Nuclear Medicine. General concept Radiopharmaceutics mCi, MBq (1mCi = 37MBq) Planar image and SPECT...
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Transcript of Nuclear Medicine. General concept Radiopharmaceutics mCi, MBq (1mCi = 37MBq) Planar image and SPECT...
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 onse
t 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
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
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
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,
Gastrointestinal imaging Liver-spleen scintigraphy : 99mTc-sulfur
colloid Cholescintigraphy : 99mTc-DISIDA GI bleeding : 99mTc-RBC Ectopic gastric mucosal scan : 99mTcO4
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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 atre
sia 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)
Skeletal imaging 99mTc-MDP (bone hydroxyapatite crystal) Regional blood flow, tissue extraction, o
steoblastic activity Metastases, osteomyelitis, AVN, stress fx,
occult bone trauma, joint prosthesis… sensitivity high, specificity moderate
67Ga scan Bind to transferrin and accumulate in a wid
e variety of malignant neoplasms and their metastases
Inflammatory image Detection and staging of Hodgkin’s diseas
e, non-Hodgkin’s lymphoma, melanoma, lung cancer, hepatoma, leukemia, gastric cancer, esophageal cancer…
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 func
tion Lasix : ddx of non-obstructive dilatati
on & mechanical obstruction, Capoten : renovascular hypertension
Renal scan (99mTc-DMSA) Children APN, renal scarring, renal i
nfarct, 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 pulmo
nary embolism after anti-coagulant therapy, perfusion change secondary to lung tumor, pre-operative evaluation for pneumonectomy, post-operative F/U…
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 (melano
ma, 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 ob
struction, DM gastroparesis, s/p vagotomy, gastrinoma…
Follow up and evaluation of the effectiveness of treatment.