Name: 
 

Test Your Knowledge: PET Neurology



Multiple Choice
Identify the choice that best completes the statement or answers the question.
 

 1. 

What is the energy emission of Thallium-201?
a.
512-536 KeV
c.
93-123 KeV
b.
324-517 KeV
d.
69-83 KeV
 

 2. 

Which of the following is not used in a brain tumors scan?
a.
[123I] labeled tracers
c.
18F-FDG
b.
11C-acetate
d.
201TI
 

 3. 

What is the quantitative assessment of 18F-FDG?
i   Metabolic rate of glucose utilization
ii  Tumor/cortex ratio
iii Tumor/white matter ratio
iv Tumor/background ratio
a.
iv
c.
i, iv
b.
ii, iii
d.
i
 

 4. 

Which of the following will alter cerebral metabolism?
i   Sedatives
ii  Narcotics
iii Caffeine
iv Corticosteroids
a.
ii, iii, iv
d.
i, ii, iv
b.
i, iii, iv
e.
all of the above
c.
i, ii, iii
 

 5. 

Which of the following is the function of PET scan?
i   Glucose metabolism
ii  Protein synthesis
iii Cellular metabolism
iv Aminoacid transport
a.
ii, iii, iv
d.
i, ii, iii
b.
i, iii, iv
e.
all of the above
c.
i, ii, iv
 

 6. 

Which of the following tracers is used in SPECT?
i   99mTc-HMPAO
ii  99mTc-DTPA
iii [123I]alphamethyl-L-Tyrosine
iv [123I]N-isopropyl-p-Iodoamphetamine
a.
i, iii, iv
d.
i, ii, iii
b.
ii, iii, iv
e.
i, ii, iv
c.
all of the above
 

 7. 

Which of the following materials is not prohibited from intake for patient before the procedure?
a.
water
c.
alcohol
b.
caffeine
d.
drugs
 

 8. 

Which of the following radiopharmaceutical is not used in brain scan in a planar gamma camera?
a.
99mTc-Glucoheptonate
c.
99mTc-DTPA
b.
99mTc-sestamibi
d.
99mTc-pertecnetate
 

 9. 

Organs receiving the largest radiation dose in using 18F-FDG as radiopharmaceutical in PET are ______.
a.
skin
c.
liver
b.
urinary bladder
d.
lung
 

 10. 

If the blood glucose of the patient is greater than ______, physician should reschedule the patient for another scan.
a.
50 - 100 mg/dL
c.
0 -50 mg/dL
b.
150 - 200 mg/dL
d.
100 - 150 mg/dL
 

 11. 

The brain can be studied with nuclear medicine procedures to assess:
i   Metabolism
ii  Brain blood barrier integrity
iii Cellularity
iv Receptors
a.
i, iii, iv
d.
i, ii, iii
b.
ii, iii, iv
e.
all of the above
c.
i, ii, iv
 

 12. 

Monitoring of EEG should be started ______ before injection in order to ensure that 18F-FDG is not injected in a postictal state.
a.
3 hours
c.
30 minutes
b.
1 hours
d.
2 hours
 

 13. 

IN the brain, glucose metabolism provide approximately ______ of adenosine triphosphate required for brain function.
a.
95%
c.
100%
b.
25%
d.
30%
 

 14. 

Which of the following is related to the mechanism of tumor localization for thallium-201?
i   Blood flow
ii  Tumor viability
iii Calcium ion channel exchange
iv Increased cell membrane permeability
a.
i, ii, iv
d.
ii, iii, iv
b.
i, ii, iii
e.
i, iii, iv
c.
all of the above
 

 15. 

Some PET system is using radiation source for attenuation purpose. Which of the following radioactive sources is used?
i   68Ge
ii  68Ga
iii 123I
iv 137Cs
a.
i, ii, iii
d.
i, ii, iv
b.
i, iii, iv
e.
ii, iii, iv
c.
all of the above
 

 16. 

Which of the following is the advantage of PET/CT scan over transmission scan for the purpose of attenuation corrections?
i   Lower cost
ii  The detection of X-rays from the CT scan is not affected by the emission photons
iii Reduced time
iv Lower energy consumption
a.
i, iii
c.
ii, iv
b.
i, iv
d.
ii, iii
 

 17. 

