cns system

Which radiopharmaceutical is used for ictal SPECT imaging? a. 99mTc-HMPAO b. 111In-labeled DTPA c. 99mTc-pertechnetate d. 18F-FDG

a. 99mTc-HMPAO

. A patient is scheduled for a SPECT brain procedure. Before the radiopharmaceutical is administered, the patient should a. be well hydrated. b. be placed in a quiet, dimly lit room. c. have received Lugol's solution. d. have undergone a CT scan of the brain.

b. be placed in a quiet, dimly lit room.

2. 99mTc-pertechnetate and 99mTc-DTPA are two examples of radiopharmaceuticals that a. distribute in the cerebral parenchyma according to blood flow. b. distribute in the blood vessels. c. can distribute between synapses to image psychological disorders. d. only distribute in situations of an altered blood-brain barrier.

b. distribute in the blood vessels.

All of the following are true about acetazolamide or its use in brain imaging EXCEPT a. it acts as a vasodilator. b. it causes increased perfusion. c. it serves to localize an epileptogenic focus. d. it improves diagnostic accuracy in cerebral vascular disease.

b. it causes increased perfusion.

A patient arrives at a nuclear medicine department for a CSF shunt evaluation. The technologist readies the patient for an injection into the a. antecubital vein. b. shunt reservoir. c. subarachnoid space. d. shunt tubing.

b. shunt reservoir.

. A patient is sent to the nuclear medicine department for a CSF study. The technologist prepares for the radiopharmaceutical injection by a. dimming the lights in the procedure room. b. setting up a three-way stop cock with a saline flush. c. setting up for an intrathecal injection. d. observing the patient for seizures.

c. setting up for an intrathecal injection.

CSF is made mostly of: (a) Protein (b) Water (c) Glucose (d) Blood

(b) Water

The dose which would commonly be used for a radionuclide angiogram with 99mTc DTPA is: (a) 5 mCi (b) 10 mCi (c) 20 mCi (d) 25 mCi

(c) 20 mCi

What is the usual dose for a radionuclide cisternogram in adults? (a) 5 mCi of 111In DTPA (b) 100 μCi of 111In DTPA (c) 500 μCi of 111In DTPA (d) 2.5 mCi of 111In DTPA

(c) 500 μCi of 111In DTPA

Why is 111In DTPA preferred over 99mTc DTPA for cisternography in adults? (a) Because it has lower-energy photons (b) Because it has two photopeaks (c) Because it has a longer half-life allowing delayed imaging (d) Because it has a superior biodistribution

(c) Because it has a longer half-life allowing delayed imaging

For DaTscan® study, which of the following is correct? (a) DaTscan® detects beta-amyloid deposition. (b) DaTscan® detects brain infarction. (c) DaTscan® detects brain presynaptic dopamine transporter. (d) DaTscan® detects brain neurofibrillary tangles. (e) DaTscan® detects brain Lewy bodies.

(c) DaTscan® detects brain presynaptic dopamine transporter.

Which dose could be used for 99mTc ECD or 99mTc HMPAO for SPECT brain imaging? (a) 2-5 mCi (b) 5-7 mCi (c) 7-10 mCi (d) 20 mCi

(d) 20 mCi

. Which radiopharmaceutical is not commonly used for brain perfusion imaging with SPECT? (a) 99mTc DTPA (b) 99mTc HMPAO (c) 99mTc ECD

(a) 99mTc DTPA

Planar images of the brain using 99mTc DTPA are obtained: (a) Immediately after the dynamic exam (b) 30 min after injection (c) 1 h after injection (d) 1.5 h after injection

(a) Immediately after the dynamic exam

Which of the following is true regarding injection of the radiopharmaceuticals for SPECT brain imaging? (a) Lights should be dimmed during injection. (b) The patient should be encouraged to read or watch TV during injection to take his or her mind off any pain. (c) Family members should be allowed to talk to the patient during injection. (d) Injection should be made immediately after venous puncture to avoid clot formation.

(a) Lights should be dimmed during injection.

The function of cerebrospinal fluid is to: (a) Protect the brain and spinal cord against shock. (b) Filter plasma. (c) Produce neurotransmitters. (d) All of the above.

(a) Protect the brain and spinal cord against shock.

