Clinical Nuclear Medicine

Clinical Nuclear Medicine THIRD EDITION

Edited by M. N. Maisey

BSc MD FRCR FRCP Division of Radiological Sciences

Guy's and St Thomas' Hospital London, UK

K. E. Britton MD MSc FRCR FRCP

Department of Nuclear Medicine St Bartholomew's Hospital

London, UK

B. D. Collier BAMAMD

Nuclear Medicine Department Medical College of Wisconsin

Milwaukee, Wisconsin USA

with the assistance of

Q. H. Siraj MScPhD

Springer-Science+Business Media, B.V. m

First edition 1983 Second edition 1991 Third edition 1998

ISBN 978-0-412-75180-6 ISBN 978-1-4899-3356-0 (eBook) DOI 10.1007/978-1-4899-3356-0

© 1983, 1991, 1998 Springer Science+Business Media Dordrecht

Originally published by Chapman & Hall in 1998.

Softcover reprint of the hardcover 3rd edition 1998

Thomson Science is division of International Thomson Publishing

Typeset in Palatino 9Yz/ll by Best-set Typesetter Ltd., Hong Kong

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publishers. Applications for permission should be addressed to the rights manager at the London address of the publisher.

The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. Whilst every effort is made to ensure that drug doses and other quantities are presented accurately, readers are advised that new methods and techniques described involving drug usage should be followed only in conjunction with the drug manufacturer's own published literature.

A catalogue record for this book is available from the British Library

Library of Congress Catalog Card Number: 97-76965

§ Printed on acid-free text paper, manufactured in accordance with ANSI/NISO Z39.48-1992 (Permanence of Paper).

Contents

Colour plates appear between pages 608 and 609

Contributors ix

Preface to the first edition xiii

Preface to the third edition xv

SECTION ONE CLINICAL TOPICS 1

1 Radionuclide therapy 3 Bones and joints 3 E. B. Silberstein (University of Cincinnati Medical Center, Cincinnati, USA)

Thyroid disease 9 S. E. M. Clarke (Guy's and St Thomas' Hospital, London, UK)

Neuro-ectodermal tumours 27 C. A. Hoefnagel (Het Nederlands Kanker Instituut, Amsterdam, The Netherlands)

Haematology 35 .M. Pollycove (US Nuclear Regulatory Commission, Rockville Pike, USA)

Radioimmunological therapy 39 G. Paganelli and M. Chinol (Instituto Europeo di Oncoglogia, Milan, Italy)

Lymphoma 53 R. L. Wahl (University of Michigan Medical Center, Ann Arbor, USA)

2 Cancer imaging: principles and practice 65 S. E. M. Clarke (Guy's and St Thomas' Hospital, London, UK) and K. E. Britton (St Bartholomew's Hospital, London, UK)

3 Clinical positron emission tomography 75 H. N. Wagner Jr and J. W. Buchanan (Johns Hopkins Medical School, Baltimore, USA) and M. N. Maisey (Guy's and St Thomas' Hospital, London, UK)

4 Paediatric issues 85 D. L. Gilday (The Hospital for Sick Children, Toronto, Canada)

vi Contents

SECTION TWO CLINICAL SYSTEMS

5 Infection and immunology HIV disease and other immunosuppressed patients M. J. O'Doherty (Guy's and St Thomas' Hospital, London, UK)

Infection J. Buscombe (Royal Free Hospital, London, UK)

Autoimmune diseases A. Signore and M. Chianelli (Istituto di Clinica Medica II, Universita 'La Sapienza', Rome, Italy)

6 Cardiovascular Myocardial ischaemia P. Rigo and T. Benoit (Centre Hospitalier Universitaire de Liege, Liege, Belgium)

Other cardiac applications P. Rigo (Centre Hospitalier Universitaire de Liege, Liege, Belgium)

Peripheral vascular disease P. J. A. Robinson and A. Parkin (St James' University Hospital, Leeds, UK)

Venous thrombosis L. C. Knight and A. H. Maurer (Temple University Hospital, Philadelphia, USA)

7 Pulmonary and thoracic Pulmonary embolism H. D. Royal (Mallinckrodt Institute of Radiology, St Louis, USA)

Lung cancer H. D. Royal (Mallinckrodt Institute of Radiology, St Louis, USA)

Other pulmonary applications M. J. O'Doherty (Guy's and St Thomas' Hospital, London, UK)

