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Nuclear Medicine: A Case-Based Approach
Munir Ghesani, Nasrin Ghesani, E Gordon DePuey, Amir Kashefi, Yi Chen Zhang
SECTION 1: GENERAL NUCLEAR MEDICINE
CASE 1: ASSESSMENT OF OSSEOUS METASTATIC DISEASE IN THYROID CANCER
Brief History
Findings
Main Teaching Points
CASE 2: EVALUATION OF HYDRONEPHROSIS
Brief History
Findings
Main Teaching Points
CASE 3: ASSESSMENT OF GASTROINTESTINAL (GI) BLEEDING SITE
Brief History
Findings
Main Teaching Points
CASE 4: ASSESSMENT OF POSTRENAL TRANSPLANT COMPLICATIONS
Brief History
Findings
Main Teaching Points
CASE 5: ASSESSMENT OF BILATERAL BREAST UPTAKE IN GALLIUM SCAN
Brief History
Findings
Main Teaching Points
CASE 6: ASSESSMENT OF NEUROENDOCRINE MALIGNANCIES
Brief History
Findings
Main Teaching Points
CASE 7: ASSESSMENT OF LIVER AND SPLEEN USING TC-99M SULFUR COLLOID
Brief History
Findings
Main Teaching Points
CASE 8: ASSESSMENT OF PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY COMPLICATIONS
Brief History
Findings
Main Teaching Points
CASE 9: ASSESSMENT OF TRAUMATIC BILIARY INJURY
Brief History
Findings
Main Teaching Point
CASE 10: ASSESSMENT OF PERIPROSTHETIC INFECTION
Brief History
Findings
Main Teaching Points
CASE 11: ASSESSMENT OF HYPERTHYROIDISM
Brief History
Findings
Main Teaching Point
CASE 12: ASSESSMENT OF NEW HEARING LOSS
Brief History
Findings
Main Teaching Point
CASE 13: ASSESSMENT OF OSSEOUS METASTASIS
Brief History
Findings
Main Teaching Point
CASE 14: ASSESSMENT OF PAROTID GLAND SWELLING
Brief History
Findings
Main Teaching Point
CASE 15: ASSESSMENT OF HEPATOPULMONARY SYNDROME
Brief History
Findings
Main Teaching Point
CASE 16: ASSESSMENT OF OSSEOUS METASTATIC DISEASE
Brief History
Findings
Main Teaching Points
CASE 17: ASSESSMENT OF OSTEOMYELITIS
Brief History
Findings
Main Teaching Points
CASE 18: ASSESSMENT OF SUSPECTED ACUTE PYELONEPHRITIS
Brief History
Findings
Main Teaching Point
CASE 19: ASSESSMENT OF RISING TG LEVELS STATUS POSTRADIOIODINE ABLATION
Brief History
Findings
Main Teaching Point
CASE 20: EVALUATION OF GASTROINTESTINAL HEMORRHAGE
Brief History
Findings
Main Teaching Point
CASE 21: ASSESSMENT OF METABOLIC BONE DISEASE
Brief History
Findings
Main Teaching Points
CASE 22: ASSESSMENT OF CHRONIC HYDRONEPHROSIS
Brief History
Findings
Main Teaching Point
CASE 23: ASSESSMENT FOR SUSPECTED DELAYED GASTRIC EMPTYING
Brief History
Findings
Main Teaching Point
CASE 24: ASSESSMENT OF LOW BACK PAIN IN A YOUNG PATIENT
Brief History
Findings
Main Teaching Points
CASE 25: EVALUATION OF ABDOMINAL PAIN FOLLOWING RENAL TRANSPLANTATION
Brief History
Findings
Main Teaching Points
CASE 26: ASSESSMENT OF RIGHT UPPER QUADRANT PAIN
Brief History
Findings
Main Teaching Points
CASE 27: ASSESSMENT OF RENAL ECTOPIA AND ASSOCIATED COMPLICATIONS
Brief History
Findings
Main Teaching Point
CASE 28: ASSESSMENT OF SHORTNESS OF BREATH
Brief History
Findings
Main Teaching Points
CASE 29: ASSESSMENT OF DIFFUSE SKELETAL METASTASES
Brief History
Findings
Main Teaching Points
CASE 30: ASSESSMENT OF UNCONTROLLED HYPERTENSION
Brief History
Findings