HMPAO and ECD are lipophilic agents that do not significantly redistribute in the brain. (a) True (b) False

(a) True

In a Diamox challenge study, vascular disease will appear as decreased perfusion after the use of Diamox. (a) True (b) False

(a) True

When positioning for a radionuclide angiogram, the patient should be positioned: (a) Posteriorly (b) Anteriorly (c) With as much facial activity as possible excluded (d) None of the above

(b) Anteriorly

. The venous phase of a cerebral blood flow study is signaled by: (a) Visualization of the jugular veins (b) Appearance of the radiopharmaceutical in the superior sagittal sinus (c) Disappearance of radiopharmaceutical from the carotid arteries (d) Appearance of radiopharmaceutical in the middle cerebral arteries

(b) Appearance of the radiopharmaceutical in the superior sagittal sinus

The localization of 99mTc HMPAO is related to: (a) A breakdown of the blood-brain barrier (b) Cerebral blood flow (c) Glucose metabolism (d) Distribution of neuroreceptors

(b) Cerebral blood flow

. A technologist neglects to give a patient potassium perchlorate before injection with 20 mCi of 99mTc pertechnetate. How will this affect the static brain images taken at 1 h after injection? (a) Thyroid activity may be seen. (b) Choroid plexus may be seen. (c) Salivary glands may be seen

(b) Choroid plexus may be seen.

. White matter has about four times greater blood flow than gray matter: (a) True (b) False

(b) False

. In which area is the radiopharmaceutical not visible in a normal cisternogram? (a) Basal cisterns (b) Cerebral convexities (c) Lateral ventricles (d) Sylvian fissure

(c) Lateral ventricles

The images obtained with a PET study using 18FDG can best be described as: (a) Anatomical (b) Perfusion (c) Metabolic (d) Dynamic

(c) Metabolic

To prepare a patient for DaTscan® study, which of the following is correct? (a) NPO overnight or at least 4 h. (b) No coffee or tea at least 12 h prior to the study. (c) Thyroid blockage by SSKI prior to the study is required. (d) Void before imaging

(c) Thyroid blockage by SSKI prior to the study is required.

The purpose of placing an elastic band around a patient's head just above the orbits during a radionuclide angiogram is: (a) To decrease the activity from the orbits (b) To increase intracranial pressure (c) To decrease blood supply to small scalp vessels (d) To immobilize the patient

(c) To decrease blood supply to small scalp vessels

What is the purpose of pledget placement in a suspected CSF leak? (a) To make the patient more comfortable during subarachnoid puncture (b) To alter the biodistribution of the radiotracer (c) To test them for contamination suggesting the presence of leaking CSF in the nose or ears (d) To avoid contamination of the scintillation detection system

(c) To test them for contamination suggesting the presence of leaking CSF in the nose or ears

CSF dynamics are studied following administration of 111In DTPA: (a) Via intravenous injection (b) Via intraperitoneal injection (c) Via intrathecal injection (d) Via intradermal injection

(c) Via intrathecal injection

To perform a DaTscan® study, which of the following is correct? (a) Imaging can be obtained 3-6 h after tracer injection. (b) Dedicated head holder should be used. (c) The camera should be very close to the head. (d) (a-c).

(d) (a-c).

Which of the following agents will cross an intact blood-brain barrier? (a) 99mTc DTPA (b) 99mTc GH (c) 99mTc pertechnetate (d) 99mTc HMPAO

(d) 99mTc HMPAO

. Advantages of using ECD over HMPAO for SPECT imaging of the brain include: (a) Can be injected up to 6 h after preparation (b) More rapid clearance from the bloodstream (c) Better target to background ratio (d) All of the above (e) None of the above

(d) All of the above

. Considerations for successful SPECT imaging of the brain include: (a) Minimizing sensory stimulation during injection (b) Minimizing patient to detector distance (c) Immobilizing the patient (d) All of the above (e) (b) and (c) only

(d) All of the above

Ictal SPECT and PET studies require an injection of radiopharmaceutical: (a) During a seizure (b) Immediately after a seizure (c) Between seizures (d) Both (a) and (b)

(d) Both (a) and (b)

. Radionuclide angiography is most commonly used to: (a) Locate neoplasms (b) Investigate brain perfusion (c) Evaluate cerebrovascular reserve (d) Confirm brain death

(d) Confirm brain death

. The injection for a CSF shunt patency study is: (a) Intravenous (b) Subcutaneous (c) Intrathecal (d) Into the shunt reservoir or tubing

(d) Into the shunt reservoir or tubing

Shunts which divert the flow of CSF are often used to treat: (a) Communicating hydrocephalus (b) Noncommunicating hydrocephalus (c) CSF leak (d) All of the above (e) (a) and (b) only

(e) (a) and (b) only

The most commonly encountered radiopharmaceutical for imaging CNS tumors is a. 99mTc-ECD. b. 18F-FDG. c. 18F-thymidine. d. 11C-methionine.

a. 99mTc-ECD.

