CNSExam

2 names for 99mTcCeretec:

HMPAO and exametazine (It becomes immediately hydrolyzed)

18F-FDG is a glucose analog that maybe used to evaluate glucose metabolism?

TRUE

A low pass filter can over smooth and therefore lead to contrast loss in slices

TRUE

A low pass filter in nuclear medicine is a Butterworth:

TRUE

Filtering reduces noise:

TRUE

Mannitol can also be used as a facilitating agent for the transportation of pharmaceuticals directly into the brain:

TRUE

Pre processing= 2-D smoothing filter to planar images:

TRUE

The COR and FOV uniformity and attenuation corrections are applied during reconstruction:

TRUE

201Tl can be used for brain tumor imaging?

TRUE, , it diffuses across an altered BBB:

15. Which one of the following statements regarding DaTscan imaging is false? a. DaTscan is classified as a Schedule 1 controlled substance b. DaTscan imaging can reduce overdiagnosis of Parkinson's disease c. DaTscan imaging can help distinguish patients with essential tremor from Parkinson's tremor d. DaTscan is structurally related to cocaine

a. DaTscan is classified as a Schedule 1 controlled substance

When imaging for epileptic foci, the radiopharmaceutical injection occurs: a. 2 hours prior to the scheduled scan b. during the ictal state c. during the interictal state d. when the patient is in a private room

b. during the ictal state

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

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 post-processing filters c. perform the attenuation correction outside the ellipse d. use a transmission scan

b. use pre- and post-processing filters

18. The maximum approved dosage of In-111 DTPA for cisternography is: a. 50 microcuries b. 250 microcuries c. 500 microcuries d. 2 millicuries

c. 500 microcuries

SPECT reconstruction:

smoothing, ramp filter, buttersworth, ect.

I213: KCl04 or Lugol's solution is given _______hrs_ prior to rphx administration

1-24

Average number of counts recommended for each projection in a brain SPECT study is:

200K counts

Delayed imaging

• DTPA --> 0.5-1 hour • HMPAO --> 0.25-3 hours • 123I-iodoamphetmine--> 0.5-1 • 133 Xe gas----> none • Pertechnetate ---> 2-4 hours

What makes for positive criteria for brain death:

• ECG with flat response 2 times, 24 hours apart • Areflexic extremities • Pupils are unreactive • No gag reflux • No response to posturing to the supra-orbital stimulation

How long after a 99mTc neurolite kit prepared is it good for:

6 hours

Which is more stable once reconstituted? Neurolite or HMPAO?

99mTc Neurolite (less breakdown in the kit)

Name Non-BBB penetrating rphxs:

99mTc-DTPA TcO4- 201Tl(nonlipophillic)

What is another name for 99mTc Neurolite?

99mTc-ECD

BBB penetrators:

99mTc-HMPAO, 99mTc-ECD, 133 Xe gas, 111In-DTPA

The application of a smoothing filter will increase the noise of images:

FALSE

We need to use a blocking agent with 99mTc DTPA:

FALSE

BBB is an anatomical membrane:

FALSE: a physiologic mechanism

A RAMP filter is a low-pass filter:

FALSE; high pass filter

Delayed standard planar images of 99mTc should take place immediately post injection?

False

Amyvid is the third FDA-approved agent for:

False, the first

99mTcECD or 99mTc-HMPAO requires a filter for injection?

HMPAO

Which has lipophilic agents shows more rapid brain clearance and has a higher brain/soft tissue ratio:

Neurolite

QUIZ SHOW

QUIZ SHOW

13. Which one of the following statements is true? a. F-18 fluorodopa and I-123 ioflupane have similar patterns of distribution in the brain but different mechanisms of localization b. I-123 ioflupane binds to VMAT 2 whereas F-18 fluorodopa binds to presynaptic DAT c. I-123 ioflupane binds to presynaptic DAT whereas F-18 fluorodopa binds to VMAT 2 d. I-123 ioflupane uptake is a measure of dopamine synthesis

a. F-18 fluorodopa and I-123 ioflupane have similar patterns of distribution in the brain but different mechanisms of localization

11. During an acetazolamide stress test, which one of the following statements is true for a patient with non-compliant CVR? a. The brain region in question demonstrates decreased blood flow at stress compared to rest. b. The brain region in question demonstrates no difference in blood flow at rest and stress c. A patient with an infarct would have a blood flow as described in response "b" above d. The patient is administered 30 mCi Tc-HMPAO followed by 1 gram of acetazolamide intravenously

a. The brain region in question demonstrates decreased blood flow at stress compared to rest.