Main Teaching Point
CASE 31: EVALUATION OF BRAIN DEATH
Brief History
Findings
Main Teaching Points
CASE 32: ASSESSMENT OF DELAYED VISUALIZATION OF GALLBLADDER
Brief History
Findings
Main Teaching Points
CASE 33: ASSESSMENT OF CHRONIC URINARY OBSTRUCTION
Brief History
Findings
Main Teaching Point
CASE 34: ASSESSMENT OF DIFFUSE RENAL UPTAKE ON BONE SCAN
Brief History
Findings
Main Teaching Points
CASE 35: ASSESSMENT OF HYPERCALCEMIA AND HYPERPARATHYROIDISM
Brief History
Findings
Main Teaching Points
CASE 36: ASSESSMENT OF BACK PAIN
Brief History
Findings
Main Teaching Points
CASE 37: ASSESSMENT OF HYPERPARATHYROIDISM
Brief History
Findings
Main Teaching Points
CASE 38: ASSESSMENT OF INTRACRANIAL MASS LESION IN THE SETTING OF HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Brief History
Findings
Main Teaching Points
CASE 39: ASSESSMENT OF HIP PAIN
Brief History
Findings
Main Teaching Point
CASE 40: ASSESSMENT FOR METASTATIC NEUROENDOCRINE NEOPLASM
Brief History
Findings
Main Teaching Points
CASE 41: ASSESSMENT OF VENTRICULOPERITONEAL (VP) SHUNT PATENCY
Brief History
Findings
Main Teaching Points
CASE 42: EVALUATION OF SOLITARY COLD THYROID NODULE
Brief History
Findings
Main Teaching Points
CASE 43: ASSESSMENT OF SSTR POSITIVE TUMORS
Brief History
Findings
Main Teaching Points
CASE 44: ASSESSMENT OF BILIARY OBSTRUCTION IN NEONATES
Brief History
Findings
Main Teaching Points
CASE 45: ASSESSMENT OF LYTIC BONY LESIONS
Brief History
Findings
Main Teaching Point
CASE 46: ASSESSMENT OF THYROIDITIS
Brief History
Findings
Main Teaching Point
CASE 47: ASSESSMENT OF INFECTION/INFLAMMATION WITH WBC SCAN
Brief History
Findings
Main Teaching Points
CASE 48A: EVALUATION OF OSTEOMYELITIS
Brief History
Findings
Main Teaching Point
CASE 48B: EVALUATION OF OSTEOMYELITIS
Brief History
Findings
Main Teaching Point
CASE 49: ASSESSMENT OF THYROID CANCER METASTASES
Brief History
Findings
Main Teaching Points
CASE 50: EVALUATION OF HYPERTHYROIDISM
Brief History
Findings
Main Teaching Point
CASE 51: EVALUATION OF RENAL ANOMALIES
Brief History
Findings
Main Teaching Points
CASE 52: EVALUATION OF RENAL UPTAKE ON GALLIUM SCAN
Brief History
Findings
Main Teaching Points
CASE 53: ASSESSMENT OF CARDIAC EJECTION FRACTION
Brief History
Findings
Main Teaching Point
CASE 54: EVALUATION OF LIVER METASTASES
Brief History
Findings
Main Teaching Points
CASE 55: ASSESSMENT OF MULTIGATED EQUILIBRIUM ANGIOCARDIOGRAPHY (MUGA) SCAN ARTIFACTS
Brief History
Findings
Main Teaching Point
SECTION 2: NUCLEAR CARDIOLOGY
CASE 56: NORMAL FEMALE
CASE 57: NORMAL MALE; NONVISUALIZATION OF GALLBLADDER (GB) DUE TO PRIOR CHOLECYSTECTOMY
CASE 58: INADEQUATE RESTING TETROFOSMIN TAG
CASE 59: SHORT SEPTUM
CASE 60: PROMINENT ANTEROSEPTAL RIGHT VENTRICLE INSERTION SITE
CASE 61: APICAL PHYSIOLOGIC THINNING
CASE 62: MARKED ANTERIOR BREAST ATTENUATION ARTIFACT
CASE 63: INFEROLATERAL BREAST ARTIFACT
CASE 64: MODERATE DIAPHRAGMATIC ATTENUATION
CASE 65: SUBDIAPHRAGMATIC SCATTER
CASE 66: SEVERE INFEROLATERAL SCAR; LEFT VENTRICULAR EJECTION FRACTION (LVEF) = 32%
CASE 67: SCAR BASAL HALF INFERIOR WALL
