Scans: Dr. Padmesh. V

SCANS
Dr. Padmesh. V
Diuretic Renal scans:
Diuretic Renal scans:

These are primarily done to rule out
obstruction at Pelvi-ureteric or Vesico-ureteric
junction in a child with hydronephrosis.
Additionally, information about the function
of each kidney can be gathered.
There are 3 agents which can be used for a
diuretic renal scan- DTPA or MAG3 or LLEC.
All three are good but LLEC is supposed to be
the best as the image quality is the best.
DTPA / MAG 3 Scan

Involves an injection of either DTPA
(99mTc-diethylene triamine
pentaacetic acid) or MAG3 followed
by immediate images of the kidneys as
the injection enters the body.
In doing this, we can get information on
renal blood flow,
GFR,
tubular function and
urinary excretion.
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DTPA / MAG 3 Scan

Clinical Indications:
Assessment of GFR
Differential renal function
Acute renal failure
Chronic renal failure
Acute & chronic rejection
Screening of patients with suspected renal
hypertension
Obstruction
Hydronephrosis
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DTPA / MAG 3 Scan
DTPA / MAG 3 Scan
DTPA scan showing retention of

isotope in Left kidney, right kidney
has cleared off well.
DMSA Scan
DMSA Scan
Technetium99m DMSA (Di mercapto
succinic acid) is the radiotracer that is
injected intravenously into the patient in
order to visualise the renal cortex of the
kidneys.
This injection will take 3 hours to be
bound to the kidneys before any imaging
can commence.
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DMSA Scan
Assessment of Renal Scarring

Urinary Tract Infection
Pyelonephritis
Renal infarct
Horseshoe kidney
Ectopic kidney
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DMSA Scan
DMSA Scan
Horse-shoe kidney
DMSA Scan
Right pelvickidneyon Tc99m-DMSA scan.
Ectopic kidney
Bone Scan
Bone Scan
A Bone scan is a two part test involving an
intravenous radioactive injection
(Technetium99m HDP) followed by images
of the blood flow and blood pool to the
area of interest.
The HDP takes 2-3 hours to be absorbed
by the bones, so a delay is required in
order to visualise the bone structures.
Bone Scan
Metastatic Disease
Primary Malignant Bone Tumours
Benign Primary Tumours
Osteomyelitis
Septic Arthritis
Fractures - Traumatic, Stress, Insufficiency
Pagets Disease
Avascular Necrosis
Legg-Calve Perthes Disease
Arthritides - Degenerative Joint Disease, Rheumatoid
Arthritis, Pseudoarthritis.
Bone Scan
Bone Scan
POSITIVE BONE SCANS OBSERVED IN A
VARIETY OF TUMOR TYPES;
BONE METASTASIS:
HIDA SCAN
HIDA SCAN
Patients will be injected with Technetium99m Hepatolite
(HIDA) .
Hydroxy imino diacetic acid (HIDA).

