In a 1959 autopsy study of 3000 patients, an intrapancreatic accessory spleen ipas was found in 17% of patients who were identified with accessory spleens. Nuclear medicine is boon of technological advancement which uses safe, painless, and costeffective techniques to image the body and treat disease. In korea, four cases of abdominal and two cases of pelvic splenosis have been reported previously 1016 table 1. Nuclear medicine is a discipline of medicine using radioisotopes for diagnosis and treatment of diseases. A tc99m sulfur colloid study was performed to confirm a suspected diagnosis of splenosis. Splenosis should be considered in the differential diagnosis of gastrointestinal hemorrhage in patients who have experienced prior splenic trauma or splenectomy. Thoracic splenosis should be considered in a patient who has a healed left lower rib fracture, an absent spleen, and left lower pleural nodules. Guiberteau md, in essentials of nuclear medicine imaging sixth edition, 2012. A case of multiple intraabdominal splenosis with computed. A nuclear medicine liverspleen scan is a diagnostic exam used to evaluate the size of the liver andor spleen. Tc99m sulfur colloid liver and spleen imaging was introduced in 1963 and became the standard clinical method for liver and spleen imaging until the advent of ct. It is divided into three sections for convenient and easy reading. Thoracic splenosis ts is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury.
A liver and spleen nuclear scan with 5 mci of technetium99m sulfur colloid, showed no spleen. Dmsa, with flow, with spect 42915 d nuclear bmedicine study renal imaging dynamic renogram and vascular flow 42920 nuclear medicine study renovascular study, baseline 42930 c nuclear medicine study renovascular study, with intervention 42940 c nuclear medicine study b indirect voiding cystogram 42950. The ternational nuclear medicine community, unlike many other larger specialty areas, has remained relatively small. History, technical feasibility, mechanism of action, normal biodistribution, and diagnostic performance in bone metastasis detection compared with other imaging modalities. Ct examination andor petct scan revealed suspicious findings in the left upper abdomen. Nuclear medicine shunt patency what is a shunt patency study. In most models intended for nuclear medicine patients the uptakes in stomach wall and salivary glands are included. Case report of tc99m sulfur colloid singlephoton emission. The ct scan also identified two similar nodular lesions medially to the left. Shunt patency study university of illinois at chicago. Abreu author, douglas van nostrand editor, harvey a. This book is designed to ensure ease of use in clinical practice and provides the most relevant information on nuclear medicine as applied to endocrine pathology.
There have been a number of case reports where intraabdominal splenosis or accessory spleens have mimicked metastatic cancer. Superior demonstration of splenosis by heatdenatured tc. Preoperative diagnosis of splenosis should be made with the use of nuclear imaging studies such as the 99mtc heatdamaged erythrocyte. Irgil departments of nuclear medicine and general surgery, uludag university hospital, bursa, turkey we used scintigraphy with sulphur colloid and heatdamaged red cells to detect splenosis after. Doctors also administer treatments using nuclear medicine because radiation damages cancer cells more than it harms normal cells. The snmmi procedure standardeanm practice guideline for. A patient with profound weight loss, positive ppd and left upper lobe lung density on a chest radiograph was felt to have a strong clinical suspicion of. The chart showing pdf series, html series, scan qr codes html series. The first section which comprises two chapters is an. Identification of perirenal or renal splenosis from. Lymphoscintigraphy and intraoperative localization.
Abdominal splenosis is seen after abdominal trauma or surgery e. It was within this spirit that clinical nuclear medicine was born. Excision of the nodule is not indicated if the patient is asymptomatic, however diagnosis has frequently been made intraoperatively in. From the nuclear medicine service, veterans affairs medical center and nuclear radiology section, department of radiology, medical college of georgia, augusta, georgia. Ipas is benign, asymptomatic, stable over years of followup imaging and often. Intrathoracic splenosis is a rare condition that usually occurs following trauma. A catalogue record for this book is available from the british library library of congress cataloguinginpublication data sharp, peter f. Scintigraphic image acquisition of nuclear medicine requires administration of various kinds of radiopharmaceuticals, which go into specific organ and are imaged by gamma camera. Selected atlases of bone scintigraphy atlases of clinical. A csf shunt study is used to evaluate ventricular shunt patency and function. Preoperative diagnosis of splenosis by 99m tcsulfur colloid scanning fitzer, p m, m.