CASE 68: INFEROAPICAL SCAR; LVEF = 50%
CASE 69: LAD ISCHEMIA
CASE 70: MARKED INFEROAPICAL ISCHEMIA
CASE 71: INCREASED SEPTAL UPTAKE DUE TO LEFT VENTRICULAR HYPERTROPHY (LVH) (S/P AVR)
CASE 72: HYPERTROPHIC CARDIOMYOPATHY
CASE 73: REST/DELAYED THALLIUM; INFERIOR RESTING ISCHEMIA
CASE 74: REST/DELAYED THALLIUM; SCAR WITHOUT ISCHEMIA
CASE 75: MUGA, DECLINE IN LVEF POSTCHEMOTHERAPY
CASE 76: ANTERIOR, APICAL, AND INFERIOR SCAR
CASE 77: D1 AND LCX ISCHEMIA
CASE 78: APICAL AND INFEROLATERAL ISCHEMIA; MULTIVESSEL DISEASE
CASE 79: LAD AND RCA ISCHEMIA; TRANSIENT ISCHEMIC DILATATION (TID)
CASE 80: ANTERIOR AND INFEROLATERAL ISCHEMIA; TID, CONSISTENT WITH MULTIVESSEL DISEASE
CASE 81: APICAL ISCHEMIA AND BASAL INFERIOR ISCHEMIA
CASE 82: EXTENSIVE LATERAL SCAR WITH MODERATE PERI-INFARCT ISCHEMIA AT ANTEROLATERAL BORDER; MILD TID
CASE 83: ANTERIOR ISCHEMIA; LATERAL SCAR + ISCHEMIA
CASE 84: ANTERIOR ISCHEMIA WITH MARKED POST-STRESS STUNNING
CASE 85: LEFT VENTRICULAR ANEURYSM WITH SLIGHT PERI-INFARCT ISCHEMIA
CASE 86: PULMONARY HYPERTENSION WITH RIGHT VENTRICULAR (RV) HYPERTROPHY AND HYPOKINESIS (REST ONLY)
CASE 87: PERMANENT PACEMAKER WITH APICAL FIXED DEFECT AND DYSKINESIS
CASE 88: APICAL HYPERTROPHY
CASE 89: STATUS POST LEFT MASTECTOMY; NORMAL FEMALE
CASE 90: SHIFTING BREAST ATTENUATION ARTIFACT; ENTIRE SCAN REPEATED
CASE 91: LEFT BREAST CANCER; ANTERIOR AND LATERAL ISCHEMIA WITH MODERATE TID
CASE 92: ABSENT GALLBLADDER STATUS POST CHOLECYSTECTOMY; SPLENOMEGALY (CLL); MILD ISCHEMIA BASAL HALF OF THE ANTERIOR WALL (NO FUNCTIONAL IMAGES)
CASE 93: UPPER MEDIASTINAL NEOPLASM; NORMAL MYOCARDIAL PERFUSION
CASE 94: GRANULOMATOUS LUNG DISEASE (REST ONLY); NORMAL MYOCARDIAL PERFUSION
CASE 95: HIATAL HERNIA; NORMAL MYOCARDIAL PERFUSION
CASE 96: INFEROLATERAL BREAST ATTENUATION ARTIFACT; DIFFUSE NONISCHEMIC CARDIOMYOPATHY
CASE 97: D-SHAPED LEFT VENTRICLE; DILATED, HYPOKINETIC RIGHT VENTRICLE; PULMONARY HYPERTENSION DOCUMENTED BY ECHOCARDIOGRAPHY
CASE 98: MILD REVERSIBLE APICAL DEFECT WITH MODERATE TID (1.25); CATHETERIZATION DEMONSTRATED MULTIVESSEL DISEASE CONSISTENT WITH “BALANCED ISCHEMIA”
CASE 99: MULTIPLE AXILLARY NODES FROM BREAST CANCER; NORMAL PERFUSION SCAN
CASE 100: PERICARDIAL EFFUSION WITH SEPTAL AKINESIS; MULTIVESSEL ISCHEMIA
CASE 101: REVERSE TID DUE TO HIGH POST-STRESS HEART RATE
CASE 102: NON-INJECTED STRESS DOSE
CASE 103: NORMAL SCAN, GOITER
CASE 104: THREE-VESSEL ISCHEMIA
CASE 105: SEVERE ANTERIOR AND SEPTAL SCAR, INCREASED L/H RATIO, LEFT PLEURAL EFFUSION
CASE 106: HERNIATED BOWEL; NORMAL MYOCARDIAL PERFUSION
SECTION 3: PET/CT
CASE 107: DETECTION OF DISTANT METASTASES IN ESOPHAGEAL CANCER WITH RADIOGRAPHICALLY OPERABLE DISEASE
Brief History
Findings
Main Teaching Point
CASE 108: ASSESSMENT OF RECURRENCE OF PULMONARY MALIGNANCY
Brief History
Findings
Main Teaching Points
CASE 109: INCIDENTAL CANCER WHILE STAGING NEW PULMONARY MALIGNANCY
Brief History
Findings
Main Teaching Point
CASE 110: MONITORING RESPONSE TO LUNG CANCER THERAPY
Brief History
Findings
Main Teaching Points
CASE 111: CHARACTERIZATION OF A SUSPICIOUS PULMONARY NODULE
