below 150 mg/dL
  • Above 250 mg/dL
  • Below 200 mg/dL (correct)
  • Between 200 - 250 mg/dL

Which of the following medications should be discontinued two days before testing to avoid affecting gastric emptying?

  • Atropine (correct)
  • Metformin
  • Ibuprofen
  • Insulin

What is the quantity of liquid egg whites recommended in the standard meal preparation?

  • 130 mL
  • 100 mL
  • 150 mL
  • 118 mL (correct)

How long are initial imaging sessions conducted immediately after a meal ingestion?

<p>1 minute (C)</p> Signup and view all the answers

What is the purpose of dynamic imaging in a gastric emptying study?

<p>To accurately calculate emptying halftime (C)</p> Signup and view all the answers

Where are the kidneys located in relation to the vertebrae?

<p>Between the 12th thoracic and 4th lumbar vertebrae (B)</p> Signup and view all the answers

Which of the following activities is recommended between imaging sessions during a gastric emptying study?

<p>Resting quietly (C)</p> Signup and view all the answers

What is the characteristic position of the right kidney in relation to the left kidney?

<p>Slightly lower than the left kidney (B)</p> Signup and view all the answers

What is the primary purpose of testicular imaging?

<p>To differentiate between acute torsion of the spermatic cord and epididymitis (C)</p> Signup and view all the answers

During testicular imaging, in which position should the patient be placed?

<p>Supine with penis taped to the pubic bone (A)</p> Signup and view all the answers

What condition necessitates immediate treatment when diagnosed via testicular imaging?

<p>Acute torsion of the spermatic cord (B)</p> Signup and view all the answers

Which radiopharmaceutical is administered for testicular imaging?

<p>Tc99m-Pertechnetate (D)</p> Signup and view all the answers

What is the imaging procedure following the injection of 99mTc-pertechnetate for testicular imaging?

<p>Dynamic images at 2-3 second intervals, then static images (C)</p> Signup and view all the answers

What symptom is associated with acute torsion of the spermatic cord?

<p>Acute severe pain (B)</p> Signup and view all the answers

Which radiopharmaceutical would be used for performing GFR measurements?

<p>Tc99m-Pentetate (C)</p> Signup and view all the answers

What is the significance of differentiating between ureteral reflux and other conditions during imaging?

<p>Ureteral reflux can lead to chronic kidney disease if untreated (C)</p> Signup and view all the answers

Which cell type is primarily responsible for phagocytosis in the liver?

<p>RE cells (A)</p> Signup and view all the answers

What is the primary function of the liver's blood supply from the hepatic portal vein?

<p>To deliver nutrient-rich blood (B)</p> Signup and view all the answers

What imaging priority should be adhered to when performing liver/spleen imaging?

<p>Perform liver/spleen imaging before GI tract studies (A)</p> Signup and view all the answers

What is the recommended fasting period before administering a tracer for hepatobiliary imaging?

<p>2-4 hours (B)</p> Signup and view all the answers

What is the dose of Technetium-99m sulfur colloid used for liver/spleen imaging?

<p>10 mCi (C)</p> Signup and view all the answers

What imaging technique begins after a time frame of 10-15 minutes post-tracer localization?

<p>Static imaging (B)</p> Signup and view all the answers

What is the main purpose of using Sincalide in hepatobiliary imaging?

<p>To induce gallbladder contraction (D)</p> Signup and view all the answers

When should Sincalide not be administered during the procedure?

<p>After the administration of morphine sulfate (B)</p> Signup and view all the answers

What role do RE cells play in the biodistribution of Technetium-99m sulfur colloid?

<p>Engulfing the colloid uniformly throughout the liver (D)</p> Signup and view all the answers

What is the typical time frame for gallbladder emptying after Sincalide administration?

<p>2 minutes (B)</p> Signup and view all the answers

Which of the following is NOT typically included in patient history for liver/spleen imaging?

<p>History of smoking (A)</p> Signup and view all the answers

Which standard view is NOT a projection used in static liver/spleen imaging?

<p>Superior view (A)</p> Signup and view all the answers

What imaging acquisition method should be used initially after tracer administration?

<p>Sequential 5-minute images (D)</p> Signup and view all the answers

Why might delayed imaging be required in hepatobiliary imaging?

<p>If gallbladder or bile ducts are not visualized initially (B)</p> Signup and view all the answers

During imaging, which position should the patient be in for optimal visualization of involved organs?

<p>Lying supine on their back (B)</p> Signup and view all the answers

What is the maximum duration for delayed imaging after initial acquisition?

<p>24 hours (A)</p> Signup and view all the answers

What is the primary purpose of SPECT Imaging in relation to liver and spleen abnormalities?