8 Musculoskeletal P. J. Ryan (Medway Hospital, Gillingham, UK) and I. Fogelman (Guy's and St Thomas' Hospital, London, UK)

9 Neuropsychiatric Tracers L. Pilowsky (Institute of Psychiatry, London, UK)

Epilepsy H. A. Ring (Royal London School of Medicine, London, UK)

Dementia D. C. Costa (Middlesex Hospital, London, UK)

Cerebrovascular disease J. Patterson and D. J. Wyper (Southern General Hospital, Glasgow, UK)

Infection and oncology D. C. Costa and P. J. Ell (Middlesex Hospital, London, UK)

Psychiatric disorders A. Lingford-Hughes (Institute of Psychiatry, London, UK)

113

115 115

125

139

149 149

185

195

203

215 215

231

237

245

277 277

287

295

305

313

319

Contents vii

10 Endocrine 331 Thyroid 331 M. N. Maisey (Guy's and St Thomas' Hospital, London, UK)

Adrenal 357 R. T. Kloos (University of Alabama, Birmingham, USA), F. Khafagi (St Andrew's War Memorial Hospital, Brisbane, Australia), M. D. Gross and B. Shapiro (University of Michigan and Ann Arbor Veterans Affairs Medical Center, Ann Arbor, USA)

Parathyroid 381 A. J. Coakley and C. P. Wells (Kent and Canterbury Hospital, Canterbury, UK)

11 Kidney and urinary tract 389 Renal disease 389 K. E. Britton (St Bartholomew's Hospital, London, UK) and M. N. Maisey (Guy's and St Thomas' Hospital, London, UK)

Vesicoureteric reflux and ureteric disorders 425 S. R. Payne and H. J. Testa (Manchester Royal Infirmary, Manchester, UK)

Renal transplantation 433 A. J. W. Hilson (Royal Free Hospital, London, UK)

12 Genital 439 Testicular perfusion scintigraphy 439 Q. H. Siraj (Nuclear Medicine Centre, Pakistan)

Impotence 449 Q. H. Siraj (Nuclear Medicine Centre, Pakistan)

Infertility 461 M. P. Iturralde (University of Pretoria, Pretoria, Republic of South Africa)

Gynaecological cancer 475 K. E. Britton and M. Granowska (St Bartholomew's Hospital, London, UK)

Prostate cancer 481 K. E. Britton and V. U. Chengazi (St Bartholomew's Hospital, London, UK)

13 The abdominal contents 485 S. S. Tumeh (Bon Secours DePaul Medical Center, Norfolk, USA)

14 Blood, bone marrow and lymphoid 517 Lymphomas 517 H. M. Abdel-Dayem (New York Medical College and St Vincent's Hospital and Medical Center, New York, USA) and H. A. Macapinlac (Memorial Sloan Kettering Cancer Center, New York, USA)

Blood disorders 525 A. M. Peters and D. M. Swirsky (Hammersmith Hospital, London, UK)

Lymphoscintigraphy 541 H. M. Abdel-Dayem (New York Medical College and St Vincent's Hospital and Medical Center, New York, USA), Q. H. Siraj (Nuclear Medicine Centre, Pakistan) and B. D. Collier (Medical College of Wisconsin, Milwaukee, USA)

15 Head and neck disease Cancer of the head and neck M. N. Maisey and E. B. Chevretton (Guy's and St Thomas' Hospital, London, UK)

553 553

V111 Contents

Salivary glands 557 N. D. Greyson (St Michael's Hospital, Toronto, Canada)

Lacrimal apparatus 567 N. D. Greyson (St Michael's Hospital, Toronto, Canada)

SECTION THREE TECHNICAL TOPICS 573

16 Radiopharmaceuticals 575 Introduction 575 C. R. Lazarus (Guy's and St Thomas' Hospital, London, UK)

Interactions 579 S. R. Hesslewood (City Hospital NHS Trust, Birmingham, UK)

Untoward reactions 587 D. H. Keeling (formerly at Derriford Hospital, Plymouth, UK)

Introduction of new radiopharmaceuticals 601 S. ]. Mather (St Bartholomew's Hospital, London, UK)

17 New tracer approaches 609 Radiopeptides 609 S. ]. Mather (St Bartholomew's Hospital, London, UK)

Radioimmunoscintigraphy 617 K. E. Britton and M. Granowska (St Bartholomew's Hospital, London, UK)

