0:04

I use this case for the first week, uh,

0:06

to go through my search pattern.

0:08

I hope you already went through that so quickly.

0:11

Just going quickly through it, there is, um,

0:13

nothing in the brain really to, uh, attract your attention.

0:18

Um, changing the intensity pattern,

0:23

there is a brown fat, as I explained

0:25

before, this is the, um, exact pattern

0:28

for the brown fat neck.

0:30

Bilateral symmetric,

0:31

beautiful bilateral neck Cleve accelerate

0:35

intercostal, superior mediastinal.

0:37

If you look here in the pet only,

0:42

and you look where it is exactly in the Fus image, in the CT

0:47

and correlated, it's just fat.

0:50

It's a typical pattern for, for brown fat.

0:52

And your clue is just look at the map, the map,

0:55

give it away right away.

0:57

This is a typical pattern for brown fat.

0:59

You'll get used to it. You will see it a lot specific,

1:02

especially that we're getting into the, um, winter.

1:05

Now we see increasingly in the fall

1:08

and winter months, more in younger patient, thinner females.

1:14

Um, as you see here

1:16

and going through, there is nothing as you see,

1:19

this was an example of a normal FDG, just to get used

1:23

to the normal pattern, normal bio distribution.

1:25

Once you start looking at pet

1:27

or general nukes in gen, any nuclear medicine,

1:31

anytime you are starting a neurology, pharmaceutical,

1:34

you have to get yourself used to how does, uh, the normal,

1:38

uh, biodistribution of the ED pharmaceutical historical,

1:42

so FDG, the workhorse brain is your glue.

1:46

You look at the MEB

1:47

and you see a brain, it has to be an FDG, right?

1:50

Cardiac uptake is variable depending on many things.

1:54

The most important is how long did this patient fast.

1:57

So there, for example, this, there's a lot of FDG uptake

1:59

of the, uh, heart,

2:01

which means this patient was ly fasted only for six hours.

2:04

Prolonged fasting.

2:05

If the patient fasted for 12 hours, so let's say the patient

2:08

had, um, like an afternoon, um, appointment

2:13

and he would fasted from the night

2:14

before, you will not have any myocardial uptake,

2:17

for example, right?

2:19

He, you'll have liver uptakes pain uptake,

2:21

of course excreted through the kidney.

2:22

So you'll have, uh, bial, uh, collection collecting system,

2:27

uh, draining through the ureters and bladder.

2:30

Um, variable bowel uptake.

2:33

Some, sometimes you'll have a lot

2:34

of intense uptake in the bowel

2:35

because a lot of our patients are diabetic,

2:38

are on metformin.

2:39

This is a known effect.

2:41

Um, and um,

2:45

in this patient there is mild marrow uptake.

2:48

This is a little bit more than uh, what we usually see.

2:51

Maybe this patient is a little bit anemic and we look here.

2:54

If you look here, there is the

2:57

blood here is a little bit hypo

2:58

Attenuating. So

2:59

most probably the patient is a little bit ic.

3:02

This is why we see that the mirror is a little

3:03

bit hyper functioning.

3:06

More than that, the,

3:08

usually the testicles are a little bit hot,

3:10

sometimes a little bit hotter than that.

3:12

This is physiologic. There's nothing,

3:13

um, abnormal about that.

3:15

Just looking at the pattern, going back

3:17

to our normal search pattern.

3:20

Um, you look at the lungs quickly, you just, I, we need

3:24

to go through five cases, so I'm not

3:26

gonna take a lot of time.

3:28

You see here, there are auxiliary lymph nodes.

3:32

That's normal. They look benign on the CT here.

3:37

Nice thin cortex, fatty hilum avid.

3:41

So what they can be mildly to moderately avid,

3:44

the accelerated inguinal lymph node.

3:46

Otherwise they look benign.

3:47

There is nothing, um, really, um, catching my eye on it.

3:51

There's some uptick here in the scapula,

3:53

but when I look at it, it's,

3:56

there is nothing abnormal in this uptake.

3:58

I think it's just benign uptake.

4:05

And we scan the, I mean, I'm not gonna go through this case.

4:07

We looked through this case already, already.

4:09

You guys, all of you got the

4:11

chance to look through the case.

4:12

There is no nodules in the lung,

4:17

no lymph nodes.

4:20

The liver looked nice,

4:26

adrenal glands are okay.

4:29

There was nothing really, um,

4:31

to attract your attention in this case.

4:34

The reason why we included this case, just

4:36

to show you the normal, uh, biodistribution, the normal.

4:39

But one thing I wanted to show you here is this here, um,

4:46

here, this, the activity here, the,

4:49

the brown fat even can be hot in the submarine region.

4:52

So don't get confused.

4:54

This is still a brown fat act activation.

4:57

So it can be, uh, brown fat activation can, uh,

5:00

appear in very weird location.

5:02

So don't be, uh, fooled with this.

5:05

Some patients have very, uh,

5:07

intense prompt activation in a weird location.

5:10

Um, don't forget to look at the exile Corona,

5:14

the coronal sagittal pet only ct.

5:17

And uh, I have it in the other monitor.

5:19

You are not seeing it. So I'm not gonna do this

5:21

because I don't wanna waste your time.