<p>To better assess the size, location, and depth of abnormalities. (A)</p> Signup and view all the answers

What percentage of Tc99m-sulfur colloid is typically found in the liver?

<p>85% (C)</p> Signup and view all the answers

Which of the following is NOT a source of artifacts that can distort liver shape in imaging?

<p>Enlarged left hepatic lobe (A)</p> Signup and view all the answers

What imaging finding typically indicates severe diffuse liver disease?

<p>Colloid shift and increased spleen tracer concentration. (C)</p> Signup and view all the answers

How can breast shadow artifacts be mitigated during SPECT imaging?

<p>By positioning the breast out of the way. (D)</p> Signup and view all the answers

Which condition is NOT known to cause liver displacement?

<p>Cholecystitis (C)</p> Signup and view all the answers

What is the result of imaging too soon after the injection of Tc99m-sulfur colloid?

<p>Increased cardiac blood-pool activity in imaging. (C)</p> Signup and view all the answers

Which imaging technique aids in differentiating artifacts from true defects?

<p>SPECT imaging or additional planar views. (B)</p> Signup and view all the answers

What is the primary method through which the kidneys drain blood from the body?

<p>Inferior vena cava via renal veins (A)</p> Signup and view all the answers

What is the main function of the nephron?

<p>Filter waste and excess fluid from the blood (C)</p> Signup and view all the answers

Which of the following imaging methods is used to evaluate renal trauma or abnormalities?

<p>Static Renal Imaging (D)</p> Signup and view all the answers

What is a contraindication for performing a radionuclide renal study?

<p>Patients with acute tubular necrosis after renal arteriogram (B)</p> Signup and view all the answers

What is the primary purpose of Technetium-99m (99mTc)-Pentetate (DTPA) in renal imaging?

<p>Demonstrate glomerular filtration capabilities (C)</p> Signup and view all the answers

Which radiopharmaceutical is used primarily for assessing effective renal plasma flow (ERPF)?

<p>99mTc-Mertiatide (MAG3) (C)</p> Signup and view all the answers

What should be the positioning of the patient during renal perfusion imaging?

<p>Supine with kidneys centered over the detector (A)</p> Signup and view all the answers

What indicates poor renal function when assessing laboratory values?

<p>High blood urea nitrogen and creatinine levels (C)</p> Signup and view all the answers

Flashcards

What is the liver?

The largest solid organ in the body, located on the right side under the ribs and beneath the diaphragm.

What are Kupffer cells?

Specialized cells in the liver responsible for engulfing and breaking down particles like bacteria.

Where are Kupffer cells found?

They are found primarily in the liver, but are also present in smaller amounts in the spleen, bone marrow, and lymphatic system.

What is Liver/Spleen Imaging?

Imaging the liver and spleen, commonly used to assess size, shape, and detect abnormalities like tumors and cysts.

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What radiopharmaceutical is used in liver/spleen imaging?

Technetium-99m sulfur colloid is used as the radiopharmaceutical, which is taken up by Kupffer cells.

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What is the purpose of a flow study in Liver/Spleen Imaging?

To demonstrate the blood flow within the liver and spleen, allowing identification of blood vessel problems.

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How long does static imaging take in Liver/Spleen Imaging?

Static imaging begins after 10-15 minutes to allow the radiopharmaceutical to distribute throughout the liver and spleen.

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What are the standard views in Liver/Spleen Imaging?

Standard views include anterior, posterior, lateral, and oblique projections, allowing for a comprehensive view of the liver and spleen.

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Drug Restriction Before Hepatobiliary Imaging

Medications that loosen the sphincter of Oddi should be stopped before hepatobiliary imaging.

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Opiates and Gallbladder Filling

Opiates like morphine can increase sphincter muscle tone, leading to a full gallbladder.

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Fasting Before Hepatobiliary Imaging

Patients should fast for 2-4 hours before receiving the tracer for hepatobiliary imaging.

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Reason for Fasting Before Imaging

The purpose of fasting before hepatobiliary imaging is to prevent the gallbladder from emptying the tracer before the scan.

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Sincalide Usage

Sincalide (Kinevac) is a medication used to empty the gallbladder before hepatobiliary imaging.

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Sincalide Administration

Sincalide is given intravenously over 3-5 minutes, 30-60 minutes before the tracer injection.

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Sincalide Indication

Sincalide is used in patients who have fasted for a long time or are receiving hyperalimentation.

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Sincalide and Morphine Interaction

Sincalide should not be used after morphine sulfate administration because it can affect the results of the imaging.

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What is SPECT Imaging?