When compared to FDG PET images, 99mTc-sestamibi SPECT brain images have a lower resolution but: a. a higher target-to-nontarget contrast b. a lower target-to-nontarget contrast c. the same target-to nontarget contrast d. comparable target-to-nontarget contrast

a. a higher target-to-nontarget contrast

7. The rationale for using Tc-99m labeled HMPAO or ECD for localizing seizure foci in the brain is their: a. ability to measure regional cerebral blood flow b. ability to measure cellular metabolism c. ability to measure blood flow and metabolism d. hydrophilicity

a. ability to measure regional cerebral blood flow

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

What other indication is dopamine transporter imaging used for in Europe? a.) Differentiation of dementia with Lewy bodies from Alzheimer disease. b.) Evaluation of attention deficit hyperactivity disorder. c.) Large-vessel verses small-vessel disease and associated stroke risk. d.) Personality disorder related to chemical imbalance of dopamine in the brain.

a.) Differentiation of dementia with Lewy bodies from Alzheimer disease.

1. Which one of the following agents is not a typical choice for the evaluation of patients suspected of brain death? a. Tc-99m pentetate (DTPA) b. Tc-99m pertechnetate c. Tc-99m exametazime (HMPAO) d. Tc-99m bicisate (ECD)

b. Tc-99m pertechnetate

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

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 quiet dimly lit room c. have received Lugol's solution d. have undergone a CT scan of the brain

b. be placed in quiet dimly lit room

The typical adult dose of 123I-FP-CIT is... a.) 18.5 MBq (500 μCi). b.) 185 MBq (5 mCi). c.) 370 MBq (10 mCi). d.)925 MBq (25 mCi)

b.) 185 MBq (5 mCi).

1. Which of the following statements about the motor symptoms of Parkinson disease is correct? a.) Initial symmetric tremor of both hands. b.) Slow movement. c.)Flaccid bilateral limbs. d.) Rapid onset and progression.

b.) Slow movement.

Why do we image dopamine transporter (DAT) concentration rather than aspects of neuronal function for diagnosis and evaluation of Parkinson disease (PD)? a.)The major pathology of PD is not related to neurodegeneration. b.)DAT correlates with the density of dopaminergic neurons. c.)The concentration of DAT is directly proportional to dopamine synthesis. d.)Other radionuclides for neuronal function are more difficult and costly to obtain.

b.)DAT correlates with the density of dopaminergic neurons.

Things you should know about KCl0 or Lugols

blocks the salivary glands, choroid plexus, thyroid, bowel, stomach. *Patients in renal failure do not receive KCl04

10. Which one of the following statements is false? a. CVR is mediated via autoregulatory control. b. Loss of CVR is associated with chronic ischemia c. A normal CVR response is triggered by reduced amounts of carbon dioxide and hydrogen ion d. A normal CVR response maintains rCBF as perfusion pressure drops

c. A normal CVR response is triggered by reduced amounts of carbon dioxide and hydrogen ion

17. Which one of the following statements about radionuclide cisternography with In-111 pentetate (DTPA) is false? a. Choroid plexus activity will not be evident b. Radioactivity will enter the ventricular system in patients with normal pressure hydrocephalus c. Clearance of the radiotracer from the CSF space occurs by diffusion through the meningeal membranes of the spinal chord d. It normally takes 2 to 3 days for most of the In-111 radioactivity to clear from the CSF space

c. Clearance of the radiotracer from the CSF space occurs by diffusion through the meningeal membranes of the spinal chord

12. Which one of the following statements is true? a. Dopamine is synthesized in postsynaptic neurons of the striatum b. Dopamine is removed from the synaptic cleft by VMAT 2 c. Dopamine is stored in presynaptic neuronal vesicles d. Dopamine stimulates presynaptic neuronal receptors on during neuronal transmission

c. Dopamine is stored in presynaptic neuronal vesicles

14. The pattern of I-123 ioflupane activity distribution in the right and left striatum of the brain as Parkinson's disease progresses is best described as follows. a. Caudate and putamen show uniform declining activity with disease progression b. Caudate activity only declines with disease progression c. Putamen activity declines more so earlier with disease progression compared to the caudate d. Putamen activity only declines with disease progression

c. Putamen activity declines more so earlier with disease progression compared to the caudate

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

2. In a patient who is assessed clinically to be brain dead, Tc-HMPAO activity is expected to be seen in each of the following anatomic areas except the: a. carotid arteries b. nasopharynx c. brain parenchyma d. venous sinus region

c. brain parenchyma

9. All of the following are radiotracer requirements for assessing rCBF except: a. BBB penetration b. brain retention c. brain redistribution d. lipophilicity

c. brain redistribution

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

1. 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

c. it serves to localize an epileptogenic focus

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

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

Which of the following best describes the normal 123I-FP-CIT uptake scan pattern? a.) Bilateral symmetric uptake throughout the brain. b.) Intense uptake in the corpus callosum with minimal uptake throughout the rest of the brain tissue. c.) Bilateral comma-shaped uptake deep within the brain corresponding to the striatum. d.) Intense uptake in the brain stem, moderate uptake in the cerebellum, with minimal uptake elsewhere.

c.) Bilateral comma-shaped uptake deep within the brain corresponding to the striatum.

Which of the following patient preparation procedures is required for an ioflupane study? a.) Discontinuation of antiparkinsonism drugs for 10 d. b.) Sensory-attenuated state for 30 min after injection. c.) Discontinuation of all central nervous system stimulants for 4 wk. d.) Fasting 8 h before the injection.

c.) Discontinuation of all central nervous system stimulants for 4 wk.

