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3.19. Evaluation of radionuclide phlebography

Radionuclide phlebography ( venography ) multistatic scintigraphy is used to assess the patency of the deep and superficial venous syst Emu especially the legs.

The evaluation of this static scintigraphy consists of two stages:

Saving studies

We perform scintigraphic examination after application of approx. 100 MBq 99m Tc-MAA in a small volume with a thin needle into the peripheral vein on the leg dorsum. In radionuclide phlebography, the areas of the calf veins, popliteal veins, thigh veins and pelvic veins are imaged immediately after application. We perform two series of scintigrams:

  1. After application, the tourniquet is above the ankle and below the knee, with the blood flow circulating through the deep venous trunks of the calf and thigh.
  2. After the release of the tourniquets, when the blood flows through the deep and superficial veins.

Recommended storage mode:

matrix 128 ´ 128, 16 bits, preselection min. 200,000 imp.

Series with tourniquets:

Picture 1: Shank 2nd picture: Thigh 3rd picture : Ileophemic transition 4. Pelvis

Series without throttles:

5.obraz: Lower thigh 6.obraz: Thigh 7.obraz: Ileofem.přechod 8th Pan

This order of projections corresponds to the default preset in the FLEBOGR program, so there is no need to permute the order of projections when evaluating it.

Study evaluation

First we call up the required scintigraphic study in the basic menu PROCESSING (if it consists of several studies, we select them one by one and use the “Next” command to combine them into one for evaluation). We will launch a comprehensive program FLEBOGR - static phlebography .

Sequence of projections and visual evaluation

The display shows the accumulated images and describes the names of the projections in the default order: Shank - Thigh - Ileof transition. If the order of the projections agrees and we want to keep all the images, we will answer the question of the program "Order of projections okay?" positive. Otherwise (negative response) Specify e gradually instructions to program the real picture assign names projections. In this way, it is possible not only to switch the order of projections, but also to select certain images and reject others for further display, processing and documentation.

If we have displayed images with the corresponding assignment of projections, a visual evaluation begins . The normal image of the veins is contrasting and well defined, evenly wide. In pathological cases, we can observe an interruption of the course of the displayed venous strain (thrombosis), retention of a radioindicator (eg at the site of inflammation or thrombus), or display of collateral circulation due to closure.

For visual evaluation, we can use either the implicit standard formulation of normal evaluation, eg:

After application of the 99m-Tc-MAA radioindicator on the dorsum ... right ... left ... of the foot,
we observe the outflow of the radioindicator through the deep
venous system of the shin, then through the v. Poplitea and femoral vein into the v
After removal of the tourniquets, the radiolabel flows out partly through the superficial
and partly deep venous system.

N ormal finding in radionuclide phlebography.

or a non-standard free text of a pathological finding.

Final protocol

The display then shows all selected images, and we can set their optimal modulation (LT / UT). In the box below we can edit the text of the verbal description of the scintigraphic images and the conclusion. Finally, we can print a report containing (in addition to basic data such as the patient's name) the relevant images, the text of the verbal evaluation, conclusion and signature - Fig.3.18.1.

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