Brief History
Findings
Main Teaching Points
CASE 112: INITIAL STAGING OF PATHOLOGICALLY PROVEN PULMONARY MALIGNANCY
Brief History
Findings
Main Teaching Points
CASE 113: BREAST CANCER EVALUATION AND RESPONSE TO THERAPY
Brief History
Findings
Main Teaching Points
CASE 114: INCIDENTAL LUNG CANCER WHILE STAGING ANOTHER MALIGNANCY
Brief History
Findings
Main Teaching Points
CASE 115: INITIAL STAGING OF BREAST CANCER
Brief History
Findings
Main Teaching Points
CASE 116: RESTAGING OF ESOPHAGEAL CANCER AFTER CHEMORADIATION THERAPY
Brief History
Findings
Main Teaching Points
CASE 117: POTENTIALLY RESECTABLE ESOPHAGEAL CANCER WITH NO DISTANT METASTASES
Brief History
Findings
Main Teaching Points
CASE 118: RESOLVING EQUIVOCAL BREAST FINDINGS ON ANATOMICAL IMAGING
Brief History
Findings
Main Teaching Points
CASE 119: BENIGN ETIOLOGY WITH SIMILAR APPEARANCE TO CANCER
Brief History
Findings
Main Teaching Points
CASE 120: INCIDENTAL BREAST CANCER DURING SURVEILLANCE OF OTHER MALIGNANCIES
Brief History
Findings
Main Teaching Points
CASE 121: DISCRIMINATION OF POST-RADIOTHERAPY ESOPHAGEAL TUMOR MASS
Brief History
Findings
Main Teaching Points
CASE 122: COMPLEMENTARY ROLE OF BONE SCAN AND POSITRON EMISSION TOMOGRAPHY/ COMPUTED TOMOGRAPHY (PET/CT) FINDINGS IN BREAST CANCER
Brief History
Findings
Main Teaching Points
CASE 123: PHYSIOLOGIC OVARIAN ACTIVITY
Brief History
Findings
Main Teaching Points
CASE 124: INITIAL STAGING OF LYMPHOMA
Brief History
Findings
Main Teaching Points
CASE 125: EVALUATION OF RESPONSE TO LYMPHOMA THERAPY
Brief History
Findings
Main Teaching Points
CASE 126: LYMPHOMA WITH SPLENIC INVOLVEMENT
Brief History
Findings
Main Teaching Points
CASE 127: THYMIC REBOUND
Brief History
Findings
Main Teaching Points
CASE 128: LYMPHOMATOUS INVOLVEMENT OF BONE MARROW
Brief History
Findings
Main Teaching Points
CASE 129: MUSCULAR INVOLVEMENT OF LYMPHOMA
Brief History
Findings
Main Teaching Points
CASE 130: PROGNOSTIC VALUE OF 18F FLUORODEOXYGLUCOSE (FDG) POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT) AFTER A SINGLE CYCLE OF CHEMOTHERAPY
Brief History
Findings
Main Teaching Points
CASE 131: RECURRENT MALIGNANT MELANOMA
Brief History
Findings
Main Teaching Points
CASE 132: ADRENAL METASTASIS
Brief History
Findings
Main Teaching Points
CASE 133: PLEOMORPHIC SARCOMA
Brief History
Findings
Main Teaching Points
CASE 134: BENIGN MUSCLE ACTIVITY
Brief History
Findings
Main Teaching Points
CASE 135: SENTINEL LYMPH NODE IDENTIFICATION FROM DOSE EXTRAVASATION
Brief History
Finding
Main Teaching Points
CASE 136: COLORECTAL CANCER FOUND DURING STAGING OF ANOTHER PRIMARY SITE
Brief History
Findings
Main Teaching Points
CASE 137: LOCAL RECURRENCE AT ANASTOMOTIC SITE
Brief History
Findings
Main Teaching Points
CASE 138: COLON CANCER POSTSURGICAL CHANGES AT ANASTOMOTIC SITE
Brief History
Findings
Main Teaching Points
CASE 139: PERITONEAL CARCINO-MATOSIS
Brief History
Findings
Main Teaching Points
CASE 140: RESPONSE TO THERAPY
Brief History
Findings
Main Teaching Points
CASE 141: POSITIVE RELAPSE WITH NEGATIVE CEA
Brief History
Findings
Main Teaching Points
