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NM 4203 Scanning & Imaging

NM 4203 Scanning & Imaging. Gastrointestinal System. Alimentary Canal . Mouth Pharynx Esophagus Stomach Small intestine Large intestine (colon). Accessory Organs. Salivary glands Pancreas Liver Gallbladder. Stomach Anatomy & Physiology. Three Regions:

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NM 4203 Scanning & Imaging

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  1. NM 4203Scanning & Imaging Gastrointestinal System

  2. Alimentary Canal • Mouth • Pharynx • Esophagus • Stomach • Small intestine • Large intestine (colon)

  3. Accessory Organs • Salivary glands • Pancreas • Liver • Gallbladder

  4. Stomach Anatomy & Physiology • Three Regions: • Fundus : controls liquid emptying • Corpus (body) • Antrum : controls solid emptying

  5. Gastric Emptying Study • Indications • Nausea, vomiting • Weight loss • Abdominal bloating • Mechanical causes • Ulcer, tumor, post-radiotherapy, pyloric stenosis, post-surgical • Nonmechanical causes • Diabetes, hypo or hypertension, neuropathy, gastroparesis, anorexia, amyloidosis

  6. Gastric Emptying Study • Each lab must standardize meal type and size. • Solid phase could be meat, chicken liver, eggs, french toast, etc (99mTc Sulfur Colloid) • Liquid phase could be water, orange juice, apple juice. (111In DTPA)

  7. Gastric Emptying Study • Patient fasting for at least 8 hrs. • Medium energy collimator (if doing liquid phase with In111DTPA) • Should eat meal within 5 minutes, followed by liquid.

  8. Liver Anatomy & Physiology • Right upper quadrant of abdomen • Right lobe generally larger than left • Composed of: • Kupffer cells • Hepatocytes • Conversion of bilirubin to bile • Spleen: not part of the GI system

  9. Liver – Spleen imaging • 99mTc Sulfur Colloid or 99mTc Albumin Colloid • Can do a flow (looking at vascularity of some defects) • No pt. prep • Static images 15 min. after injection • Anterior, RAO, Rt lat, RPO, posterior, LPO, Lt lat, LAO

  10. Liver – Spleen Colloid Image

  11. Liver Hemangioma • 99mTc – Labeled Red Blood Cells • No pt. prep • Bolus 15 – 25 mCi with immediate flow imaging • Followed by pool images per facility protocol • SPECT usually 2-3 hours after injection.

  12. Liver Hemangioma

  13. Liver Hemangioma • Little or no blood flow to the lesion on early flow images • Delayed imaging usually shows increased uptake in hemangioma. • Other types of lesions will retain RBC’s, but only hemangiomas retain RBC’s for over 2 hrs. • Some consider this test to be 100% accurate for Hemangioma detection.

  14. Gallbladder Anatomy & Physiology • Concentrates and stores bile • Stimulated by fatty meal to contract and release bile into the duodenum • Bile is useful to breakdown fats during digestion.

  15. Extrahepatic biliary anatomy

  16. Hepatobiliary Imaging • Radiopharmaceuticals • 99mTc HIDA, 99mTc DISIDA, 99mTc Mebrofenin • Pt. should fast at least 2 hrs. before study, no more than 24 hrs. • Pain medications (opium or morphine based) should not be taken prior to imaging. • Rt. Lateral image is helpful to separate Gb (Gallbladder should be anterior to other structures)

  17. Acute Cholecystitis • Usually due to cystic duct obstruction • Visualization of GB with radiopharmaceutical excludes diagnosis of acute cholecystitis • No GB visualized in 4 hrs, high probability of acute cholecystitis

  18. Acute Cholecystitis

  19. Gallbladder Imaging: other medications • Cholecystokinin (CCK) • Causes gb contraction • Relaxes the sphincter of Oddi • Used for GB Ejection Fraction • Peptide hormone, naturally secreted by duodenum • Morphine • Decreases peristalsis • Constricts the sphincter of Oddi • Used when Gb is not visualized to “force” radiopharmaceutical into the gb.

  20. Biliary Leak • Usually requested after surgery or trauma • Subtle leaks that may accumulate in the pelvis • May mimic a gb ~ labeled bile in the gallbladder fossa

  21. Intestine anatomy & physiology • Small intestine • Duodenum, jejunum, and ileum • 20 feet long • Digestion and absorption of nutrients • Large intestine • Cecum, ascending colon, transverse colon, descending colon,sigmoid colon, and rectum. • Resorption of water

  22. GI Bleed Imaging • Radiopharmaceutical • 99mTc Sulfur Colloid or 99mTc –labeled RBC’s (each facility may have different labeling method) • Bolus injection with immediate flow imaging

  23. GI Bleed

  24. Causes of GI Bleeding • Diverticular disease • Angiodysplasia • Neoplasms • Inflammatory bowel disease • Not uncommon to never find a reason

  25. Meckel’s Diverticulum • Common cause of GI bleeding in children. • Most are located in the ileum • 99mTc Pertechnetate ~ concentrates in gastric mucosa

  26. Meckel’s Diverticulum • Painless rectal bleeding • More common in children • Some Meckel’s do not contain gastric mucosa, won’t show on scan • Glucagon – given i.v. 10 minutes after Tc injection or Zantac given i.v. prior to Tc injection • Decrease small bowel activity

  27. Schilling Test • GI absorption of vitamin B12 • 57Co vitamin B12 given orally • Followed by IM injection of non-labeled vitamin B12 (saturates the liver) • Urine collected for 24 hrs.

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