Radiology publishes cutting edge and impactful imaging research articles in radiology and medical imaging in order to help improve human health. It is an acquired condition and is defined as autoimplantation of one or more focal deposits of splenic tissue in various compartments of the body. Guide for authors aims and scope nuclear medicine and biology publishes original research addressing all aspects of radiopharmaceutical science. The newly implanted splenule will become vascularized by adjacent pulmonary vessels. Intrathoracic splenosis is a rare condition that usually occurs following. Massey md, stevens sresidual spleen found on denatured red blood cell scan following negative colloid scan. This book looks at the latest research studies on apoptosis in medicine. Department of radiology, faculty of medicine siriraj hospital, department of. Nuclear medicine shunt patency procedures johns hopkins. When tc99m sulfur colloid fails to confirm the presence of splenic tissue, tc99mtagged heatdamaged rbc scan tc99mdrbc with autologous erythrocytes. Annals of nuclear medicine, volume 6, issue 2 springer. Division of nuclear medicine department of radiology siriraj hospital october 2016 2. One of the missions of the nuclear medicine physician is to promote.
This manuscript presents radiological and scintigraphic images of splenosis foci located in the peritoneal cavity and liver capsule of a 46yearold man who underwent splenectomy due to traumatic splenic rupture 30. Infrequently performed studies in nuclear medicine. Splenosis in the abdominal and pelvic cavities occurs more frequently than in the thoracic cavity and ts is commonly accompanied by abdominal splenosis 3, 9. To evaluate the usefulness of tc99mlabelled denatured red. Intrathoracic splenosis nuclear medicine radiology case. Nuclear medicine therapy presents the state of the art in targeted radionuclide therapy, both in clinical practice and contemporary clinical investigation and trials. For dose estimation in nuclear medicine, the mird model by berman et al.
Nuclear medicine is a fascinating application of nuclear physics. Csf shunt study ga68 dotatate petct gallium gastric emptying and reflux gastric retention study gastrointestinal bleeding study glomerular filtration rate gfr gates method hemangioma hepatobiliary cholecystitis hepatobiliary leak hepatobiliary neonatal jaundice hepatobiliary sphincter of oddi liver maa pre y90 microspheres liver spleen scan. The differential diagnosis of splenosis foci from malignant masses can be challenging by conventional imaging and lead to unnecessary invasive procedures. Chest ct scan with multiple pleural and mediastinal nodules. Biopsy is not essential for the diagnosis once nuclear medicine can confirm. Splenosis is an acquired ectopic autotransplantation of splenic tissue. Pdf role of nuclear medicine imaging in differential diagnosis of.
Splenosis is one type of ectopic splenic tissue the other being accessory spleen. Focal tumorlike conditions of the pleura include pleural plaque, thoracic splenosis, thoracic endometriosis causing catamenial pneumothorax, and pseudotumor caused by pleural effusion. The fourth edition of clinical nuclear medicine highlights the continued growth in clinical applications for pet and other aspects of molecular imaging. Clinical radiology 1994 49, 115117 scintigraphic detection of splenosis. Intrathoracic splenosis nuclear medicine radiology. Essential nuclear medicine physics provides an excellent introduction to the basic concepts of the daunting area of nuclear physics. Nuclear medicine conventional, mr, ct, spleen, abdomen. General nuclear medicine nuclear medicine imaging uses small amounts of radioactive materials called radiotracers that are typically injected into the bloodstream, inhaled or swallowed. The first isotope commonly called hydrogen has a mass number of 1, an atomic number of 1 and hence is identified as. Icrp 2001 has also published a model for iodine in the pregnant woman and the foetus. Nuclear cardiology encompasses studies that diagnose and risk stratify.
What will happen when you have your csf shunt study. The shunt system is generally composed of a valve that regulates flow of cerebrospinal fluid csf, a proximal catheter that drains it from the brain or spinal column to the valve and a distal catheter that drains the csf from the valve into the abdominal cavity or heart generally. Lymphoscintigraphy with 99m tcsulfur colloid has been used to determine regional lymph node drainage pathways from malignant neoplasms, which may direct therapeutic management decisions, including radiation therapy fields. Selected atlases of bone scintigraphy atlases of clinical nuclear medicine softcover reprint of the original 1st ed. It is used to demonstrate patency of the system and to localize the general area of obstruction, which can be important for presurgical planning. Overview this procedure differs from a total body bone scan in that images are taken of a particular area of interest in both an arterial phase, a cellular blushblood pool stage, and a normal static stage. A tc99m sc liverspleen scan of the abdomen and thorax indicated the lung density was consistent with thoracic splenosis. Ana p i nuclear medicine study renal imaging, static e. Get a printable copy pdf file of the complete article 1.
