0:04

So this is the next one, which is just to look at pssm A

0:08

as a negative case to ize the s bio distribution.

0:13

Whenever a new pharmaceutical come in, play in the market,

0:16

first thing you have to do is to familiarize yourself

0:18

with the normal bio distribution.

0:21

Where does it normally go?

0:23

What is the theological sides of the,

0:25

um, radio pharmaceutical?

0:28

So when you look at PSMA, where does it go to?

0:31

Ric glands course intensely go to the parid

0:34

and subular glands as you see here, right?

0:37

Lacrimal glands.

0:39

So see caps, it's like the gallium, remember the 67 inns

0:44

is one of the scans that looks at you.

0:46

The study is looking at you, right? It has eyes, right?

0:51

And then you'll have liver, some liver

0:55

and spleen, kidneys.

0:57

And then Q is usually lights up more like there's bowel,

1:00

but you, a lot of times you see the good Jordan is very,

1:03

very intense.

1:05

And then it's excreted to the kidneys, to the, um, bladder.

1:08

So there's, there's bladder activity and that's it.

1:12

This is how the scan looks like, right?

1:14

So this is one of the things you have to look at.

1:17

Another thing I want you guys to look at is the,

1:23

in a, in a PSMA PET ct, it's important to know

1:27

that there are activity

1:29

that you can see in the sympathetic parasympathetic ganglia.

1:33

Like for example here, if an intensity more, let's say here,

1:38

you will see in the ganglia, in the sympathetic angle here,

1:43

sometimes it's, you don't notice it at all,

1:45

but sometimes it's noticeable.

1:47

And it might, let's see here.

1:49

It might confuse you for lesions

1:51

or lymph nodes, especially when you see it in here

1:57

in the aortic area

1:59

because it's like, here, look at this one.

2:02

Here's a good example. You a lot

2:06

of time you might confuse for a paraic influence.

2:09

See here, here's the general gland.

2:11

This is the general gland here.

2:15

So here's your original gland.

2:16

This is the general gland, right? I'll go below it.

2:19

And then you see this here, it's avid psm A have it,

2:24

and it's per aortic.

2:27

And like in this case here, it's a little bit bulkier.

2:29

It's not a slit. Like,

2:31

and then you might, if you don't, if you're not aware

2:33

that there's a person, there's, there's sympathetic.

2:36

Uh, this is the Celia ganglia, right?

2:39

And if you're not aware that it picks up the pssm a not used

2:42

to seeing it, you might go this a lymph node.

2:45

It's not a lymph node. Just be careful.

2:48

And of course there's this, the down there,

2:49

the sal chain as well.

2:51

It can pick it up and it can be hot.

2:54

And it's not metastatic. It's not perineural invasion.

2:56

In this case, a

2:59

Look here, it picks up

3:04

in the ganglia.

3:06

PMA specifically as a tracer is known to do that.

3:09

So keep this in mind.

3:11

This is one of the pitfalls that, um, I like to talk about,

3:16

to be careful with.

3:17

When you read, when we started reading PMA, this is one

3:20

of the things that we have to be careful with.

3:23

Um, other than that is the same as, uh, other tracers,

3:26

inflammatory, like reactive lymph node can, uh,

3:28

an inflammatory lymph node can be mildly added.

3:31

And all the other like pitfalls, like other, you have

3:35

to be careful with.