Acetylcholine is a. excitatory in the brain and inhibitory in the heart. b. inhibitory in the brain and excitatory in the heart. c. excitatory in the brain and excitatory in the heart. d. inhibitory in the brain and inhibitory in the heart.

a. excitatory in the brain and inhibitory in the heart.

Following a nuclear medicine study to assess CSF dynamics, the patient should be instructed to a. remain in a horizontal position for 2 hours after injection. b. drink plenty of fluids and void urine frequently. c. keep distance between themselves and children for 2 days after injection. d. not have any radiographic brain studies for 1 week.

a. remain in a horizontal position for 2 hours after injection.

. A patient is sent to the nuclear medicine department to have a CNS 111In-DTPA study performed to a. assess integrity of the blood-brain barrier. b. assess cerebral spinal flow dynamics. c. localize seizure focal points. d. assess brain death.

b. assess cerebral spinal flow dynamics.

To produce high-resolution, low-noise images, the resolution in the images on a SPECT brain scan, the technologist will a. use the electronic zoom. b. use pre- and postprocessing filters. c. perform the attenuation correction outside the ellipse. d. use a transmission scan.

b. use pre- and postprocessing filters.

Exametazime is also known as: (a) DTPA (b) MAG3 (c) HMPAO (d) ECD

c

Which form of dementia demonstrates on SPECT with hypoperfusion and PET with reduced glucose metabolism in the frontal and temporal lobes with sparing of the remaining cerebral cortex? a. Alzheimer's disease b. Parkinson's disease c. Frontotemporal dementias d. Lewy body dementia

c. Frontotemporal dementias

The intrathecal injection for CSF imaging allows for the dose to be a. administered during a seizure. b. administered into the subdural space. c. administered into the subarachnoid space. d. administered into the spinal cord

c. administered into the subarachnoid space.

. 99mTc-HMPAO is an example of radiopharmaceutical that a. does not cross the blood-brain barrier but diffuses across an altered blood-brain barrier. b. most accurately demonstrates CSF dynamics and any altered CSF pathology. c. is a neutral lipid-soluble radiopharmaceutical and crosses the blood-brain barrier. d. is an analog to glucose and is avidly picked up by the brain.

c. is a neutral lipid-soluble radiopharmaceutical and crosses the blood-brain barrier.

All of the following are true regarding SPECT or PET functional brain imaging on patients with neurodegenerative disease, EXCEPT a. may show structural changes before anatomic imaging. b. may identify those patients with mild cognitive impairment who are more likely to progress. c. may slow the progression of certain forms of neurodegenerative disease. d. certain patterns of radiopharmaceutical distribution are suggestive for specific types of dementia.

c. may slow the progression of certain forms of neurodegenerative disease.

The images in a cerebrospinal fluid leak study show an initial wide segmental appearance with no activity in the basal cisterns at 2 to 3 hours after injection. The technologist should a. count the pledgets. b. continue routine images at 6, 24, and 48 hours after injection. c. prepare for a reinjection. d. have the patient change position and then repeat the image.

c. prepare for a reinjection.

Bicisate is also known as: (a) DTPA (b) MAG3 (c) HMPAO (d) ECD

d ecd

All of the following may be spared from the effects of Alzheimer's disease, EXCEPT a. thalamus. b. basal ganglia. c. visual cortex. d. frontal lobe.

d. frontal lobe.

A patient is scheduled for a 99mTc-HMPAO brain scan. The technologist must remember that 99mTc-HMPAO a. only crosses a compromised blood-brain barrier and in proportion to blood flow. b. remains trapped in the subarachnoid space for 20 minutes after injection. c. acts as an analog to thallium-201. d. remains trapped in the brain in proportion to cerebral blood flow at the time of injection.

d. remains trapped in the brain in proportion to cerebral blood flow at the time of injection.