Of what value is anatomic imaging in the diagnosis of parkinsonism? a.) None of these are correct. b.) It has absolutely no value. c.) It can rule out secondary causes of parkinsonism. d.)It can evaluate the severity of the disease

c.) It can rule out secondary causes of parkinsonism

Biorouting of 99mTc04-

choroid plexus, salivary glands, thyroid, stomach mucosa

19. Regarding evaluation of CSF leak, the nasal pledget-to-plasma activity ratio must be greater than ________ for a leak to be present. a. 5-to-1 b. 3-to-1 c. 2.3-to-1 d. 1.5-to-1

d. 1.5-to-1

8. The standard adult dose of administered activity for Tc-99m HMPAO or ECD SPECT tracers for localizing seizure foci in the brain is: a. 3 - 5 mCi b. 5 - 10 mCi c. 10 - 20 mCi d. 15 - 30 mCi

d. 15 - 30 mCi

20. Which one of the following statements is true regarding a CSF VP shunt evaluation following administration of Tc-DTPA? a. Evidence of ventricle activity indicates patency of the distal limb of the shunt b. Evidence of ventricle activity indicates obstruction of the distal limb of the shunt c. Evidence of peritoneal activity indicates patency of the proximal limb of the shunt d. Evidence of peritoneal activity indicates patency of the distal limb of the shunt

d. Evidence of peritoneal activity indicates patency of the distal limb of the shunt

5. Which one of the following statements is false regarding diagnostic imaging in temporal lobe epilepsy? a. The seizure focus with Tc-99m labeled HMPAO and ECD demonstrates increased uptake during ictus and decreased uptake interictally b. The seizure focus demonstrates decreased uptake interictally with F-18 FDG c. A desirable diagnostic procedure is to perform the ictal study with Tc-99m HMPAO and interictal study with F-18 FDG d. F-18 FDG is the best agent to use for ictal imaging because it measures both blood flow and metabolism

d. F-18 FDG is the best agent to use for ictal imaging because it measures both blood flow and metabolism

6. Which one of the following statements is false regarding SPECT imaging with Tc-99m HMPAO in temporal lobe epilepsy? a. Imaging can begin within 30 to 60 minutes and up to 4 hours post seizure b. Seizure focus identification is most accurate if the tracer is injected within 20 seconds of seizure onset c. The order of sensitivity from highest to lowest for identifying a seizure focus is ictal imaging > postictal imaging > interictal imaging d. Performing an independent ictal or postictal study is the most accurate procedure for identifying a seizure focus

d. Performing an independent ictal or postictal study is the most accurate procedure for identifying a seizure focus

3. A disadvantage of diffusible tracers for brain death evaluation is: a. a flow study cannot be done b. the static brain scan must be done within 1 hour of tracer administration c. a repeat study may not be possible on the same day d. interfering uptake in the nasopharynx

d. interfering uptake in the nasopharynx

4. The major parameter evaluated to confirm brain death with a non-diffusible tracer is: a. parenchymal uptake in the brain b. lack of blood flow in the carotid arteries c. the presence of the "hot nose" sign d. lack of blood flow in the anterior and middle cerebral arteries

d. lack of blood flow in the anterior and middle cerebral arteries

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

d. only distribute in situations of an altered blood-brain barrier

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

16. Each of the following is a requirement for purchase and receipt of DaTscan except: a. submission of a form with the nuclear medicine physician's DEA number b. submission of a form by each person who will place orders for DaTscan c. submission of a form by a study coordinator DEA contact person d. submission of DaTscan order forms must be made through a contract nuclear pharmacy

d. submission of DaTscan order forms must be made through a contract nuclear pharmacy

Which of the following statements about disease prevalence is correct? a.) Parkinson disease is the most common neurodegenerative disorder. b.) Dementia represents the second most prevalent neurologic disease after movement disorders. c.) Drug-induced parkinsonism is the most common cause of parkinsonism. d.) Approximately 1%-2% of people over 65 y old have Parkinson disease.

d.) Approximately 1%-2% of people over 65 y old have Parkinson disease

2. Which of the following statements about 123I-FP-CIT is correct? a.) It is the first and only agent of its kind available worldwide. b.)The approved indications for its use in the United States include assessment of Parkinson disease treatment response. c.) Striatal uptake of this agent is greatly increased in Parkinson disease. d.) It is a radioiodinated analog of cocaine.

d.) It is a radioiodinated analog of cocaine

For which of the following situations is dopamine transporter imaging clinically useful? a.) To confirm all Parkinson-related diagnoses. b.) To use as a stand-alone diagnostic tool for Parkinson disease. c.) To use before 18F-FDG PET evaluation of Parkinson syndromes. d.) To distinguish drug-induced parkinsonism from true parkinsonism when the patient is on antiepileptic or antipsychotic drug.

d.) To distinguish drug-induced parkinsonism from true parkinsonism when the patient is on antiepileptic or antipsychotic drug.