Radio-oligonucleotides 637 D. J. Hnatowich (University of Massachusetts Medical Center, Worcester, USA)

18 Diagnostic accuracy and cost-benefit issues 645 M. N. Maisey (Guy's and St Thomas' Hospital, London, UK)

19 Technology and instrumentation 663 SPECT issues 663 P. H. ]arritt (UCL Medical School, London, UK)

Image registration 679 D. J. Hawkes (Guy's and St Thomas' Hospital, London, UK)

20 Radiation 691 Radiation risks and patient issues 691 A. B. Brill (Vanderbilt University, Nashville, USA), L. K. Harding and W. H. Thomson (City Hospital NHS Trust, Birmingham, UK)

Pregnancy and breast-feeding 709 P. ]. Mountford (North Staffordshire Hospital, Stoke-an-Trent, UK) and A. ]. Coakley (Kent and Canterbury Hospital, Canterbury, UK)

21 Quantitation 719 H. D. Royal (Mallinckrodt Institute of Radiology, St Louis, USA) and B. ]. McNeil (Harvard Medical School, Massachusetts, USA)

Index 737

Hussein M. Abdel-Dayem MD Department of Radiology New York Medical College and St Vincent's

Hospital and Medical Center New York, USA

Therese Benoit MD Centre Hospitalier Universitaire de Liege Service de Medicine Nucleaire Liege, Belgium

A. Bertrand Brill MD PhD Department of Radiology and Radiological

Science Vanderbilt University Nashville, USA

Keith E. Britton MD MSc FRCR FRCP Department of Nuclear Medicine St Bartholomew's Hospital London, UK

Julia W. Buchanan BS Department of Radiology The Johns Hopkins Medical Institutions Baltimore, USA

John Buscombe MD MSc MRCP Department of Nuclear Medicine Royal Free Hospital London, UK

V. U. Chengazi MB BS MSc PhD Department of Nuclear Medicine 5t Bartholomew's Hospital London, UK

Contributors

Elfy B. Chevretton BSc MS FRCS Department of Oral Surgery Guy's and St Thomas' Hospital London, UK

Marco Chianelli, MD PhD Servizio Medicina Nucleare Istituto di Clinica Medica II Universita 'La Sapienza' Roma, Italy

Marco Chinol PhD Division of Nuclear Medicine Istituto Europeo di Oncologia Milano, Italy

S. E. M. Clarke MSc FRCP Department of Nuclear Medicine Guy's and St Thomas' Hospital London, UK

A. J. Coakley MB ChB MSc FRCR FRCP Department of Nuclear Medicine Kent and Canterbury Hospital Canterbury, UK

B. D. Collier BA MA MD Nuclear Medicine Department Medical College of Wisconsin Milwaukee, USA

Durval C. Costa MD MSc PhD FRCR Institute of Nuclear Medicine UCL Medical School Middlesex Hospital London, UK

x Contributors

Peter Josef Ell MD MSc PO FRCR FRCP Institute of Nuclear Medicine Middlesex Hospital London, UK

Ignac Fogelman BSc MD FRCP Department of Nuclear Medicine Guy's and St Thomas' Hospital London, UK

David Gilday BEng, MD, FRCPC Nuclear Medicine Division The Hospital for Sick Children Toronto, Canada

Marie Granowska MD MSc FRCR Department of Nuclear Medicine St Bartholomew's Hospital London, UK

N. David Greyson MD FRCPC University of Toronto Department of Medical Imaging St Michael's Hospital Toronto, Canada

Milton D. Gross MD Division of Nuclear Medicine The Univerisity of Michigan Ann Arbor, USA

L. Keith Harding BSc FRCR FRCP Department of Physics and Nuclear Medicine City Hospital NHS Trust Birmingham, UK

David J. Hawkes PhD Radiological Sciences Guy's and St Thomas' Hospital London, UK

Stuart R. Hesslewood BPharm PhD MRPharmsS MCPP

Radiopharmacy Department City Hospital NHS Trust Birmingham, UK

Andrew J. W. Hilson MA MSc FRCP Department of Nuclear Medicine Royal Free Hospital London, UK

D. J. Hnatowich PhD Department of Nuclear Medicine University of Massachusetts Medical Center Worcester, USA

C. A. Hoefnagel MD PhD Department of Nuclear Medicine Het Nederlands Kanker Instituut Amsterdam, The Netherlands

Mario P. Iturralde MD DMC DM Department of Nuclear Medicine University of Pretoria Pretoria, Republic of South Africa