This wikibook is intended to support a basic introductory course in an early semester of an undergraduate program. Accessory spleen is a congenital anomaly found in approximately 10% of the population, with only one out of six cases occurring in the pancreatic tail 1, 2. Man, 53 yearsold, ctscan for sudden rise of alphafetoprotein in a cirrhotic subject. Preoperative diagnosis of splenosis by 99mtcsulfur. Technetium99m sulfur colloid liver and spleen imaging. Doctors perform tests for diagnosis using nuclear medicine assuming that the risk of disease is more serious than the possible harm to the patient. A clinicians guide to nuclear medicine, 2nd edition. The nuclear medicine physician may follow the conventional liverspleen scan with spect imaging for detection of deep lesions. Atlas of clinical nuclear medicine journal of nuclear. Any information contained in this pdf file is automatically generated from digital material submitted. Computed tomography ct of the abdomen identified 5 further nodules around the stomach and in the lower abdomen.
Preoperative diagnosis of splenosis in these patients should be made with the use of nuclear imaging studies such as the 99m tc heatdamaged erythrocyte study rather than ctguided biopsy or invasive surgery. Section head, nuclear medicine and molecular imaging. A small injection of a radioactive tracer will be injected into the shunt reservoir. The third isotope commonly called tritium is identified as. The ability to learn faster will accelerate the progress you make as you study for the test.
With contributions from an internationallydistinguished group of physicians and scientists, the book is devoted entirely to the use of nuclear medicine techniques and technology for therapy of malignant and benign diseases. It is used to evaluate for various liverspleen diseases. Guide for authors nuclear medicine and biology issn. A patient with profound weight loss, positive ppd and left upper lobe lung density on a chest radiograph was felt to have a strong clinical suspicion of a malignant pulmonary lesion. Nuclear medicine protocols the university of new mexico. The radiotracer travels through the area being examined and gives off energy in the. It involves application of radioactive substances in very tiny amount to human body by injection, ingestion, or inhalation. Logically structured and clearly written, this is the book of choice for anyone entering the field of nuclear medicine, including nuclear medicine residents and fellows, cardiac nuclear medicine fellows and nuclear medicine technology students. The second isotope commonly called deuterium has a mass number of 2, an atomic number of 1 and is identified as. The majority of cases of ts are asymptomatic and are diagnosed in the course of an evaluation of incidentally discovered pulmonary lesions. Ectopic splenic implants in the thoracic cavity and subcutaneous tissue are comparatively rare. It is divided into three sections covering general aspects of nuclear medicine, the role of nuclear endocrinology in diagnosis, and the role of nuclear endocrinology in therapy. Imaging features of intrapancreatic accessory spleen. A thorough description of the shunt anatomy should be provided to nuclear medicine prior to injection.
The authors present a case that demonstrates the continued high sensitivity of tc99m sc liverspleen imaging for thoracic splenosis. The radiotracer travels through the area being examined and gives off energy in the form of gamma rays which are detected by a special. Thoracic splenosis is a rare condition resulting from. The book is organized by sections of increasing difficulty, with over 600 multiplechoice questions covering all areas of nuclear medicine, including radiation safety. Chapter 1 click here for an animated version of this figure. A case of intrahepatic splenosis after splenic rupture with difficulty in.
Superiority of tomographic selective spleen scintigraphy i. Request pdf identification of perirenal or renal splenosis from undetermined masses. Thoracic splenosis as a differential diagnosis of juxtapleural nodules. Selected views of the tc99m sulfur colloid nuclear scan showing increased. Superior demonstration of splenosis by heatdenatured tc99m. Indications determination of abscesses such as osteomyelitis vs cellulitis of the soft tissue. Guide for authors nuclear medicine and biology issn 09698051. Welcome to the radiology assistant educational site of the radiological society of the netherlands by robin smithuis md. The snmmieanm will periodically define new standardsguidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients.
Dacroscintigraphy, the nuclear medicine lacrimal gland study, is a noninvasive, lowradiationdose method of evaluating the nasolacrimal drainage system. Nuclear medicine physicians have almost uniformly been willing to share their expertise at national and international meetings. A noninvasive diagnosis in the age of nuclear medicine splenosis is a benign entity whereby splenic tissue autotransplants, generally in the abdominal or peritoneal cavity, following spleen rupture or splenectomy. There is no preparation for the liverspleen scan, however if you have recently had a barium study, the scan may not be scheduled for a few days as the barium. Nuclear medicine technology study guide springerlink. Role of nuclear medicine imaging in differential diagnosis. Evaluation of ventriculoatrial or ventriculoperitoneal shunt patency. Uptake could be clearly identified in only 3 of the nodules, so a tc99m heatdenatured red blood cell rbc study was undertaken. Common nuclear medicine studies ii jiraporn sriprapaporn, m. If cavernous hemangioma is suspected, the colloid scan should be followed by a tc99mlabeled rbc study ordered as a radionuclide hepatic angiogram. All six patients had a history of splenic injury, due to falls or traf.