Nuclear Medicine

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Nuclear Medicine
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General concept

• Radiopharmaceutics
• mCi, MBq (1mCi 37MBq)
• Planar image and SPECT image
• Clinical presentation

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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

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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

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Radionuclide Cisternography

• NPH communicating hydrocephalus ,
• a delay in CSF absorption over
• the convexity
• CSF leakage

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2 h
4 h
1 h
48 h
6 h
24 h
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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

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Thyroid scintigraphy

• Thyroid nodule
• Congenital hypothyroidism
• Thyroid cancer follow up
• 131I treatment

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I 131
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Parathyroid scintigraphy

• Detection and localization of parathyroid adenoma

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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

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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

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201Tl
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Myocardial perfusion scintigraphy

• Pharmacologic stress test Dipyridamole,
  Adenosine
• Homogeneous, heterogeneous
• Reversible redistribution
• Fixed defect
• Reverse redistribution

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MUGA (radionuclide ventriculography)

• For evaluation of ventricular size, RVEF, LVEF,
  regional wall motion

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Angio-venography

• Lower extremities edema
• Detection and route out DVT, venous
  insufficiency, inflammation process, varicose
  vein,

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Subcutaneous radionuclide Venography
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Subcutaneous radionuclide Venography
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Gastrointestinal imaging

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

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Liver-spleen scan

• 99mTc-sulfur colloid Liver (Kupffers 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

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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 (gt30
  mins)

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1 h
30 m
15 m
5 m
24 h
4 h
2 h
6 h
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1h
30m
15m
5m
24h
7h
2h
4h
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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

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Three phase bone scan
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Oncologic imaging

• 67Ga, 201Tl, 99mTc-MIBI, 18FDG

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67Ga scan

• Bind to transferrin and accumulate in a wide
  variety of malignant neoplasms and their
  metastases
• Inflammatory image
• Detection and staging of Hodgkins disease,
  non-Hodgkins lymphoma, melanoma, lung cancer,
  hepatoma, leukemia, gastric cancer, esophageal
  cancer

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67Ga scan
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67Ga scan
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Renal imaging

• Glomerular agents 99mTc-DTPA
• Tubular agents 99mTc-MAG3
• Cortical agents 99mTc-DMSA
• Diuretic renography
• Captopril renography

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Renal scan (99mTc-DTPA)

• Baseline GFR, quantitative renal function
• Lasix ddx of non-obstructive dilatation
  mechanical obstruction,
• Capoten renovascular hypertension

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Renal scan (99mTc-DMSA)

• Children APN, renal scarring, renal infarct,
  renal trauma, horseshoe kidney, ectopic kidney,
  renal cyst, renal abscess, renal tumor.

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Pulmonary imaging

• Perfusion image 99mTc-MAA (1090um)
• Ventilation image 133Xe, 99mTc-DTPA aerosol
• PIOPED interpretation criteria
• V/Q mismatch

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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

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ANT
LEFT
LPO
POST
RPO
RIGHT
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Salivary gland scintigraphy

• 99mTcO4-
• Symmetric gland accumulation, drainage, increased
  or decreased function.
• Salivary gland function, dry mouth, Sjogrens
  syndrome, parotid tumor, NPC post radiation
  therapy

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Lymphoscintigraphy

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

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Testicular/scrotal scintigraphy

• 99m-TcO4-
• D/D testicular torsion from epididymitis,
• hydrocele, hematocele, abscess...

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Gastric empty scintigraphy

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

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