nuclear medicine

Nuclear Medicine

General concept Radiopharmaceutics mCi, MBq (1mCi = 37MBq) Planar image and SPECT image Clinical presentation

Neurology imaging 99mTc-HMPAO : cross to BBB and fix in the brain proportionally to perfusion 18FDG : glucose metabolism 99mTc-TRODAT : dopamine transporter 111In-DTPA, 99mTc-DTPA : CSF dynamics, V-P shunt patency study

Brain Perfusion Scan CVD : as early as 2 hours after the onset of symptoms, evaluate prognosis, Seizure : localize the seizure focus Brain tumor : an ancillary role Dementia : early detect Neuro-psychiatric

Radionuclide Cisternography NPH : communicating

hydrocephalus , a delay in CSF absorption

over the convexity CSF leakage

1 h 2 h 4 h

6 h 24 h 48 h

Endocrine imaging Thyroid scan : 99mTcO4- , 123I, 131I, 201Tl Parathyroid scan : 99mTcO4-/ 201Tl subtraction, 99mTc-MIBI Adrenal cortex scan : NP-59 Adrenal medulla scan : 131I-MIBG

Thyroid scintigraphy Thyroid nodule Congenital hypothyroidism Thyroid cancer follow up

131I treatment

I 131

Parathyroid scintigraphy Detection and localization of

parathyroid adenoma

Adrenal medulla scintigraphy

131I-MIBG : via the norepinephrine reuptake mechanism into catecholamine storage vesicles of adrenergic nerve ending. Confirm lesion discovered by CT and localize extraadrenal pheochromocytoma, Neuroblastoma, paraganglioma

Cardiovascular imaging Perfusion agents : 99mTc-MIBI, 201Tl Viability agents : 18FDG, 201Tl Multi-gated cardiac function (MUGA):

99mTc-RBCs Infarct agents : 99mTc-pyrophosphate Angio-venography : 99mTc-RBCs

201Tl

Myocardial perfusion scintigraphy Pharmacologic stress test : Dipyridamole, Adenosine Homogeneous, heterogeneous Reversible redistribution Fixed defect Reverse redistribution

MUGA (radionuclide ventriculography) For evaluation of ventricular size,

RVEF, LVEF, regional wall motion

Angio-venography Lower extremities edema Detection and route out DVT,

venous insufficiency, inflammation process, varicose vein,

Subcutaneous radionuclide Venography

Subcutaneous radionuclide Venography

Gastrointestinal imaging Liver-spleen scintigraphy : 99mTc-sulfur colloid Cholescintigraphy : 99mTc-DISIDA GI bleeding : 99mTc-RBC Ectopic gastric mucosal scan : 99mTcO4- Gastric empty time

Liver-spleen scan 99mTc-sulfur colloid : Liver (Kupffer’s cell)85%, Spleen 10%, Bone marrow 5% Detect the space-occupying lesion and evaluate its reticuloendothelial function, D.D. FNH from the other lesion splenic infarct, accessory spleen. 99mTc-RBC scan for hemangioma

Cholescintigraphy biliary obstruction, D.D. of biliary atresia and neonatal hepatitis, bile leakage Normal : liver (5 mins), intrahepatic biles ducts (10-15 mins), common bile, gall bladder and duodenum duct (15-30 mins), small intestine (>30 mins)

24 h6 h

1 h

4 h

30 m15 m5 m

2 h

24h7h2h 4h

1h30m15m5m

Skeletal imaging 99mTc-MDP (bone hydroxyapatite crystal) Regional blood flow, tissue extraction, osteoblastic activity Metastases, osteomyelitis, AVN, stress fx, occult bone trauma, joint prosthesis… sensitivity high, specificity moderate

Three phase bone scan

Oncologic imaging 67Ga, 201Tl, 99mTc-MIBI, 18FDG

67Ga scan Bind to transferrin and accumulate in a wide variety of malignant neoplasms and their metastases Inflammatory image Detection and staging of Hodgkin’s disease, non-Hodgkin’s lymphoma, melanoma, lung cancer, hepatoma, leukemia, gastric cancer, esophageal cancer…

67Ga scan

67Ga scan

Renal imaging Glomerular agents : 99mTc-DTPA Tubular agents : 99mTc-MAG3 Cortical agents : 99mTc-DMSA Diuretic renography Captopril renography

Renal scan (99mTc-DTPA) Baseline : GFR, quantitative renal function Lasix : ddx of non-obstructive dilatation & mechanical obstruction, Capoten : renovascular hypertension

Renal scan (99mTc-DMSA) Children APN, renal scarring, renal infarct, renal trauma, horseshoe kidney, ectopic kidney, renal cyst, renal abscess, renal tumor.

Pulmonary imaging Perfusion image : 99mTc-MAA

(10~90um) Ventilation image : 133Xe, 99mTc-

DTPA aerosol PIOPED interpretation criteria V/Q mismatch

Pulmonary imaging pulmonary embolism, F/U pulmonary embolism after anti-coagulant therapy, perfusion change secondary to lung tumor, pre-operative evaluation for pneumonectomy, post-operative F/U…

ANT LEFT LPO

POST RPO RIGHT

Salivary gland scintigraphy 99mTcO4- Symmetric gland accumulation, drainage, increased or decreased function. Salivary gland function, dry mouth, Sjogren’s syndrome, parotid tumor, NPC post radiation therapy…

Lymphoscintigraphy 99mTc-sulfur colloid Lymphatic obstruction Detect sentinel lymph node (melanoma, breast cancer…)

Testicular/scrotal scintigraphy 99m-TcO4- D/D testicular torsion from epididymitis, hydrocele, hematocele, abscess...

Gastric empty scintigraphy 99mTc-sulfur colloid in eggs (solid meal) Half-empty time (solid meal,60 土 30min; liquid meal, 30 土 15min) Gastric outlet obstruction or function obstruction, DM gastroparesis, s/p vagotomy, gastrinoma… Follow up and evaluation of the effectiveness of treatment.