SPECT CT in the Evaluation of Musculoskeletal Disease
|
|
|
- Neil Hawkins
- 5 years ago
- Views:
Transcription
1 SPECT CT in the Evaluation of Musculoskeletal Disease Dr. Kevin Banks Department of Radiology San Antonio Military Medical Center and Health Education Consortium Assistant Professor of Radiology and Nuclear Medicine Uniformed Services University of the Health Sciences
2 I HAVE NO DISCLOSURES
3 LEARNING OBJECTIVES œ Review principles and applications of SPECT-CT in musculoskeletal radiology Diagnosis of malignant disease in axial skeleton Imaging of musculoskeletal infections Applications in benign MSK disorders
4 BACKGROUND œ œ œ œ œ œ COREGISTRATION OF FUNCTIONAL AND ANATOMIC IMAGING (PET & SPECT with CT) Introduced in 1980s Significantly impacted by motion artifacts and differences in patient positioning Potential paucity of functional landmarks to serve as reference points Improved with development of automated software using elastic transformations and/or non-linear warping Coregistration accuracy ~5-7 mm Forster GJ, et al. SPECT/CT image co-registration in the abdomen with a simple and cost-effective tool. Eur J Nucl Med Mol Imaging 2003;30:32-39.
5 SPECT/CT œ œ œ INTEGRATED SPECT/CT SYSTEM œ œ Originally only low-dose x-ray tube CT provided attenuation map Less noise Faster acquisition œ No decaying transmission source(s) Interpretable anatomical images Patient convenience Easier access to both sets of images Co-registration accuracy ~3mm
6 MALIGNANT BONE DISEASE œ œ œ œ œ œ œ œ Spine and pelvis most frequent sites of metastases Detection and assessment complicated by frequency of co-existing benign pathology Degenerative disk/facet disease Compression fracture(s) Accuracy SPECT >> Planar BS in vertebral column General rule Vertebral body or pedicle = metastasis Periphery of vertebra or facet = degenerative change(s)
7 CONFIDENCE OF DIAGNOSING BENIGN VS MALIGNANT BONE DISEASE BY MODALITY BENIGN PROBABLY BENIGN PROBABLY MALIGNANT MALIGNANT PLANAR SPECT SPECT/CT % 92% PLANAR SPECT SPECT/CT Heylar V. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma lf the prostate. EJNMMI 2010.
8 DEGENERATIVE OSTEOPHYTES FACET ARTHRITIS Bhargava P, et al. Pictorial review of SPECT/CT imaging applications in clinical nuclear medicine. Am J Nucl Med Mol Imaging 2012
9 OCCULT BONY METASTASES Bhargava P, et al. Pictorial review of SPECT/CT imaging applications in clinical nuclear medicine. Am J Nucl Med Mol Imaging 2012
10 UNSUSPECTED LIVER METASTASIS Bhargava P, et al. Pictorial review of SPECT/CT imaging applications in clinical nuclear medicine. Am J Nucl Med Mol Imaging 2012
11 CONFIDENCE OF DIAGNOSING BENIGN VS MALIGNANT BONE DISEASE BY MODALITY BENIGN PROBABLY BENIGN PROBABLY MALIGNANT MALIGNANT PLANAR SPECT SPECT/CT x4 24 x2 72% 92% PLANAR SPECT SPECT/CT Heylar V. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma lf the prostate. EJNMMI 2010.
12 AGREEEMENT OF DIAGNOSING BENIGN VS MALIGNANT BONE DISEASE BY MODALITY 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 87% 56% 43% PLANAR 1 SPECT 2 SPECT/CT 3 DISAGREE AGREE Series2 Series1 Heylar V. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma lf the prostate. EJNMMI 2010.
13 SPECT/CT vs SPECT + CT vs SPECT ASSESSMENT OF SUSPECTED BONE METASTASIS 45 oncologic patients (42 men, 21 women, 64.7 yrs +/- 8.7) 42 metastatic foci, 40 benign foci (confirmed by MRI and/or long-term follow-up) Graded = definitely benign 2 = probably benign 3 = indeterminate 4 = probably mets 5 = definitely mets METASTASES N (%) BENIGN N (%) Vertebral Body 9 (21%) 14 (35%) Pedicle 8 (19%) 3 (8%) Body + Pedicle 8 (19%) 2 (5%) Facet Joint 3 (7%) 10 (25%) Rib 7 (17%) 6 (15%) Pelvis 3 (7%) 2 (5%) Femur 4 (10%) 3 (8%) Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
14 70 YO WITH PANCREATIC CANCER POSTERIOR PLANAR BONE SCINTIGRAPHY Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
15 AXIAL SPECT SPECT 2 = PROBABLY BENIGN SPECT + CT 1 = DEFINITELY BENIGN SPECT/CT 1 = DEFINITELY BENIGN Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
16 66 YO WITH OSTEOSARCOMA OF SCAPULA POSTERIOR PLANAR BONE SCINTIGRAPHY Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
17 AXIAL SPECT SPECT 2 = PROBABLY BENIGN SPECT + CT 5 = DEFINITELY MET SPECT/CT 5 = DEFINITELY MET Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
18 63 YO WITH PROSTATE CANCER ANTERIOR PLANAR BONE SCINTIGRAPHY Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
19 CORONAL SPECT SPECT 3 = INDETERMINATE SPECT + CT 2 = PROBABLY BENIGN SPECT/CT 1 = DEFINITELY BENIGN Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
20 66 YO WITH LUNG CANCER SPECT 3 = INDETERMINATE SPECT/CT 5 = DEFINITELY MET Kulakiene I, Jurkiene N. SPECT-CT of the skeleton. Lithuanian University of Health Sciences.
21 SPECT-CT vs SPECT + CT vs SPECT 0.8 TRUE POSITIVE FRACTION Fused SPECT-CT AUC Side-by-side SPECT + CT AUC SPECT AUC FALSE POSITIVE FRACTION Utsunomiya D, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
22 SPECT-CT vs SPECT + CT vs SPECT 0.8 FALSE POSITIVE FRACTION Fused SPECT-CT AUC Side-by-side SPECT + CT AUC SPECT AUC INCREASED DIAGNOSTIC CONFIDENCE WITH FUSED SPECT-CT COMPARED TO SPECT WITH OR WITHOUT CT CORRELATION FALSE POSITIVE FRACTION Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006
23 ? BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR
24 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 1/8
25 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 2/8
26 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 3/8
27 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 4/8
28 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 5/8
29 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 6/8
30 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 7/8
31 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR? 8/8
32 BONE SCAN FOR INDETERMINATE LEFT KNEE LESION SEEN ON XR SPECT INDETERMINATE? AXIAL SPECT AT LEVEL OF LESSER TROCHANTER
33 ? SPECT/CT = BENIGN - Liposclerosing Mxyoid Fibrous Tumor - Cystic Fibrous Dysplasia - Intraosseous Lipoma Degen Changes
34 BONE SCAN FOR PROSTATE CANCER AND RISING PSA? SPECT INDETERMINATE AXIAL SPECT AT LEVEL OF L2
35 SPECT/CT = METASTASIS - Atypical Lytic Prostate met? AXIAL CT AT LEVEL OF L2
36 ACCURATELY DIAGNOSING BENIGN VS MALIGNANT BONE DISEASE WHY IT REALLY MATTERS BENIGN PROBABLY BENIGN PROBABLY MALIGNANT MALIGNANT PLANAR SPECT SPECT/CT PROSTATE CANCER SURVIVABILITY M0 vs M1 DISEASE 5-YEARS: M0 = 100% vs M1 28% 10-YEARS: M0 >>50% vs M1 = 7% American Cancer Society Heylar V. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma lf the prostate. EJNMMI 2010.
