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Nuclear Medicine

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Nuclear Medicine General concept Radiopharmaceutics mCi, MBq (1mCi = 37MBq) Planar image and SPECT image Clinical presentation Neurology imaging 99mTc-HMPAO : cross ... – PowerPoint PPT presentation

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Title: Nuclear Medicine


1
Nuclear Medicine
2
General concept
  • Radiopharmaceutics
  • mCi, MBq (1mCi 37MBq)
  • Planar image and SPECT image
  • Clinical presentation

3
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

4
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

8
2 h
4 h
1 h
48 h
6 h
24 h
9
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

10
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

20
201Tl
21
Myocardial perfusion scintigraphy
  • Pharmacologic stress test Dipyridamole,
    Adenosine
  • Homogeneous, heterogeneous
  • Reversible redistribution
  • Fixed defect
  • Reverse redistribution

22

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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,

31
Subcutaneous radionuclide Venography
32
Subcutaneous radionuclide Venography
33
Gastrointestinal imaging
  • Liver-spleen scintigraphy 99mTc-sulfur colloid
  • Cholescintigraphy 99mTc-DISIDA
  • GI bleeding 99mTc-RBC
  • Ectopic gastric mucosal scan 99mTcO4-
  • Gastric empty time

34
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
40
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

43
Three phase bone scan
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Oncologic imaging
  • 67Ga, 201Tl, 99mTc-MIBI, 18FDG

51
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

52
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

56
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

62
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

63
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...

71
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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