Peter Jarritt BSc PhD Institute of Nuclear Medicine UCL Medical School London, UK

David H. Keeling MA MB MSc FRCR FRCP formerly at Department of Nuclear Medicine Derriford Hospital Plymouth, UK

Frederick Khafagi MB FRACP St Andrew's War Memorial Hospital Brisbane, Australia

Richard T. Kloos MD Divisions of Endocrinology and Metabolism, and

Nuclear Medicine The University of Alabama at Birmingham Birmingham, USA

Linda C. Knight PhD Division of Nuclear Medicine Department of Diagnostic Imaging and Sol

Sherry Thrombosis Research Center Temple University Hospital and School of

Medicine Philadelphia, USA

Colin R. Lazarus BPharm PhD MRPharmS Department of Nuclear Medicine Guy's and St Thomas' Hospital London, UK

Anne Lingford-Hughes MA PhD BM BCh MRCPsych

Institute of Psychiatry De Crespigny Park London, UK

Homer A. Macapinlac MD Nuclear Medicine Service Department of Radiology Memorial Sloan Kettering Cancer Center New York, USA

B. J. McNeil, MD Department of Radiology Harvard Medical School Cambridge Massachusetts, USA

M. N. Maisey BSc MD FRCR FRCP Division of Radiological Sciences Guy's and St Thomas' Hospital London, UK

Stephen J. Mather BPharm MSc MRPharmS PhD

Department of Nuclear Medicine St Bartholomew's Hospital London, UK

Alan H. Maurer MD Departments of Diagnostic Imaging and Internal

Medicine Temple University Hospital and School of

Medicine Philadelphia, USA

P. J. Mountford BSc PhD CPhys FInstP FIPEMB

Division of Radiation Physics North Staffordshire Hospital (Royal Infirmary) Stoke-on-Trent, UK

M. J. O'Doherty MSc MD FRCP Radiological Sciences Guy's and St Thomas' Hospital London, UK

Giovanni Paganelli MD Division of Nuclear Medicine Istituto Europeo di Oncologia Milano, Italy

Adrian Parkin PhD FIPEMB Medical Physics Department St James' and Seacroft University Hospitals NHS

Trust Leeds, UK

Contributors xi

Jim Patterson PhD Department of Clinical Physics Institute of Neurological Sciences Southern General Hospital Glasgow, UK

S. R. Payne MS FRCS FEBU Department of Urological Surgery Manchester Royal Infirmary Manchester, UK

A. M. Peters MSc MD MRCP FRCR FRCPath Department of Imaging Imperial College School of Medicine Hammersmith Hospital London, UK

Lyn S. Pilowsky PhD MRCPsych Institute of Psychiatry De Crespigny Park London, UK

Myron Pollycove MD US Nuclear Regulatory Commission Washington, DC, USA Formerly at: Departments of Laboratory Medicine

and Radiology San Fransisco General Hospital San Fransisco, USA

Pierre Rigo MD Centre Hospitalier Universitaire de Liege Service de Medicine Nucleaire Liege, Belgium

Howard A. Ring MRCPsych MD Academic Department of Psychological Medicine St Bartholomew's and the Royal London

School of Medicine London, UK

Philip J. A. Robinson FRCR FRCP Department of Clinical Radiology St James' University Hospital Leeds, UK

Henry D. Royal MD Mallinckrodt Institute of Radiology Washington University School of Medicine St Louis, USA

xii Contributors

Paul J. Ryan MSc MRCP Nuclear Medicine Dept Medway Hospital Gillingham, UK

Brahm Shapiro MB ChB PhD Department of Internal Medicine The University of Michigan Medical Center and

Ann Arbor Veterans Affairs Medical Center Ann Arbor, USA

Alberto Signore MD Servizio Medicina Nucleare Istituto di Clinica Medica II Universita 'La Sapienza' Roma, Italy

Edward B. Silberstein MD FACNP Division of Nuclear Medicine University of Cincinnati Medical Center Cincinnati, USA

Qaisar H. Siraj MSc PhD Nuclear Medicine Centre A. F. Institute of Pathology Rawalpindi, Pakistan