Which of the following is the clinical indications for functional brain imaging?
i   Differentiation of focal infection from focal lymphoma in acquired immune deficiency patients.
ii  Differentiation of viable tumor from edema surrounding the tumor.
iii Determination of the hystological grade.
iv Differentiation of recurrent and persistent tumor from radiation necrosis.
a.
ii, iii, iv
d.
all of the above
b.
i, iii, iv
e.
i, ii, iv
c.
i, ii, iii
 

 18. 

Which of the following is not used to show anatomical imaging of brain tumors?
i   CT
ii  MRI
iii SPECT
iv PET
a.
i, ii
c.
ii, iii
b.
i, iv
d.
iii, iv
 

Matching
 
 
a.
2D acquisition mode
e.
3D acquisition mode
b.
Euglycemic
f.
Hyperglycemia
c.
Dynamic tomographic images
g.
Static limited field tomographic images
d.
Cold transmission
h.
Hot transmission
 

 19. 

______ is the standard procedure for older generation full ring PET systems for the measurement of attenuation prior to FDG-injection.
 

 20. 

______ happen when there is increased competition of elevated plasma glucose with FDG at the carrier enzyme.
 

 21. 

Best results for clinical FDG imaging of the brain in diabetics can be achieved in a ______ situation during stable therapeutic management.
 

 22. 

In ______,  coincidences are detected only within a single detector ring and between adjacent detector rings.
 

 23. 

______ will took multiple sequential images in a field of view, usually covering the whole brain.
 
 
a.
Compartmental modeling
e.
Neurodegenerative diseases
b.
Normalization procedure
f.
Stereotactic surface projection
displays
c.
Hybrid attenuation correction
g.
Hippocampal axis
d.
Absolute glucose metabolism
h.
Atypical parkinsonian syndromes
 

 24. 

______ is used to ensure the existence of an adequate correction of the changes in efficiency among the crystals of the detectors.
 

 25. 

Typical topographic patterns of hypometabolism may help diagnose the main ______ at a predementia stage.
 

 26. 

______ calculate an attenuation image based on a short transmission measurement followed by image segmentation.
 

 27. 

______ is a quantitative analysis that performed when it is possible to
calculate the curve of the arterial FDG concentration against time.
 

 28. 

______ is used for estimating rate constants.
 

 29. 

18F-FDG PET can be used for the differentiation between Parkinson's disease and ______.
 

 30. 

Individual statistical maps such as Z score maps are based on slice display or ______.
 

 31. 

Re-slicing along the ______ is preferred for evaluation of suspected temporal lobe epilepsy.
 
 
a.
Morphological abnormalities
c.
Pulse oximetry
b.
Lumped constant
 

 32. 

Matching of cortical hypometabolism with ______ on MRI or with the EEG help to plan for epilepsy surgery.
 

 33. 

______ should be performed to recognize the possibility of cardiopulmonary depression in the usage of sedative.
 

 34. 

A correction factor called ______, can be used to convert the FDG values to values reflecting glucose metabolism.
 

True/False
Indicate whether the statement is true or false.
 

 35. 

The retention of the 99mTc compounds is mainly dependent upon the viability of the tissue.
 

 36. 

When hyperglycemia is present, stochastic noise may increase and  contrast between white and grey matter uptake will decreased and causing diagnostic accuracy decrease.
 

 37. 

For low grade tumors such as astrocytomas grade III-IV will have a 18F-FDG uptake of 7.4tf037-1.jpg3.5mg/100g/min.
 

 38. 

Patient with tumors with a high metabolism have a 33 months median survival.
 

 39. 

Correction factors for attenuation are obtained by measuring the ratio between a blank scan and a transmission scan.
 

 40. 

Type, location and medication for epilepsy should be obtained before performing the procedure.
 

 41. 

Transmission imaging following FDG injection is less favorable with Ge-68/68-Ga because of the potential overestimation of attenuation of structures with high uptake, especially in sub-cortical regions.
 

 42. 

The advantage of using PET/CT system for attenuation correction is that the detection of X-rays from the CT scan is not affected by the emission photons.
 

 43. 

18F-FDG ability to accumulate in neuronal tissue depending on facilitated transport of glucose and hexokinase mediated phosphorylation make it a good candidate for imaging regional cerebral glucose consumption with PET.
 

 44. 

Typical pixel size for a PET image is 8-10 mm.
 

 45. 

Deviation from resting state during the uptake period and scanning needs to be recorded and considered when interpreting scans.
 

 46. 

Benzodiazepine is used to apply conscious sedation for uncooperative patients.
 

