Gated heart pool scanning - breast uptake

Hunter Health Imaging Service

Getting to the heart of the matter!

Todd Charge Senior Technologist Nuclear Medicine and PET Centre Hunter Health Imaging Service


Background • 29yr old female

• Benign cyst removed from Right breast 1995

• Fatty lump noted at time

• Regular follow up U/S


Background U/S Dec 2002 abnormal right breast Mammogram widespread calcification Palpable axillary nodes U/S adbo, chest clear CXR normal FBC, biochem normal LFT, serum alkaline phosphatase normal


Background CXR Jan 2003 abnormality R lung base CT normal 5 days later Right side mastectomy Axillary dissection Post op evacuation of

haematoma


Background Invasive ductal carcinoma Measuring 10cm Grade 3 Pagets disease invol nipple Extensive lymphatic, vascular invasion 18/27 lymph nodes involved Extension up to 2mm beyond capsule


Background Oestrogen, progesterone receptors neg. Her-2 marker strongly positive High risk of local recurrence Required radiation treatment and chemo 10yr survival 13% With chemotherapy inc. to 30%


Background

Smoker (ceased six years) Social drinker Three children, unremarkable pregnancies No family history breast cancer 24 weeks pregnant


Treatment Six cycles of AC chemotherapy Three weekly Plan to deliver at 37 weeks Post delivery commence radiation treatment Monthly foetal growth U/S No randomised studies Case studies suggest no detrimental effects


Treatment Induced labour, normal vaginal delivery Normal, healthy 8.3pound female infant Breast feeding successfully on left breast Paused breastfeeding for 5 days to

complete sixth cycle of chemo Right chest wall irradiation with inclusion of

lymph node drainage areas


Treatment No evidence of local recurrence or distant

disease Commence Herceptin trial Baseline LVEF


Administration • 1ml Radpharm PYP IVI via left posterior

hand

• 1hr interval

• 900MBq Tc04- IVI via left cubital fossa

• Imaging commenced immediately

• 3 lead ECG gating


Scanning • Anterior, LAO35, Left Lateral views • 10 mins per view • 24 bin gating • 75-85bpm heart rate • Normal sinus rhythm


Images

PScope


Images

LAO35 Static


Images

Anterior Cine


Images

LAO35 Cine


Images

LtLat Cine


Images

Gated SPECT


Images

Zoomed Short Axis


Outcome Normal wall motion No LVEF due to technical difficulties No evidence in literature search Highlights the need to consider uptake of

radiopharmaceuticals in lactating females as normal variant

Gated SPECT processed same as Sestamibi/Thallium cardiac to obtain LVEF after overcoming technical difficulties

Health & Medicine

Gated heart pool scanning - breast uptake