0:01

This is a doted pet CT that shows normal distribution.

0:06

When I first open the case, I get this image

0:09

and it shows a very intense uptake in the liver and kidney.

0:13

And this is on a scale of zero to five

0:15

and it's normal that you have to kind

0:19

of change a little bit the scale to be able to now

0:23

appreciate the contrast of the different organs.

0:26

So starting top to bottom, uh,

0:28

let's see what's physiologic and what's not.

0:31

The pituitary gland, uh, has normal uptake

0:35

and this is one of the things

0:38

that might help you determine what tracer you have, uh,

0:43

in front of you as this is a very distinctive

0:47

feature of this tracer.

0:50

Moving on, we have normally the symmetric

0:53

and low level uptake in the salivary glands

0:56

and also there's always some low level uptake

1:00

in the thyroid gland.

1:02

See here the liver, as you can see as intense

1:08

tracer uptake, but it should be homogeneous

1:12

and you can play around a little bit with the contrast

1:14

to be able to depict if there were, uh, areas

1:18

of metastatic disease.

1:21

The spleen is another organ that has intense

1:24

of the data uptake and look at the difference of degree.

1:28

The spleen has greater uptake than the liver.

1:31

In normal circumstances,

1:34

the adrenal glands physiologically have uptake

1:38

with the tracer and it helps also when you see them nicely

1:44

thin with the nodules, uh, as you can have neuro endocrine

1:49

tumors in the adrenal glands.

1:50

So the lack of nodules

1:52

and symmetric uptake points towards just normal physiology.

1:56

The kidneys are seen

1:58

because this tracer is excreted also through the kidneys

2:02

and uh, you can have both cortical uptake

2:06

and uh, uptake in the ex executory system as well

2:09

as moving down.

2:11

Uh, you have normal accumulation

2:14

of the tracer in the bladder.

2:17

The bowel physiologically has low level

2:21

of FG uptake

2:23

and is greater in the small bowel compared

2:27

to the colon.

2:30

Normally you don't see uptake in other organs like the

2:34

lungs or the bones.

2:37

We'll comment, uh, shortly, some several pitfalls,

2:40

but in general you should expect very low

2:45

or essentially absent uptake in in the rest of the body.

2:50

Other organs that show uptake would be the pancreas

2:53

and the uptake is always greater at the ate process.

2:57

And two

2:58

Things to notice is that

3:02

these tracer will be seen in some

3:05

neural organs.

3:07

In this case is the celiac axis ganglion

3:12

and then the higher up the ate ganglion.

3:17

This is a Dota take pet, uh, in another patient

3:21

that I wanted to show you to demonstrate

3:24

two additional sites of physiologic uptake.

3:28

In this case, we see that there is also salivary gland

3:31

uptake that is greater than the patient we just discussed.

3:35

But I want to draw your attention to the thoracic inlet

3:40

where we see on pit we see best The two areas

3:44

of focal uptake that correspond to

3:49

very small kind of soft tissue nodules in the ct.

3:55

These are the cell ganglion.

3:59

The find the same findings lower down

4:03

by the celiac axis, see the right one

4:07

or easily than we do the left side

4:10

because it's partially obscured by the

4:14

left adrenal gland.

4:16

And these are also ganglions called celiac axis ganglions.

4:20

These ganglions are essentially a collection

4:22

of sympathetic nerves that have physiologic uptake,

4:26

but it has variable uptake.

4:29

Some patients you may not find it,

4:31

but if you find it, don't think this is disease.

4:35

Just know that this is a physiologic structure.