37 OSSEOUS INFECTION œ œ œ œ œ Accurate diagnosis remains a diagnostic challenge œ œ œ Often confounded by non-infectious pathology Diabetic foot Orthopedic hardware Underlying fracture MRI remains imaging modality of choice œ Can be hindered by non-specific marrow signal changes Radionuclide imaging limited by non-specific uptake œ Improved somewhat with use of SPECT CT useful for morphologic changes œ œ œ Cortical destruction Sequestration Involucra Goal of SPECT/CT IMPROVE SPECIFICITY & PPV
38 CONFIDENCE OF DIAGNOSING OSTEOMYELITIS (OM) WITH BONE SCINTIGRAPHY BY MODALITY ASSESSMENT OF SUSPECTED OSTEOMYELITIS 3-phase Bone Scan using Tc-99m DPD Low dose SPECT/CT 31 patients (15 men, 16 women, mean age 51 yrs) Lesion locations Extremities n=13 Spine n=7 Skull n=7 Pelvis n=5 Dx confirmed by: Surgery/biopsy (n=15) Follow-up 9+ months Clinical +/- radiology +/- lab Horger, et al. Added value of SPECT/CT in patients suspected of having bone infection. Arch Orthop Trauma Surg. 2007:127:
39 CONFIDENCE OF DIAGNOSING OSTEOMYELITIS (OM) WITH BONE SCINTIGRAPHY BY MODALITY INTERPRETATION DIAGNOSIS Planar + SPECT OM Equivocal No OM Total + OM 7 (78%) 0 2 (22%) 9 - OM 6 (28%) 5 (22%) 11 (50%) 22 Total SPECT/CT OM Equivocal No OM Total + OM 7 (78%) 0 2 (22%) 9 - OM 2 (9%) 1 (4%) 19 (87%) 22 Total Horger, et al. Added value of SPECT/CT in patients suspected of having bone infection. Arch Orthop Trauma Surg. 2007:127:
40 CONFIDENCE OF DIAGNOSING OSTEOMYELITIS (OM) WITH BONE SCINTIGRAPHY BY MODALITY Planar + SPECT OM Equivocal No OM Total + OM 7 (78%) 0 2 (22%) 9 - OM 6 (28%) 5 (22%) 11 (50%) 22 Total TP + TN FP + FN EQ SPECT/CT OM Equivocal No OM Total + OM 7 (78%) 0 2 (22%) 9 - OM 2 (9%) 1 (4%) 19 (87%) 22 Total TP + TN Horger, et al. Added value of SPECT/CT in patients suspected of having bone infection. Arch Orthop Trauma Surg. 2007:127:
41 39 YO MAN WITH PERSISTENT LEFT SIDED LOW BACK PAIN. FACET JOINT STEROID INJECTION 3 WEEKS PRIOR. POSTERIOR BLOOD POOL EQUIVOCAL Horger, et al. Added value of SPECT/CT in patients suspected of having bone infection. Arch Orthop Trauma Surg. 2007:127:
42 39 YO MAN WITH PERSISTENT LEFT SIDED LOW BACK PAIN. FACET JOINT STEROID INJECTION 3 WEEKS PRIOR. LOW DOSE CT DEMONSTRATED: - NO DEGENERATIVE DZ - JOINT CAPSULE FULLNESS - PERI-FACET SOFT TISSUE STRANDING INFECTION Horger, et al. Added value of SPECT/CT in patients suspected of having bone infection. Arch Orthop Trauma Surg. 2007:127:
43 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS ASSESSMENT OF SUSPECTED OSTEOMYELITIS 28 patients (17 men, 11 women, mean age 50 yrs +/- 12.5) with 31 sites of concern 13 cases suspected bone infections (Group 1) 15 cases suspected hardware infections (Group 2) Planar images 30 min, 4 hr, 24 hr Low dose SPECT/CT 6 hr Dx confirmed by: Surgery (n=19) Tissue Culture (n=12) Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
44 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS TYPE/ LOCATION N PLANAR + SPECT SPECT/CT CORRECT INCORRECT CORRECT INCORRECT SOFT TISSUE OM ST + OM PROSTHESIS SYNOVIUM NONE TOTAL Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
45 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS TYPE/ LOCATION N PLANAR + SPECT SPECT/CT SOFT TISSUE OM ST + OM PROSTHESIS SYNOVIUM NONE TOTAL COMPARED TO PLANAR + SPECT SPECT/CT EXCLUDED 3 CASES OSTEOMYELITIS (OM) 2 PROSTHESES INFECTIONS Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
46 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS TYPE/ LOCATION N PLANAR + SPECT SPECT/CT SOFT TISSUE OM ST + OM PROSTHESIS SYNOVIUM NONE TOTAL COMPARED TO PLANAR + SPECT SPECT/CT EXCLUDED 2 PROSTHESES INFECTIONS Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
47 50 YO WOMAN WITH HISTORY OF RIGHT LOWER LEG TRAUMA. OSTEOMYELITIS VS SOFT TISSUE INFECTION Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
48 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS SAGITTAL SPECT Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
49 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS SAGITTAL LOW DOSE CT SAGITTAL SPECT Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
50 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS POST-TRAUMATIC OSTEOMYELITIS SAGITTAL LOW DOSE CT SAGITTAL SPECT/CT Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
51 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS
52 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS SPECT INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS 1/5
53 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS SPECT INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS 2/5
54 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS SPECT INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS 3/5
55 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS SPECT INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS 4/5
56 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS SPECT INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS 5/5
57 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS LOW DOSE CT INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS
58 29 YO MAN WITH BILATERAL ABOVE THE KNEE AMPUTATIONS AND SOFT TISSUE INFECTION AT END OF LEFT RESIDUAL LIMB WBCs LOCALIZE TO SOFT TISSUE ONLY In-111 WBCs PLANAR INDETERMINATE FOR SOFT TISSUE INFECTION VERSUS OSTEOMYELITS SPECT/ CT CONFIRMS SOFT TISSUE INFECTION WITHOUT OSTEOMYELITS
59 56 YO WOMAN WITH LEFT SIDED LOW BACK PAIN 1 MONTH AFTER SURGERY. PARASPINOUS SOFT TISSUE INFECTION WITHOUT DISKITIS/OSTEOMYELITIS Tc-99m MDP Ga-67 Mymensingh. SPECT/CT. CNMU.
