Glossaries including common reporting terms and current classifications used can be found here: Nuclear Medicine or Ultrasound. Below is a list of useful links on this website. LINK CLINICAL ULTRASOUND NUCLEAR IMAGES Aortic aneurysm screening YES YES – – Back pain and bone scans YES YES YES Basic description of tendinopathy YES YES – YES Bone scans and the use […]
The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning Christian John Barton, Simon Lack, Steph Hemmings, Saad Tufail, and Dylan Morrissey. Br J Sports Med 2015;49:923-934. Patellofemoral pain is a chronic and prevalent condition that has complex aetiology and multiple treatment options.T his is a well thought out review […]
Basic principles Recent advances in ultrasound technology have led over several years to the development of elastography. This is the ultrasound equivalent of clinical palpation. There are different types of shear elastic properties which can be assessed by ultrasound. Several types have developed using different deformation forces and different ways of measuring the force. A […]
NUCLEAR TRACERS used in imaging prosthetic joints The tracers discussed in this article are: Tc-MDP: bone scintigraphy Tc-sulesomab (trade name LeukoScan): in vivo labelled Fab fragment of IgG1. While this also binds to neutrophils (5%) and therefore should mimic WBC labelled scans it has a non-specific accumulation at infected sites. 35% of activity at 24hrs is […]
Thyroid nodules are very common and a small percentage of these are malignant. Ask 10 thyroid specialists about their approach to biopsy and diagnosis and you will get 10 different approaches. All will be rational and based on reasonable scientific data and on experience. The different approaches arise because the research is varied in its […]
Lung scans fell out of favour with the advent of multislice CT pulmonary angiography (CTPA) which offered a great improvement on the accuracy of lung scans shown by the PIOPED study done in the 1980’s. There is no doubt that CTPA is a readily available test for diagnosing pulmonary embolism. Nuclear technology has also moved on since the PIOPED study and more recent studies from various centres tend to suggest that there is very little difference in accuracy between the two modalities. In practice it is the appropriate use and application of the test that is more important than whether it is CTPA or V/Q lung scanning. The PIOPED II STUDY (New Engl J Med 2006,354:2317) showed the overall sensitivity of CTPA for the diagnosis of pulmonary embolism was 83% and the specificity was 96%. However, these data excluded CT studies that were technically inadequate or un-interpretable . When all the studies are included the sensitivity and specificity fall to 78% and 90% respectively. The positive predictive value was 86% and the negative predictive value was 95%. Most notably the positive predictive value was only 58% when the clinical probability was low. Therefore additional testing is necessary when clinical probability is inconsistent with the scan results.
Yellow=perfusion and green=ventilation
Wang, Feng MD et al in Clinical Nuclear Medicine July 2009 (Volume 34 – Issue 7 – pp 424-427) concluded V/Q lung scan, perfusion scan combined with CR and CTPA all show high efficacy in diagnosing pulmonary embolism.
In a head to head comparison (all patients had both tests) of CTPA and SPECT-CT lung scans Gutte et al (V/Q SPECT AND LOW-DOSE CT VS MDCT IN PE. J Nucl Med 2009; 50:1987–1992) found SPECT-CT lung scans had a sensitivity of 97% and specificity of 100%. CTPA alone had a sensitivity of 68% and a specificity of 100%.
In a very recent study done at the Charles Gairdner Hospital Perth (Ling et al. Internal medicine Journal 2012;42:1257-1260) they demonstrated that the addition of low dose CT increases the diagnostic yield by providing alternative diagnoses and contributed to a final diagnosis in 36%. Their use of SPECT-CT for the diagnosis of pulmonary embolism had a sensitivity , specificity, and negative predictive values of 93%,100%, and 97% respectively.
[…]
This middle aged female was referred with shortness of breath and a CXR reported as showing oligaema in the left upper zones that could indicate pulmonary embolism. The reconstructed planar lung scan showed a large matched defect corresponding to the left upper lobe. The SPECT-CT scan shows a large airspace is responsible for the abnormality -most […]