D. M. Swirsky MRCPath FRCP Department of Haematology Imperial College School of Medicine Hammersmith Hospital London, UK

H. J. Testa MD PhD FRCR FRCP Department of Nuclear Medicine Manchester Royal Infirmary Manchester, UK

W. H. Thomson PhD Department of Physics and Nuclear Medicine City Hospital NHS Trust Birmingham, UK

Sabah S. Tumeh MD FACR Nuclear Medicine Division Bon Secours DePaul Medical Center Norfolk, USA

Henry N. Wagner Jr MD Division of Radiation Health Science The Johns Hopkins Medical Institution Baltimore, USA

Richard L. Wahl MD Division of Nuclear Medicine University of Michigan Medical Center Ann Arbor, USA

c. P. Wells MSc MIPEMB Departments of Medical Physics

and Nuclear Medicine Kent and Canterbury Hospital Canterbury, UK

David J. Wyper PhD Department of Clinical Physics Institute of Neurological Sciences Southern General Hospital Glasgow, UK

Preface to the first edition

Nuclear medicine is the bridge between a particular clinical problem and a relevant test using radionuclides. It began as a minor technical tool used in a few branches of medicine, notably endocrinology and nephrology. However, throughout the world it has now become established as a clinical discipline in its own right, with specific training programmes, special skills and a particular approach to patient management. Although the practising nuclear medicine physician must necessarily learn a great deal of basic science and technology, a sound medical training and a clinical approach to the subject remains of fundamental importance. It is for this reason that we have attempted in this book to approach the subject from a clinical standpoint, including where necessary relevant physiological material.

There exist many excellent texts which cover the basic science and technology of nuclear medicine. We have, therefore, severely limited our coverage of these aspects of the subject to matters which we felt to be essential, particularly those which have been less well covered in other texts - for example, the contents of Chapter 21 on Quantitation by Royal and McNeil. Similarly, we have included at the end of some chapters descriptions of particular techniques where we and the authors felt that it would be helpful. In order to emphasize the clinical approach of this book we have inverted the traditional sequence of material in chapters, presenting the clinical problems first in each instance. For similar reasons we have placed the chapters on Radiopharmaceuticals and Practical Instrumentation towards the end of the book.

Since medicine concerns the investigation, care and management of sick people who have specific problems, the virtues of a problem-orientated approach to the subject are becoming more widely recognized, particularly in the education of undergraduates. This approach has therefore been adopted in each chapter, making the overall structure of the book closer to that of a conventional textbook of medicine rather than a scientific treatise.

The contributors to this book come from both the United Kingdom and North America. As editors, in addition to requiring that authors should be expert in their field, we also wanted them to be particularly concerned about the day to day care of patients. We have endeavoured to emphasize the problem­orientated approach to clinical situations, whilst providing textual uniformity, without at the same time reducing the essentially individual contributions of each author.

We hope this textbook will be of value to a wide variety of medical professionals, including nuclear medicine clinicians in training, radiologists and clinicians from other specialities who use nuclear medicine in some form or other and require to know how it can help in solving their clinical problems. Finally, believing that medical students prefer the style of a textbook of medicine rather than that of a textbook of physics, we hope that the clinical priorities which have dictated the production of this book will encourage them to consult it.

M.N.M., K.E.B., London D.L.G., Toronto

Preface to the third edition

Clinical nuclear medicine continues to develop with no sign of any diminishing impact. Since the first edition was published we have seen a progressive emphasis on providing functional information critical to good patient care. With tissue characterization techniques through receptor binding peptides, monoclonal antibodies and other agents, higher specificity is being added to sensitivity in oncology, endocrinology and infectious diseases. The cost-effectiveness of myocardial perfusion studies in ischaemic heart disease is now recognized. This edition reflects these growths and focuses with more emphasis on clinical applications of new tracers including positron emission tomography (PET), which is now widely accepted and becoming increasingly available. Therapeutic applications for radionuclides are expanding and effective and this ground is covered more extensively. As in previous editions we have also selected relevant topics which we believe to be of current importance rather than undertaking a comprehensive attempt to deal with all of basic science.

Our goal and that of our many new contributors remains the provision of a clinical text devoted to the role of radionuclide tracers for the best management of our patients. Nuclear medicine is now at the heart of mainstream medical practice, with an important role in every conventional clinical discipline, and the signs are that this will increase even more with a new emphasis on molecular medicine and the need to monitor disease states and therapeutic responses more critically.

M.N.M., K.E.B., London B.D.C., Milwaukee