60 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR BONE & JOINT INFECTIONS TYPE/ LOCATION N PLANAR + SPECT SPECT/CT CORRECT INCORRECT CORRECT INCORRECT SOFT TISSUE OM ST + OM PROSTHESIS SYNOVIUM NONE TOTAL Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. JNM
61 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR DIABETIC FOOT INFECTIONS MATERIALS AND METHODS 17 patients (10 men, 7 women, mean age 55 yrs +/- 4) with 19 sites of concern 10 patients with Type I diabetes 7 patients with Type II diabetes All with clinical and lab features infection No antibiotic therapy for 20+ days Dx confirmed by: 2 Year Follow-up (n=3) Biopsy + FU (n=14) Tc-99m HMPAO WBCs Filippi L, et al. Diabetic foot infection: usefulness of SPECT/CT for 99mTc-HMPAO-labeled leukocyte imaging. JNM
62 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR DIABETIC FOOT INFECTIONS Tc-99m HMPAO WBCs PLANAR + SPECT = LIKELY OSTEOMYELITIS SPECT/CT = SOFT TISSUE INFECTION Filippi L, et al. Diabetic foot infection: usefulness of SPECT/CT for 99mTc-HMPAO-labeled leukocyte imaging. JNM
63 USEFULNESS OF SPECT/CT Tc-99m-HMPAO LEUKOCYTE SCINTIGRAPHY FOR DIABETIC FOOT INFECTIONS 16 of 19 scans were positive SPECT/CT changed interpretation for 10 of 19 cases (53%) Excluded osteomyelitis in 6 cases Revealed osteomyelitis in 1 case Revealed unknown soft tissue extension in 3 cases Did not significantly contribute to negative exams Filippi L, et al. Diabetic foot infection: usefulness of SPECT/CT for 99mTc-HMPAO-labeled leukocyte imaging. JNM
64 USEFULNESS OF SPECT/CT DUAL ISOTOPE SCINTIGRAPHY FOR DIABETIC FOOT INFECTIONS In-111 WBCs + Tc-99m Sulfur Colloid (bone marrow scintigraphy) Low dose CT protocol (140 kv, 2.5 ma) 213 patients retrospectively reviewed cases of osteomyelitis cases negative versus soft tissue infection SENS SPEC AUC PPV NPV LAMBDA Planar 93% 66% 80% 72% 91% 0.42 SPECT SPECT/CT Heiba S, et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg
65 USEFULNESS OF SPECT/CT DUAL ISOTOPE SCINTIGRAPHY FOR DIABETIC FOOT INFECTIONS In-111 WBCs + Tc-99m Sulfur Colloid (bone marrow scintigraphy) Low dose CT protocol (140 kv, 2.5 ma) 213 patients retrospectively reviewed cases of osteomyelitis cases negative versus soft tissue infection SENS SPEC AUC PPV NPV LAMBDA Planar 93% 66% 80% 72% 91% 0.42 SPECT 93% 77% 87% 80% 92% 0.61 SPECT/CT Heiba S, et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg
66 USEFULNESS OF SPECT/CT DUAL ISOTOPE SCINTIGRAPHY FOR DIABETIC FOOT INFECTIONS In-111 WBCs + Tc-99m Sulfur Colloid (bone marrow scintigraphy) Low dose CT protocol (140 kv, 2.5 ma) 213 patients retrospectively reviewed cases of osteomyelitis cases negative versus soft tissue infection SENS SPEC AUC PPV NPV LAMBDA Planar 93% 66% 80% 72% 91% 0.42 SPECT 93% 77% 87% 80% 92% 0.61 SPECT/CT 95% 94% 95% 93% 95% 0.90 Heiba S, et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg
67 USEFULNESS OF SPECT/CT DUAL ISOTOPE SCINTIGRAPHY FOR DIABETIC FOOT INFECTIONS In-111 WBCs + Tc-99m Sulfur Colloid (bone marrow scintigraphy) Low dose CT protocol (140 kv, 2.5 ma) 213 patients retrospectively reviewed cases of osteomyelitis cases negative versus soft tissue infection SENS SPEC AUC PPV NPV DX CERTAINTY Planar 93% 66% 80% 72% 91% 8% SPECT 93% 77% 87% 80% 92% 46% SPECT/CT 95% 94% 95% 93% 95% 96% Heiba S, et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg
68 BENIGN BONE DISEASE œ œ œ Evidence for role of SPECT/CT still emerging Bone scintigraphy PLANAR and SPECT œ High sensitivity œ Low specificity œ Often requires CT/MRI correlation for correct diagnosis SPECT/CT œ Significantly increases accuracy œ Completes imaging evaluation in one session œ Shortens the diagnostic process
69 BENIGN BONE DISEASE MATERIALS AND METHODS 3-phase Bone Scan using Tc-99m disphosphonate Low dose SPECT/CT (130 kv, 20 ma) 71 non-oncology patients (mean age 50 yrs +/- 19) Site of concern Foot = 23 Thigh = 7 Leg = 12 Hand(s) = 19 Knee = 9 Arm = 1 Clinically suspected diagnoses: OA = 25 FX = 7 OM/Infxn = 20 Unknown = 19 Linke R, et al. Skeletal SPECT/CT in the Peripheral Extremities. AJR. 2010
70 BENIGN BONE DISEASE SPECT/CT changed diagnosis for 23 of 71 patients (32%) OSTEOARTHRITIS N= TUMOR-LIKE LESION TRAUMA/FRACTURE OSTEOMYELITIS N= OSTEOARTHRITIS TRAUMA N= SOFT TISSUE OSTEOMYELITIS Linke R, et al. Skeletal SPECT/CT in the Peripheral Extremities. AJR. 2010
71 BENIGN BONE DISEASE SPECT/CT changed diagnosis for 23 of 71 patients (32%) OSTEOARTHRITIS N= TUMOR-LIKE LESION TRAUMA/FRACTURE 9/15 (60%) OSTEOMYELITIS N= OSTEOARTHRITIS TRAUMA N= SOFT TISSUE OSTEOMYELITIS Linke R, et al. Skeletal SPECT/CT in the Peripheral Extremities. AJR. 2010
72 BENIGN BONE DISEASE SPECT/CT changed diagnosis for 23 of 71 patients (32%) OSTEOARTHRITIS N= TUMOR-LIKE LESION TRAUMA/FRACTURE OSTEOMYELITIS N= OSTEOARTHRITIS 4/8 (50%) TRAUMA N= SOFT TISSUE OSTEOMYELITIS Linke R, et al. Skeletal SPECT/CT in the Peripheral Extremities. AJR. 2010
73 YOUNG MAN WITH LEFT KNEE PAIN PLANAR + SPECT TENTATIVE DX OF TUMOR-LIKE CONDITION Linke R, et al. Skeletal SPECT/CT in the Peripheral Extremities. AJR. 2010
74 YOUNG MAN WITH LEFT KNEE PAIN FABELLA SYNDROME Arthritic changes of lateral femoral condyle underlying fabella Linke R, et al. Skeletal SPECT/CT in the Peripheral Extremities. AJR. 2010
75 ELDERLY MAN WITH SEVERE FOOT PAIN PLANAR + SPECT SEVERE MULTIFOCAL OSTEOARTHRITIS
76 ELDERLY MAN WITH SEVERE FOOT PAIN
77 ELDERLY MAN WITH SEVERE FOOT PAIN METATARSAL INSUFFICIENCY FX TARSONAVICULAR OSTEOARTHRITIS
78 26 YO SOLDIER WITH RIGHT HIP PAIN
79 26 YO SOLDIER WITH RIGHT HIP PAIN 1/10
80 26 YO SOLDIER WITH RIGHT HIP PAIN 2/10
81 26 YO SOLDIER WITH RIGHT HIP PAIN 3/10
82 26 YO SOLDIER WITH RIGHT HIP PAIN 4/10
83 26 YO SOLDIER WITH RIGHT HIP PAIN 5/10
84 26 YO SOLDIER WITH RIGHT HIP PAIN 6/10
85 26 YO SOLDIER WITH RIGHT HIP PAIN 7/10
86 26 YO SOLDIER WITH RIGHT HIP PAIN 8/10
87 26 YO SOLDIER WITH RIGHT HIP PAIN 9/10
88 26 YO SOLDIER WITH RIGHT HIP PAIN 10/10
89 26 YO SOLDIER WITH RIGHT HIP PAIN PLANAR + SPECT BROAD DDX OF TUMOR, TUMOR-LIKE LESION, INFECTION, ATYPICAL STRESS FRACTURE, OLD INJURY
90 26 YO SOLDIER WITH RIGHT HIP PAIN
91 26 YO SOLDIER WITH RIGHT HIP PAIN TUMOR (EG) ENDOSTEAL SCALLOPING AND SOFT TISSUE DENSITY REPLACING MEDULLARY FAT
92 46 YO MAN WITH NECK PAIN
93 46 YO MAN WITH NECK PAIN
94 46 YO MAN WITH NECK PAIN
95 46 YO MAN WITH NECK PAIN
96 46 YO MAN WITH NECK PAIN
97 46 YO MAN WITH NECK PAIN
98 46 YO MAN WITH NECK PAIN
99 46 YO MAN WITH NECK PAIN
100 46 YO MAN WITH NECK PAIN
101 46 YO MAN WITH NECK PAIN
102 46 YO MAN WITH NECK PAIN
103 46 YO MAN WITH NECK PAIN