SPECT imaging uses a radioactive tracer to create 3D images of the liver and spleen, helping to identify abnormalities and distinguish them from artifacts.

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How does Tc99m-sulfur colloid distribute in the body?

Tc99m-sulfur colloid is injected into the bloodstream and mainly accumulates in the liver (85%), followed by the spleen (10%).

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What is an artifact in SPECT imaging?

An artifact is a distortion in an image that is not a real abnormality.

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What are some common sources of artifacts in SPECT imaging?

Things like barium in the gut, breast tissue, or even skin folds can create distortions in the SPECT images.

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What can cause the liver to be displaced in SPECT images?

Emphysema, abscesses, or an enlarged left hepatic lobe can push the liver out of its usual position.

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How do tumors, cysts, and abscesses appear in SPECT images?

Tumors, cysts, and abscesses show up as areas where the tracer uptake is low or absent.

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What does diffuse liver disease look like in SPECT images?

Diffuse liver disease causes uneven distribution of the tracer throughout the liver. Severe cases may show more tracer in the spleen and bone marrow.

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What are some technical considerations for SPECT imaging?

Performing imaging too soon after injection may show blood pool activity in the images, while residual barium from previous imaging can create artifacts.

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Gastric Emptying Halftime

The time it takes for half of the food to empty from the stomach.

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Standard Gastric Emptying Meal

A specialized meal used during a gastric emptying study, consisting of 118 mL liquid egg whites, 2 slices of toasted white bread, 30 g of jam or jelly, and 120 mL of water.

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Gastric Emptying Study

The use of a scintillation camera to monitor the movement of a radioactive tracer through the digestive system, allowing doctors to assess how quickly food is emptying from the stomach.

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Static Images

Images acquired at 15-minute intervals throughout a gastric emptying study to measure how much food remains in the stomach at different times, allowing calculations of the emptying time.

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Subsequent Images

Images acquired at hourly intervals for up to 4 hours in a gastric emptying study, providing information about the rate of food movement

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Diabetic Patient Preparation

The process of monitoring blood glucose levels and potentially adjusting insulin doses before and during a gastric emptying study, particularly for diabetic patients.

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Gastric Emptying Study

A study to measure how quickly food empties from the stomach in order to diagnosis problems like slow emptying, commonly called Gastroparesis.

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Prokinetic Agents

A group of drugs that help speed up the movement of food through the digestive system, often used to treat slow emptying.

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Renal Tubular Binding Scan

A nuclear medicine test that visualizes the kidneys and urinary tract, especially helpful in assessing function and detecting abnormalities like reflux.

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Captopril Renography

This test uses a radiopharmaceutical to assess kidney function and blood flow, particularly helpful in evaluating kidney transplant function.

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ERPF Scan

A test that measures the effective renal plasma flow (ERPF) offering insight into kidney function and filtration.

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GFR Scan

This nuclear medicine test evaluates the glomerular filtration rate (GFR), a key indicator of kidney function.

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Testicular Imaging

Nuclear medicine study used to differentiate acute torsion of the spermatic cord from epididymitis.

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Indirect Cystography

A type of nuclear medicine study that uses a radiopharmaceutical to visualize the bladder and urinary tract during urination.

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Direct Cystography

A nuclear medicine study that uses a catheter to directly visualize the bladder and urinary tract as it fills and empties.

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Ureteral Reflux

A condition where urine flows back up the ureters, potentially causing kidney damage.

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Blood Drainage from Kidneys

The kidneys drain blood into the inferior vena cava through the renal veins.

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What are Nephrons?

Microscopic units within the kidneys responsible for filtering waste and excess fluid from the blood.

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What is Functional Renal Imaging used for?

A type of imaging that assesses the amount of blood flow and renal function.

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What is 99mTc-Pentetate (DTPA)?

A radiopharmaceutical used to assess glomerular filtration and blood flow to each kidney. Filtered by the kidneys without much binding.

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What is 99mTc-Mertiatide (MAG3)?

This radiopharmaceutical is excreted by the kidneys through tubular secretion and used to assess effective renal plasma flow (ERPF).

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What is 99mTc-Succimer (DMSA)?

This radiopharmaceutical binds to tubules in the renal cortex and is useful for imaging space-occupying lesions or gross renal anatomy due to its long retention.

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What is the procedure for Renal Perfusion Imaging?

A posterior projection image of the kidneys is obtained with the patient lying on their back. 10-15 mCi of radiotracer is injected intravenously and sequential images are taken every 2 seconds for 30-60 seconds.

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What do elevated levels of blood urea nitrogen and creatinine indicate?

Elevated blood urea nitrogen and creatinine levels may indicate poor renal function.

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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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Liver and Spleen Imaging PDF

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.

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