 47. 

Lowering serum glucose by administration of insulin can be considered, but the administration of FDG should be delayed following insulin administration
 

 48. 

For preoperative evaluation of epilepsy, continuous EEG recording should be used.
 

 49. 

From 2-4 hours injection, 201TI will accumulated within the tumor and slowly washout.
 

 50. 

When using thresholding, it should be based upon knowledge of a normal database for FDG and instruments used in acquiring the study to avoid artifacts.
 

 51. 

201Thallium and 99mTc Tetrofosmin were excluded almost completely from normal cerebral tissue and their distribution within all the lesions was substantially parallel.
 

 52. 

11C-methionine is currently the most accurate in-vivo method for the investigation of regional human brain metabolism.
 

 53. 

Under physiological conditions, there is no connection between glucose metabolism and neuronal activity.
 

 54. 

Gallium 68 generator is used to synthesis galium-68 by extracting by elution from germanium-68.
 

 55. 

LEAP collimator has a higher resolution than a LEHR collimator thus have a better result in a brain scan.
 

 56. 

Intravenous fluid containing dextrose or parenteral feeding should be withheld for 12 hours before the scan.
 

 57. 

The administered activity for 18F-FDG in adult are 125-250 MBq  in 2D mode.
 

 58. 

Input function retrieved from PET images using the aorta, or left ventricle can be used for arterial blood sampling.
 

 59. 

3D mode acquisition is used in infants and small children in order to decrease the radiation burden.
 

 60. 

Statement containing the reason why the study are difficult to interpret should be including inside the report to aid the referring physician to better understand why a specific diagnostic entity could not be ascribed to the pattern noted.
 

 61. 

3D acquisition have a longer acquisition time than 2D as it required longer time to achieve adequate count density.
 

 62. 

Changes in neuronal activity induced by disease will be reflected in an alteration of glucose metabolism.
 

 63. 

Patient history such as past or current drug use or head trauma, neurological examination, psychiatric exam, mental status exam is not important in order to perform the procedure.
 

 64. 

Differences in mathematical attenuation correction may appear especially in the occipital and cerebellar regions making it not comparable.
 

 65. 

Corticosteroids usage will cause an opposite effect with hyperglycaemia.
 

 66. 

The emission acquisition typically begins 30-60 minutes post injection and lasts between 5 and 60 minutes depending on the injected activity, the type of scanner and acquisition protocol used (2D or 3D).
 

 67. 

Dynamic studies is used to quantitatively assess the regional rates of FDG metabolism by determining appropriate kinetic rate or influx constants.
 

 68. 

PET/CT scanners with LSO or GSO crystals only acquire images in 3D mode.
 

 69. 

A low dose CT scan for the purpose of attenuation correction have the advantage of reducing the radiation exposure almost to the level of germanium-based transmission measurement.
 

 70. 

Additional re-sliced images in coronal and sagital sections should be displayed routinely which would helps better delineation of lesions.
 

 71. 

Hanning or Shepp-Logan are the most commonly used filters for reconstruction of image using filtered back projection.
 

 72. 

High grade tumors have a high rate of glucose utilization and thus a high 18F-FDG uptake.
 

 73. 

Adults have a greater relative brain mass (10%) than infants (2-3%), so the percentage of uptake of the injected FDG activity is higher.
 

 74. 

High intracellular glucose and circulating insulin levels will drive 18F-FDG into muscle and result in reduced uptake in the brain.
 

 75. 

Sedation is recommended for patient with dementia or children and should be performed as late as possible following administration of 18F-FDG.
 

 76. 

Quantitative assessment of 18F-FDG including tumor/white matter ratio and tumor/cortex ratio.
 

 77. 

The equation of activity administered for 18F-FDG for children is : activity administered = baseline activity x multiple (dosage card).
 

 78. 

Acute correction of hyperglycaemia with insulin usually does not improve brain image quality substantially, because the correction of increased intracellular glucose level lags behind the correction of the plasma glucose level.
 

 79. 

Psychotropic pharmaceuticals may influence regional metabolic rate of glucose.
 

 80. 

In parkinsonian patients, the administration of levodopa had no effect in glucose metabolism.
 

 81. 

Physicians should avoid interaction with the patient prior to, during, and up to at least 30 minutes post injection of 18F-FDG.
 

 82. 

The 201TI retention index are applied as follows: RI= (early uptake - delayed uptake)/delayed uptake x100.
 



 
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