104 46 YO MAN WITH NECK PAIN
105 46 YO MAN WITH NECK PAIN
106 46 YO MAN WITH NECK PAIN
107 46 YO MAN WITH NECK PAIN
108 46 YO MAN WITH NECK PAIN
109 46 YO MAN WITH NECK PAIN
110 46 YO MAN WITH NECK PAIN
111 46 YO MAN WITH NECK PAIN
112 46 YO MAN WITH NECK PAIN
113 46 YO MAN WITH NECK PAIN
114 46 YO MAN WITH NECK PAIN
115 46 YO MAN WITH NECK PAIN
116 46 YO MAN WITH NECK PAIN
117 46 YO MAN WITH NECK PAIN
118 46 YO MAN WITH NECK PAIN
119 46 YO MAN WITH NECK PAIN
120 46 YO MAN WITH NECK PAIN 3
121 46 YO MAN WITH NECK PAIN 2
122 46 YO MAN WITH NECK PAIN 1
123 46 YO MAN WITH NECK PAIN LEFT C3-4 ACTIVE FACET ARTHROPATHY C2 C3 C4 C2 C3 C4
124 46 YO MAN WITH NECK PAIN LEFT C3-4 ACTIVE FACET ARTHROPATHY
125 SHORTCOMINGS SPECT/CT DOES NOT SIGNIFICANTLY CONTRIBUTE IN THE EVALUATION OF PATIENTS WITH NEGATIVE PLANAR AND SPECT IMAGING CT AND FUSION RELATED ARTIFACTS MISREGISTRATION MISAPPLICATION OF ATTENUATION CORRECTION DATA TRUNCATION ATTENUATION ARTIFACTS STREAKING INACCURATE ATTENUATION COEFFICIENT MEASUREMENT ADDITIONAL RADIATION BURDEN OF CT ~ <1-2 msv WITH LOW-DOSE TECHNIQUE 1/4 th 1/5 th STANDARD/DIAGNOSTIC CT VERSUS 6 msv FOR DISPHOSPHONATE BONE SCINTIGRAPHY
126 CONCLUSION SPECT/CT MARKEDLY IMPROVES SPECIFICITY, POSITIVE PREDICTIVE VALUE AND DIAGNOSTIC CONFIDENCE OF MSK SCINTIGRAPHY ACROSS WIDE SPECTRUM OF DISEASE TUMOR INFECTION TRAUMA OSTEOARTHRITIS TUMOR LIKE DISORDERS OPTIMAL ROLE STILL EMERGING VERSUS MRI CONCERN FOR INFECTION CONCERN FOR MALIGNANCY AND CT DEFINITIVE (METS) CORRELATION WITH DIAGNOSTIC CT LIKELY NECESSARY HARDWARE COMPLICATION OSTEOID OSTEOMA HEMANGIOMA, ETC Saha S, Burke C, Desai A, et al. SPECT-CT: applications in musculoskeletal radiology. Br J Radiol 2013;86:
127 Thank you Dr. Kevin Banks
128 Which bone scintigraphy modality provides the greatest accuracy for assessment of indeterminate bone lesions? A. SPECT B. PLANAR C. Side-by-side SPECT + CT D. Fused SPECT/CT KEY: (D) Fused SPECT/CT Increased diagnostic confidence is achieved with fused SPECT-CT compared to SPECT with or without CT correlation. In several studies, best illustrated by Utsunomiya, et al (Radiology, 2006), the accuracy increased significantly when going from planar imaging to SPECT, when going from SPECT to side-by-side interpretation of SPECT with CT, and again when comparing with fused SPECT/CT. REFERENCE: Utsunomiya D. Added value of SPECT/CT fusion in assessing suspected bone metastasis: Comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006;238:
129 What is the average radiation burden of CT when using low dose technique for SPECT/CT? A msv B. 1-7 msv C msv D msv KEY: (B) 1-7 msv 99mTc-MDP bone SPECT-CT CT effective dose (msv) ±2.8 REFERENCE: Sharma P. SPECT-CT in routine clinical practice: increase in patient radiation dose compared with SPECT alone. Nuclear Medicine Communications 2012;33:
130 When assessing for possible osteomyelitis, which imaging technique is least hindered by non-specific reactive bone marrow changes? A. Contrast-enhanced MRI B. CT C. Radiography D. In-111 WBC / Tc-99m Sulfur Colloid Scintigraphy KEY: (D) In-111 WBC / Tc-99m Sulfur Colloid Scintigraphy The use of dual isotope (In-111 WBC and Tc-99m SC) for evaluation of osteomyelitis is useful given ability to differentiate between radiotracer uptake at sites of reactive marrow versus osteomyelitis. In-111 WBCs accumulates at sites of both, while Tc-99m SC is taken up only at sites of reactive marrow. Thus, discordant osseous uptake by In- 111 WBC and Tc-99m SC is diagnostic of osteomyelitis. Both osteomyelitis and reactive marrow can show enhancement and signal changes on MRI. CT and XR are not generally helpful for assess bone marrow and thus cannot differentiate between osteomyelitis and reactive changes. REFERENCE: Heiba S, et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg Horger, et al. Added value of SPECT/CT in patients suspected of having bone infection. Arch Orthop Trauma Surg. 2007:127:
131 Which benign bone condition has shown to best benefit from evaluation with SPECT-CT scintigraphy? A. Osteomyelitis B. Trauma C. Osteoarthritis D. Metabolic bone disease KEY: (A) Osteomyelitis In a study of 71 patients with benign bone disease, Linke and colleagues found that 60% of cases of osteomyelitis had the diagnostic accuracy improved with the addition of SPECT-CT. Suspected trauma was the next disorder to most benefit from application of SPECT-CT with 50% of cases being provided an alternative diagnosis. Linke R, et al. Skeletal SPECT/CT in the Peripheral Extremities. AJR. 2010
132 SPECT-CT for hardware osteomyelitis of the great toe is best performed with what radiotracer? A. Tc-99m HMPAO WBCs B. In-111 WBCs C. Tc99m MDP D. Tc99m sulfur colloid KEY: (A) Tc-99m HMPAO WBCs. Sulfur colloid is generally not useful in the mid-to-distal foot due to a lack of marrow and thus no concern for confounding reactive marrow in these bones. Tc- 99m MDP is likely to be falsely positive in the setting of hardware related reactive changes. Given the improved imaging characteristics of Tc99m HMPAO WBCs over In-111 WBCs (increased dose providing increased counts, optimal energy of photons), it is better suited for SPECT-CT while providing improved specificity in comparison to MDP. REFERENCE: ACR SPR Practice Parameter for the Performance of Scintigraphy for Inflammation and Infection Res
133 Thank you Dr. Kevin Banks
04/03/2013. Second Annual BIR SPECT/CT Symposium London, UK 25/02/2013. NMD: Al-Jahra Hospital. NMD: Al-Jahra Hospital
Second Annual BIR SPECT/CT Symposium London, UK 25/02/2013 1 Muhammad Umar Khan, FCPS Al-Jahra Hospital; PET/CT Suite: Kuwait Cancer Control Center 25/02/2012 SPECT/CT in Imaging Infection Kuwait 25/02/2013
Utility of Dual-Energy CT to Evaluate Patients with Hip and Pelvis Pain in the ER Setting
Utility of Dual-Energy CT to Evaluate Patients with Hip and Pelvis Pain in the ER Setting Johnson, T., Moran, E., Glazebrook, K., Leng, S., Fletcher, J., and McCollough, C. An educational review ER011
Whole body F-18 sodium fluoride PET/CT in the detection of bone metastases in patients with known malignancies: A pictorial review
Whole body F-18 sodium fluoride PET/CT in the detection of bone metastases in patients with known malignancies: A pictorial review Poster No.: C-1196 Congress: ECR 2014 Type: Educational Exhibit Authors:
MRI XR, CT, NM. Principal Modality (2): Case Report # 2. Date accepted: 15 March 2013
Radiological Category: Musculoskeletal Principal Modality (1): Principal Modality (2): MRI XR, CT, NM Case Report # 2 Submitted by: Hannah Safia Elamir, D.O. Faculty reviewer: Naga R. Chinapuvvula, M.D.
Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.
Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,
Nuclear medicine and Prosthetic Joint Infections
Nuclear medicine and Prosthetic Joint Infections Christophe Van de Wiele, M.D., Ph.D. Department of Nuclear Medicine, University Hospital Ghent, Belgium Orthopedic prostheses: world market 1996 Prosthetic
Hybrid Imaging SPECT/CT PET/CT PET/MRI. SNMMI Southwest Chapter Aaron C. Jessop, MD
Hybrid Imaging SPECT/CT PET/CT PET/MRI SNMMI Southwest Chapter 2014 Aaron C. Jessop, MD Assistant Professor, Department of Nuclear Medicine UT MD Anderson Cancer Center, Houston, Texas Complimentary role
FIRST COAST SERVICE OPTIONS FLORIDA MEDICARE PART B LOCAL COVERAGE DETERMINATION
FIRST COAST SERVICE OPTIONS FLORIDA MEDICARE PART B LOCAL COVERAGE DETERMINATION CPT/HCPCS Codes 78300 Bone and/or joint imaging; limited area 78305 multiple areas 78306 whole body 78315 three phase study
Vertebral and Paravertebral Diseases
Department of Radiology University of California San Diego Vertebral and Paravertebral Diseases John R. Hesselink, M.D. Vertebral / Paravertebral Disease (Extradural) Metastatic disease Primary bone tumors
Bone is one of the most common sites of distant metastasis in cancer
Diagn Interv Radiol 2013; 19:33 40 Turkish Society of Radiology 2013 NUCLEAR MEDICINE ORIGINAL ARTICLE Hybrid SPECT-CT for characterizing isolated vertebral lesions observed by bone scintigraphy: comparison
PET-MRI in malignant bone tumours. Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany
PET-MRI in malignant bone tumours Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany Content From PET to PET/MRI General considerations Bone metastases Primary bone tumours
The Painful Prosthetic Joint: Role of Nuclear Medicine
The Painful Prosthetic Joint: Role of Nuclear Medicine Christopher J. Palestro, M.D. Professor of Radiology Hofstra North Shore-LIJ of Medicine Chief Division of Nuclear Medicine & Molecular Imaging North
Imaging of white blood cells with Scintimun
Imaging of white blood cells with Scintimun APRAMEN Réunion, Mardi 8 février 2011, Paris Wolf S. Richter SCINTIMUN : IgG1 antibody targeting white blood cells Tc-99m kit; murine IgG1 antibody target: NCA-95
INFECTION & INFLAMMATION IMAGING
INFECTION & INFLAMMATION IMAGING Radiopharmaceutical Drug Interactions & Other Interesting Case Studies MICHELLE RUNDIO, CNMT NCT MBA PCI NUCLEAR IN-111 WHITE BLOOD CELL IMAGING Interactions, Imaging Parameters
Added Value of SPECT/CT Fusion in Assessing Suspected Bone Metastasis
Added Value of SPECT/CT Fusion in Assessing Suspected Bone Metastasis Poster No.: C-1595 Congress: ECR 2015 Type: Scientific Exhibit Authors: M. Mereuta, G. Cobzac, G. Andries ; Cluj-Napoca/RO, Cluj Napoca/RO
Hybrid bone scintigraphy in gastrointestinal malignancies Institutional Experience
Hybrid bone scintigraphy in gastrointestinal malignancies Institutional Experience Nazia Rashid 1, Saima Riaz 1, Humayun Bashir 1, Shafqat Mehmood 2 1 Nuclear Medicine Department ad 2 Internal Medicine
1 Introduction. 2 Materials and methods. LI Na 1 LI Yaming 1,* YANG Chunming 2 LI Xuena 1 YIN Yafu 1 ZHOU Jiumao 1
Nuclear Science and Techniques 20 (2009) 354 358 18 F-FDG PET/CT in diagnosis of skeletal metastases LI Na 1 LI Yaming 1,* YANG Chunming 2 LI Xuena 1 YIN Yafu 1 ZHOU Jiumao 1 1 Department of Nuclear Medicine,
FLUCICLOVINE: 1 ST FDA APPROVED F-18 PET IMAGING AGENT FOR RECURRENT PROSTATE CANCER
FLUCICLOVINE: 1 ST FDA APPROVED F-18 PET IMAGING AGENT FOR RECURRENT PROSTATE CANCER KEVIN P BANKS, MD SAN ANTONIO MILITARY MEDICAL CENTER ASSISTANT PROFESSOR OF RADIOLOGY, USU I HAVE NO FINANCIAL DISCLOSURES.
F NaF PET/CT in the Evaluation of Skeletal Malignancy
F NaF PET/CT in the Evaluation of Skeletal Malignancy Andrei Iagaru, MD September 26, 2013 School of of Medicine Ø Introduction Ø F NaF PET/CT in Primary Bone Cancers Ø F NaF PET/CT in Bone Metastases
FDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave
FDG PET/CT STAGING OF LUNG CANCER Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER FDG PET/CT is used in all patients with lung cancer who are considered for curative treatment to exclude occult disease.
Austin Radiological Association Nuclear Medicine Procedure BONE MINERAL STUDY (Tc-99m-MDP, Tc-99m-HMDP)
Austin Radiological Association Nuclear Medicine Procedure BONE MINERAL STUDY (Tc-99m-MDP, Tc-99m-HMDP) Overview The Bone Mineral Study, with either Tc-99m-MDP or Tc-99m-HMDP, depicts the distribution
Nuclear Medicine in Thyroid Cancer. Phillip J. Koo, MD Division Chief of Diagnostic Imaging
Nuclear Medicine in Thyroid Cancer Phillip J. Koo, MD Division Chief of Diagnostic Imaging Financial Disclosures Bayer Janssen Learning Objectives To learn the advantages and disadvantages of SPECT/CT
Focal Sclerosis in a Vertebra: Differential Diagnosis of a Solitary Osteoblastic Metastasis
July 2001 Focal Sclerosis in a Vertebra: Differential Diagnosis of a Solitary Osteoblastic Metastasis Alice L. Fisher, Harvard Medical School Year IV Review of the Normal Anatomy of a Lumbar Vertebra:
The clinical value of xspect/ct Bone versus SPECT/CT. A prospective comparison of 200 scans
Duncan and Ingold European Journal of Hybrid Imaging (2018) 2:4 DOI 10.1186/s41824-017-0024-9 European Journal of Hybrid Imaging ORIGINAL ARTICLE Open Access The clinical value of xspect/ct Bone versus
Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors
Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors Lars Stegger, Benjamin Noto Department of Nuclear Medicine University Hospital Münster, Germany Content From PET to
SPECT/CT in knee pain
in knee pain Dr Lu Suat Jin MB, M.Med, FRCR, FAMS Department of Diagnostic Imaging National University Hospital, Singapore Tc-99m methylene diphosphonate (MDP) Sensitivity Detect bone abnormalities early
66 yr old female with groin and hip pain. Paul Jabour, MD
66 yr old female with groin and hip pain Paul Jabour, MD 2 months later 12 months later 14 months after initial presentation Acetabular Insufficiency Fracture Pelvic stress fracture Fatigue
Whole Body MRI. Dr. Nina Tunariu. Prostate Cancer recurrence, progression and restaging
Whole Body MRI Prostate Cancer recurrence, progression and restaging Dr. Nina Tunariu Consultant Radiology Drug Development Unit and Prostate Targeted Therapies Group 12-13 Janeiro 2018 Evolving Treatment
Infection Imaging In Nuclear Medicine: Arguing The Case for PET/CT.