CASE 142: NEGATIVE FINDING WITH POSITIVE CEA
Brief History
Findings
Main Teaching Points
CASE 143: COLORECTAL WITH HEPATIC METASTASIS
Brief History
Findings
Main Teaching Points
CASE 144: CERVICAL CANCER WITH METASTASIS
Brief History
Findings
Main Teaching Points
CASE 145: CERVICAL CANCER WITH RESPONSE TO THERAPY
Brief History
Findings
Main Teaching Points
CASE 146: OVARIAN CANCER SPREAD
Brief History
Findings
Main Teaching Points
CASE 147: OVARIAN CANCER WITH POOR RESPONSE TO THERAPY
Brief History
Findings
Main Teaching Points1
CASE 148: MENSES
Brief History
Findings
Main Teaching Points1
CASE 149: ENDOMETRIAL CARCINOMA WITH RESPONSE TO TREATMENT
Brief History
Findings
Main Teaching Points
CASE 150: ENDOMETRIAL CANCER—INITIAL EVALUATION
Brief History
Findings
Main Teaching Points
CASE 151: UTERINE LEIOMYOMA
Brief History
Findings
Main Teaching Points
CASE 152: LARGE UTERINE LEIOMYOMA
Brief History
Findings
Main Teaching Points
CASE 153: OCULAR MELANOMA
Brief History
Findings
Main Teaching Point
CASE 154: MELANOMA WITH DISTANT METASTASES
Brief History
Findings
Main Teaching Points
CASE 155: PET/CT OF EPILEPSY
Brief History
Findings
Main Teaching Points
CASE 156: FDG PET OF TEMPORAL LOBE EPILEPSY
Brief History
Findings
Main Teaching Points
CASE 157: FDG PET OF ALZHEIMER’S DISEASE
Brief History
Findings
Main Teaching Points
CASE 158: PET FDG OF FRONTAL TEMPORAL DEMENTIA
Brief History
Findings
Main Teaching Points
CASE 159: PET FDG OF LEWY BODY DEMENTIA
Brief History
Findings
Main Teaching Points
CASE 160: 18F-AV45 PET
Brief History
Findings
Main Teaching Points
CASE 161: FDG PET WITH MILD COGNITIVE IMPAIRMENT
Brief History
Findings
Main Teaching Points
CASE 162: FDG PET/CT AND GLIOBLASTOMA MULTIFORMES
Brief History
Findings
Main Teaching Points
CASE 163: FDG PET OF BRAIN METASTASIS
Brief History
Findings
Main Teaching Points
CASE 164: FDG PET FALSE NEGATIVE FOR GLIOBLASTOMA
Brief History
Findings
Main Teaching Point
CASE 165: FDG PET/CT WITH BROWN FAT ACTIVITY VERSUS TUMOR
Brief History
Findings
Main Teaching Points
CASE 166A: ASSESSMENT OF NEUROENDOCRINE TUMORS (NETS)
Brief History
Findings
Main Teaching Points
CASE 166B: ASSESSMENT OF NEUROENDOCRINE TUMORS (NETS)
Brief History
Findings
Main Teaching Points
CASE 167: ASSESSMENT OF PROSTATE CANCER
Brief History
Findings
Main Teaching Points
CASE 168: ASSESSMENT OF BREAST CANCER
Brief History
Findings
Main Teaching Points
CASE 169: ASSESSMENT OF RECTAL ADENOCARCINOMA RESPONSE TO THERAPY
Brief History
Findings
Main Teaching Point
CASE 170: STAGING OF RECTAL ADENOCARCINOMA
Brief History
Findings
Main Teaching Point
CASE 171: ASSESSMENT OF ALZHEIMER’S DISEASE
Brief History
Findings
Main Teaching Points
CASE 172: ASSESSMENT OF BONE METASTASIS
Brief History
Findings
Main Teaching Point
CASE 173: ASSESSMENT OF BIOLOGIC THERAPY RESPONSE IN RHEUMATOID ARTHRITIS
Brief History
Findings
Main Teaching Point
CASE 174: ASSESSMENT OF EARLY RESPONSE TO NEOADJUVANT CHEMOTHERAPY (NAC) IN BREAST CANCER
Brief History
Findings
Main Teaching Points
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