Images will be taken of the liver and gallbladder for about 60
minutes.
After this time, we will determine if the patient requires a
CCK infusion or a morphine injection.
The CCK infusion simulates the patient eating a fatty meal,
so if the gallbladder is visualised, we should expect it to
empty after the CCK infusion.
However, if the gallbladder is not seen after 60 minutes and
infusion of morphine may be given to contract the sphincter
of Oddi, which increases biliary pressure, in order to help
visualise the gallbladder.
HIDA SCAN
Biliary atresia
Neonatal hepatitis (Parenchymal liver dis)
Abnormal biliary leakage
Acute Cholecystitis
Chronic Cholecystitis
HIDA SCAN
Interpretation
A normalresult means that the gallbladder is visualized within 1
hour of the injection and the tracer is in the small intestine.
GB not visualized:If the gallbladder is not visualized within 4
hours after the injection it indicates that there is either
cholecystitis or cystic duct obstruction.
Tracer not visualized in intestinesmeans common bile duct
obstruction. If the radioactive tracer moves through bile ducts
very slowly, this may indicate a blockage or obstruction. Or it may
indicate a problem in liver. .
If the radioactivetracer is found outside of biliary systemit
indicates a leak.
Uptake is poor in parenchymal liver disease, such as neonatal
hepatitis, but excretion into the bile and intestine
eventually ensues.
HIDA SCAN
Imaging results are best when scanning is preceded by a 5-7
day period of treatment with phenobarbital to stimulate bile
flow.
After intravenous injection, the isotope is normally detected in
the bowel within 1-2 hr.
In the presence of extrahepatic obstruction, excretion of the
isotope is delayed; accordingly, serial scans should be made for
up to 24 hr after injection.
Early in the course of biliary atresia, hepatocyte function is
usually good; uptake (clearance) occurs rapidly, but
excretion into the intestine is absent. Visualization of
bowel excludes biliary atresia.
In contrast, uptake is poor in parenchymal liver disease,
such as neonatal hepatitis, but excretion into the bile
and intestine eventually ensues. Visualization of bowel
by 4-24 hrs more typical of neonatal hepatitis.
HIDA SCAN
HIDA SCAN
HIDA SCAN
BILIARY
ATRESIA:
The dye acts like

bilirubin. If the baby has
biliary atresia, the liver
will take up the dye but
it will not be able to flow
through the damaged
biliary system into the
small intestine. Rather,
the tracer enters the
circulation and collects
in the bladder.
24 hour monitoring
Visualization of bowel excludes biliary
atresia
may be
done.
HIDA SCAN
Poor uptake of isotope

by liver
Lung Scan (V/Q)
Lung Scan (V/Q)

For this study, patients are required to
inhale some radioactive gas in order to
visualise the ventilation to the lungs.
This ventilation image is then acquired
prior to an injection into the vein in order
to visualise the Perfusion to the lungs.
Once the Perfusion image is finished, we
are able to compare the two images and
look for any mismatches in the perfusion
image.
Lung Scan (V/Q)

Pulmonary Embolism
Assessment prior to lung reduction surgery
Lung Scan (V/Q)
Lung Scan (V/Q)
3-year-old boy withpulmonaryembolism.

A, Perfusionscandemonstrates no significant perfusion to
the right lung.
B, Ventilationscandemonstrates normal ventilation to both
lungs.
Lung Scan (V/Q)
Almost absence of perfusion of right lung in the perfusion scan

with normal ventilation.
Thyroid Scan
Thyroid Scan
A thyroid scan involves an intravenous
injection of Technetium Pertechnetate.
Enables us to determine the function of
the thyroid gland with or without the
presence of nodules.
It also determines the presence and site
of the thyroid tissue such as in thyroid
bed of a completely excised gland or in
other locations (ie sublingual). (ectopic)
Thyroid Scan
Hyperthyroidism - determine cause

Nodules - Assess activity
Find ectopic thyroid site
This scan has no role in the evaluation of
hypothyroidism without the presence of nodules
Thyroid Scan
Thyroid Scan
Multiple nodules
in thyroid
HOT NODULE
COLD NODULE
Thyroid Scan
Thank you!
http://oscepediatrics.blogspot.in/
http://www.slideshare.net/Dr_Padmesh

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SCANS

Diuretic Renal scans:

Diuretic Renal scans:

DTPA / MAG 3 Scan

DTPA / MAG 3 Scan

DTPA / MAG 3 Scan

DTPA / MAG 3 Scan

DTPA scan showing retention of

Assessment of Renal Scarring

Hydroxy imino diacetic acid (HIDA).

The dye acts like

Poor uptake of isotope

Lung Scan (V/Q)

Lung Scan (V/Q)

Lung Scan (V/Q)

Lung Scan (V/Q)

Lung Scan (V/Q)

3-year-old boy withpulmonaryembolism.

Lung Scan (V/Q)

Almost absence of perfusion of right lung in the perfusion scan

Hyperthyroidism - determine cause

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