Infection Imaging In Nuclear Medicine: Arguing The Case for PET/CT. LUIS A. TAMARA M.D. NUCLEAR MEDICINE /PET-CT SERVICE CHIEF MEDVAMC DISCLOSURES. 2 3 Not difficult to appreciate the difference! GA-67
Radionuclide Imaging of Infection & Inflammation
Radionuclide Imaging of Infection & Inflammation Christopher J. Palestro, M.D. Professor of Radiology Hofstra North Shore-LIJ School of Medicine Chief Division of Nuclear Medicine & Molecular Imaging North
Imaging of bone metastases
Imaging of bone metastases Antoine Feydy Service de Radiologie B Hôpital Cochin APHP Université Paris Descartes antoine.feydy@aphp.fr MEXICO 2016 INTRODUCTION Diagnostic Imaging Imaging Modalities Strengths,
Combined SPECT/CT bone scintigraphy; a superior technique for diagnosis of benign and malignant conditions in the spine.
Combined SPECT/CT bone scintigraphy; a superior technique for diagnosis of benign and malignant conditions in the spine. Poster No.: C-1686 Congress: ECR 2011 Type: Authors: Keywords: DOI: Educational
ISPUB.COM. Planar fusion: A PICTORIAL REVIEW. G Currie, R Pearce, J Wheat CASE EXAMPLES INTRODUCTION
ISPUB.COM The Internet Journal of Radiology Volume 11 Number 1 Planar fusion: A PICTORIAL REVIEW. G Currie, R Pearce, J Wheat Citation G Currie, R Pearce, J Wheat. Planar fusion: A PICTORIAL REVIEW.. The
Complex Fractures and Hip Dislocations
IMAGING OF HIP PAIN Patients may present with acute (< 2 weeks) or chronic hip pain. Acute pain may be related or not related to an acute traumatic event such as fall or trauma from a motor vehicle accident.
Screening for and Assessment of Osteonecrosis in Oncology Patients. Sue C. Kaste, DO SPR Postgraduate Course 2015
Screening for and Assessment of Osteonecrosis in Oncology Patients Sue C. Kaste, DO SPR Postgraduate Course 2015 The author declares no potential conflicts of interest or financial disclosures Osteonecrosis
This article is downloaded from.
This article is downloaded from http://researchoutput.csu.edu.au It is the paper published as: Author: B. Iqbal, G. M. Currie, J. M. Wheat, H. Raza and H. Kiat Title: The Incremental Value of SPECT/CT
Message of the Month for GPs June 2013
Message of the Month for GPs June 2013 Dr Winn : Consultant Musculoskeletal Radiologist, Manchester Royal Infirmary Imaging of the musculoskeletal system Musculoskeletal pain is a common problem in the
Nuclear Medicine: Manuals. Nuclear Medicine. Nuclear imaging. Emission imaging: study types. Bone scintigraphy - technique
Nuclear Medicine - Unsealed radioactive preparations the tracer mixes with the patients body fluids on a molecular level (e.g. after intravenous injection) - 3 main fields: - In vitro : measuring concentrations
Case Scenario 1. 4/19/13 Bone Scan: No scintigraphic findings to suggest skeletal metastases.
Case Scenario 1 3/8/13 H&P 68 YR W/M presents w/elevated PSA. Patient is a non-smoker, current alcohol use. Physical Exam: On digital rectal exam the sphincter tone is normal and there is a 1 cm nodule
Nuclear Medicine in the Diabetic Foot
26.11.2015, Uniklinik Balgrist Nuclear Medicine in the Diabetic Foot Martin Hüllner Nuklearmedizin und Neuroradiologie, USZ / UZH Outline A. Imaging modalities brief technical overview B. Nuclear medicine
The Incremental Value of SPECT/CT in Characterizing Solitary Spine Lesions. SPECT/CT IN SOLITARY SPINE LESIONS Iqbal et al. 201
The Incremental Value of SPECT/CT in Characterizing Solitary Spine Lesions Basit Iqbal 1 3, Geoffrey M. Currie 1,2,4, Janelle M. Wheat 1,2,4, Hassan Raza 3, and Hosen Kiat 1,2,4 1 Faculty of Science, Charles
Denominator Criteria (Eligible Cases): Patient encounter during the performance period (CPT): 78300, 78305, 78306, 78315, 78320
Quality ID #147: Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy National Quality Strategy Domain: Communication and Care Coordination 2018 OPTIONS
Imaging Modalities: Clinical Reasoning and Key Instructional Elements: Radiography
Imaging Modalities: Clinical Reasoning and Key Instructional Elements: Radiography Michael D. Ross, PT, DHSc, OCS mross@daemen.edu Disclosure No relevant financial relationship exists Objectives Determine
Ryan Niederkohr, M.D. Slides are not to be reproduced without permission of author
Ryan Niederkohr, M.D. CMS: PET/CT CPT CODES 78814 Limited Area (e.g., head/neck only; chest only) 78815 78816 Regional (skull base to mid-thighs) True Whole Body (skull vertex to feet) SELECTING FIELD
Heterogeneous osteoblastic activity in the right ischium of unclear etiology seen on NaF18-PET/CT
CASE REPORT Heterogeneous osteoblastic activity in the right ischium of unclear etiology seen on NaF18-PET/CT Aung Zaw Win, Carina Mari Aparici Dept. Radiology, Nuclear Medicine section, San Francisco
Epidemiology of Low back pain
Low Back Pain Definition Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like the mid or upper back, a inguinal
Colorectal Cancer and FDG PET/CT
Hybrid imaging in colorectal & esophageal cancer Emmanuel Deshayes IAEA WorkShop, November 2017 Colorectal Cancer and FDG PET/CT 1 Clinical background Cancer of the colon and rectum is one of the most
SPECT/CT in Endocrine Diseases and Dosimetry
SPECT/CT in Endocrine Diseases and Dosimetry Heather A. Jacene, MD Division of Nuclear Medicine Russell H. Morgan Dept. of Radiology and Radiological Science Johns Hopkins University Baltimore, MD Disclosures
Assessment of Skeletal Metastases in Prostate Cancer: 68Ga-PSMA PET vs 99mTc-MDP WBBS - A Case Series
Assessment of Skeletal Metastases in Prostate Cancer: 68Ga-PSMA PET vs 99mTc-MDP WBBS - A Case Series Poster No.: R-0094 Congress: 2016 ASM Type: Scientific Exhibit Authors: O. Bennett, Y.-T. T. Huang;
ISPUB.COM. Spectrum Of MRI Findings In Musculoskeletal Tuberculosis: Pictoral Essay. P Chudgar INTRODUCTION SPINE
ISPUB.COM The Internet Journal of Radiology Volume 8 Number 2 Spectrum Of MRI Findings In Musculoskeletal Tuberculosis: Pictoral Essay P Chudgar Citation P Chudgar.. The Internet Journal of Radiology.
Musculoskeletal Radiology
Musculoskeletal Radiology Hong Kong College of Radiologists MS 1 Acute osteomyelitis Acute osteomyelitis Plain radiographs reviewed Spine Other bones MRI Acute osteomyelitis diagnosed Acute osteomyelitis
FOR CMS (MEDICARE) MEMBERS ONLY NATIONAL COVERAGE DETERMINATION (NCD) FOR MAGNETIC RESONANCE IMAGING:
National Imaging Associates, Inc. Clinical guidelines BONE MARROW MRI Original Date: July 2008 Page 1 of 5 CPT Codes: 77084 Last Review Date: September 2014 NCD 220.2 MRI Last Effective Date: July 2011
Institution INSTRUCTIONS (I6) 1. This form is to be completed by a DESIGNATED STUDY NUCLEAR MEDICINE SPECIALIST
I6 ACRIN 6660 Whole Body MRI in the Evaluation of Pediatric Malignancies Conventional Scintigraphy Imaging Form If this is a revised or corrected form, indicate by checking box and fax to 215-717 - 0936.
CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 12/01/2012 Radiology Quiz of the Week # 101 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
Leucocytscintigraphy. Lene Rørdam Senior Consultant DMSci Department of Clinical Physiology and Nuclear Medicine Bispebjerg University Hospital
Leucocytscintigraphy Lene Rørdam Senior Consultant DMSci Department of Clinical Physiology and Nuclear Medicine Bispebjerg University Hospital Indications for leucocytscintigraphy in the past Inflammatory
Evidence Process for Hip Pain Guideline Research Guideline Review using ADAPTE method and AGREE II instrument 9/19/2017
9-26-17 Guideline Review using ADAPTE method and AGREE II instrument 9/19/2017 ~60 Potentially relevant guidelines identified in various resources* 16 Guidelines appraised using AGREE II analysis ~44 Guidelines
Using PET/CT in Prostate Cancer
Using PET/CT in Prostate Cancer Legal Disclaimer These materials were prepared in good faith by MITA as a service to the profession and are believed to be reliable based on current scientific literature.
Functional Orthopedic Imaging Capturing Motion, Flow and Perfusion. Case Study Brochure Centre University Hospital Nancy.
Capturing Motion, Flow and Perfusion dynamic volume CT Case Study Brochure Centre University Hospital Nancy http://www.toshibamedicalsystems.com Toshiba Medical Systems Corporation 2013. All rights reserved.
Austin Radiological Association Nuclear Medicine Procedure WHITE BLOOD CELL MIGRATION STUDY (In-111-WBCs, Tc-99m-HMPAO-WBCs)
Austin Radiological Association Nuclear Medicine Procedure WHITE BLOOD CELL MIGRATION STUDY (In-111-WBCs, Tc-99m-HMPAO-WBCs) Overview Indications The White Blood Cell Migration Study demonstrates the distribution
Dr Sneha Shah Tata Memorial Hospital, Mumbai.
Dr Sneha Shah Tata Memorial Hospital, Mumbai. Topics covered Lymphomas including Burkitts Pediatric solid tumors (non CNS) Musculoskeletal Ewings & osteosarcoma. Neuroblastomas Nasopharyngeal carcinomas
PARATHYROID NUCLEAR MEDICINE IMAGING REVIEW DISCLOSURES
PARATHYROID NUCLEAR MEDICINE IMAGING REVIEW Miguel Hernandez Pampaloni, M.D., Ph.D. Chief, Nuclear Medicine Assistant Professor of Radiology UCSF Department of Radiology and Biomedical Imaging DISCLOSURES
PET/MR:Techniques, Indications and Applications
PET/MR:Techniques, Indications and Applications Franz Wolfgang Hirsch Professor and Head of the Department of Pediatric Radiology University Hospital Leipzig / Germany Children s Hospital University Leipzig
CLINICAL IMPLEMENTATION OF HYBRID IMAGING CLINICAL IMPLEMENTATION OF HYBRID IMAGING COMBINED IMAGING CLINICAL IMPLEMENTATION OF
HYBRID OBJECTIVES OF ADDING CT-SCANNING TO NM? CLINICAL IMPLEMENTATION OF François Jamar UCL, Brussels ABR-BVS Workshop, Antwerp, Feb. 18, 2011 HYBRID COMBINED COMBINED ( PET AND CT) In-WBC 111 In COMBINED
Primary bone tumors > metastases from other sites Primary bone tumors widely range -from benign to malignant. Classified according to the normal cell
Primary bone tumors > metastases from other sites Primary bone tumors widely range -from benign to malignant. Classified according to the normal cell counterpart and line of differentiation. Among the
11/4/2018 SUBTLETIES OF LOWER EXTREMITY TRAUMA IMAGING SPEAKER DISCLOSURES
SUBTLETIES OF LOWER EXTREMITY TRAUMA IMAGING Charles S. Resnik, M.D. Professor of Radiology University of Maryland School of Medicine Upon completion of this presentation, participants will be better able
A 64 y.o. man presents to the hospital with persistent cough and hemoptysis. Fernando Mut Montevideo - Uruguay
A 64 y.o. man presents to the hospital with persistent cough and hemoptysis Fernando Mut Montevideo - Uruguay Teaching case Bone # 1 A 64 y.o. man presents to the hospital with persistent cough and hemoptysis.
THE JOURNAL OF NUCLEAR MEDICINE Vol. 53 No. 5 May 2012 Avram
Supplemental Table 1: Studies reporting utility of Post-Rx. 131-I SPECT-CT for evaluation of differentiated thyroid cancer Author No. Pts/Scans Setting Scan type Camera Site of Radioactivity Foci Journal
Update - Imaging of the Spondyloarthropathies. Spondyloarthropathies. Spondyloarthropathies
Update - Imaging of the Spondyloarthropathies Donald J. Flemming, M.D. Dept of Radiology Penn State Hershey Medical Center Spondyloarthropathies Family of inflammatory arthritides of synovium and entheses
Basic Radiographic Principles Part II
Basic Radiographic Principles Part II Kristopher Avant, D.O. October 19 th, 2016 I have no disclosures relevant to the material presented in this discussion. Good Stuff!!! 1 Really? Really! Musculoskeletal
PET/CT Frequently Asked Questions
PET/CT Frequently Asked Questions General Q: Is FDG PET specific for cancer? A: No, it is a marker of metabolism. In general, any disease that causes increased metabolism can result in increased FDG uptake
CHAPTER 13 SKELETAL SYSTEM
CHAPTER 13 SKELETAL SYSTEM Structure and Function Functions of the skeletal system Provides shape and support Protects internal organs Stores minerals and fat Produces blood cells and platelets Assists
Typical PET Image. Elevated uptake of FDG (related to metabolism) Lung cancer example: But where exactly is it located?
Typical PET Image Elevated uptake of FDG (related to metabolism) Lung cancer example: But where exactly is it located? PET/CT Oncology Imaging Anatometabolic fusion images are useful in the management
Nuclear Medicine Head and Neck Region. Bán Zsuzsanna, MD University of Pécs, Department of Nuclear Medicine
Nuclear Medicine Head and Neck Region Bán Zsuzsanna, MD University of Pécs, Department of Nuclear Medicine Thyroid scintigraphy Parathyroid scintigraphy F18-FDG PET examinations in head and neck cancer
Lumps & Bumps --When to be concerned--
Lumps & Bumps --When to be concerned-- Eric Silverstein, MD Director of Musculoskeletal Oncology Academic Director of Orthopaedic Surgery Saint Francis Hospital & Cancer Center Trinity Health of New England
Diagnostic Imaging Exams
Guide for Chiropractors Diagnostic Imaging Exams CREATED FOR OUR CHIROPRACTIC PARTNERS This document has been prepared by the specialized, board-certified radiologists who interpret patient exams for Center
Radionuclide detection of sentinel lymph node
Radionuclide detection of sentinel lymph node Sophia I. Koukouraki Assoc. Professor Department of Nuclear Medicine Medicine School, University of Crete 1 BACKGROUND The prognosis of malignant disease is
ORIGINAL ARTICLE ABSTRACT
ORIGINAL ARTICLE 99m Tc MDP Bone Scan in Lung Cancer: Predilection Sites for Metastasis Shamim M F Begum, Zeenat Jabin, Rahima Perveen, Nasreen Sultana, Laila S Banu National Institute of Nuclear Medicine
Research Article Whole-Body SPECT/CT versus Planar Bone Scan with Targeted SPECT/CT for Metastatic Workup
Hindawi BioMed Research International Volume 2017, Article ID 7039406, 8 pages https://doi.org/10.1155/2017/7039406 Research Article Whole-Body SPECT/CT versus Planar Bone Scan with Targeted SPECT/CT for
Metal Artefact Reduction in CT
Metal Artefact Reduction in CT DANIEL MARRINER Metal Artefact Reduction in CT Metal Artefact Clinical Indications for MAR SEMAR and How It Works Technical Considerations Case Studies utilising SEMAR Metal
Lab: Histology of Bone and Cartilage
WEEK 1 Time/Date Monday, October 8 Tuesday, October 9 Wednesday, October 10 Thursday, October 11 Friday, October 12 1. 2. PHARMACOLOGY 1. PATHOLOGY 2. CELL BIOLOGY/PHYSIO 4. CELL BIOLOGY/PHYSIO Concepts
MRI of Pediatric Ankle and Foot. Mahesh Thapa, MD Associate Professor Seattle Children s University of Washington School of Medicine
MRI of Pediatric Ankle and Foot Mahesh Thapa, MD Associate Professor Seattle Children s University of Washington School of Medicine Disclosures Under contract with Lippincott Williams and Wilkins (LWW)
Disseminated Primary Non-Hodgkin s Lymphoma of Bone : A Case Re p o r t 1
Disseminated Primary Non-Hodgkin s Lymphoma of Bone : A Case Re p o r t 1 Hee-Jin Park, M.D., Sung-Moon Lee, M.D., Hee-Jung Lee, M.D., Jung-Sik Kim, M.D., Hong Kim, M.D. Primary lymphoma of bone is uncommon
Chapter 3 Diagnostic Imaging. 1 Diagnostic Imaging
Chapter 3 Diagnostic Imaging 1 Diagnostic Imaging Radiographic Examination: Standards and Indications Position Statement Radiography should only be performed on the basis of clinical necessity as judged
Special Imaging MUSCULOSKELETAL INFECTION. Special Imaging. Special Imaging. 18yr old male pt What is it? Additional Imaging
MUSCULOSKELETAL INFECTION Additional Imaging May assist in diagnosis and, possibly, treatment Help create the picture May help differentiate from neoplasia 18yr old male pt What is it? Lymphoma Ewings
AIM 2014 CPT Radiology & Cardiac Codes Requiring Review
AIM 2014 CPT Radiology & Cardiac Codes Requiring Review Modality Body Part CT Head 1 70480 CT orbit, sella or posterior fossa; w/o contrast 1 CT Head 1 70481 CT orbit, sella or posterior fossa; with CT
Monostotic Paget s Disease: A Case Report
Chin J Radiol 2002; 27: 117-121 117 CASE REPORT Monostotic Paget s Disease: A Case Report CHI-CHEN HOU 1 CHI WEI LO 2 JINN-MING CHANG 1 CHING-CHERNG TZENG 3 Department of Diagnostic Radiology 1, Orthopedics
PET/CT in lung cancer
PET/CT in lung cancer Andrei Šamarin North Estonia Medical Centre 3 rd Baltic Congress of Radiology 08.10.2010 Imaging in lung cancer Why do we need PET/CT? CT is routine imaging modality for staging of
Differentiation of osteoporosis from metastasis in the vertebral fracture using chemical shift and diffusion weighted imaging
Differentiation of osteoporosis from metastasis in the vertebral fracture using chemical shift and diffusion weighted imaging Poster No.: C-0444 Congress: ECR 2012 Type: Educational Exhibit Authors: H.
Brain Atrophy. Brain Atrophy
Aging Central Nervous System Processes Age related brain atrophy Non-age related brain atrophy Cerebrovascular disease Cerebral infarction Hypertensive hemorrhage Carotid artery stenosis and occlusion
PET and SPECT in Osteomyelitis and Prosthetic Bone and Joint Infections: A Systematic Review
PET and SPECT in Osteomyelitis and Prosthetic Bone and Joint Infections: A Systematic Review Wouter van der Bruggen, MD,* Chantal P. Bleeker-Rovers, MD, PhD,, Otto C. Boerman, PhD,*, Martin Gotthardt,
Musculoskeletal System
Musculoskeletal System CPT CPT copyright 2011 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the
The radiologist and the raiders of the lost image
The radiologist and the raiders of the lost image Poster No.: P-0072 Congress: ESSR 2014 Type: Educational Poster Authors: M. J. Ereño Ealo, E. Montejo Rodrigo, B. Sancho, E. Pastor; Galdakao/ES Keywords:
A Case of an Idiopathic Massive Osteolysis with Skip Lesions
Case Report Musculoskeletal Imaging http://dx.doi.org/10.3348/kjr.2013.14.6.946 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2013;14(6):946-950 A Case of an Idiopathic Massive Osteolysis with Skip Lesions
Suspecting Tumors, or Could it be cancer?
Suspecting Tumors, or Could it be cancer? Donna E. Reece, M.D. Princess Margaret Cancer Centre University Health Network Toronto, ON CANADA 07 February 2018 Background Low back pain is common However,
Case Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2
Case Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2 Case 79 yo M with hx of T3N0 colon cancer diagnosed in 2008 metastatic liver disease s/p liver segmentectomy 2009
Topics. Musculoskeletal Infection Extremities. Detection of Infection. Role of Imaging in Extremity Infection. Detection of Infection
Topics Musculoskeletal Infection Extremities Nuttaya Pattamapaspong M.D. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Role of imaging in extremity infection
Introduction. Keywords SPECT/CT Volume rendering Threedimensional Image fusion Bone metastasis
DOI 10.1007/s12149-017-1158-3 ORIGINAL ARTICLE 3D SPECT/CT fusion using image data projection of bone SPECT onto 3D volume-rendered CT images: feasibility and clinical impact in the diagnosis of bone metastasis
Emerging Referral Patterns for Whole-Body Diffusion Weighted Imaging (WB-DWI) in an Oncology Center
Emerging Referral Patterns for Whole-Body Diffusion Weighted Imaging (WB-DWI) in an Oncology Center Poster No.: C-1296 Congress: ECR 2014 Type: Scientific Exhibit Authors: G. Petralia 1, G. Conte 1, S.
Value of true whole-body FDG- PET/CT scanning protocol in oncology and optimization of its use based on primary malignancy
Value of true whole-body FDG- PET/CT scanning protocol in oncology and optimization of its use based on primary malignancy Ronnie Sebro MD, Ph.D Carina Mari Aparici MD, Miguel Hernandez Pampaloni MD, PhD
Does PET/CT Have an Additional Value in Detection of Osteolytic Bone Metastases.
Egyptian J. Nucl. Med., Vol 2, No. 2, Dec. 2009 65 ONCOLOGY, Original Article Does PET/CT Have an Additional Value in Detection of Osteolytic Bone Metastases. R. Riad, M.D.*, M. Awad, M.D. **, E. Eldebawy,