Transcript Nuclear Medicine

Nuclear Medicine
General concept
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Radiopharmaceutics
mCi, MBq (1mCi = 37MBq)
Planar image and SPECT image
Clinical presentation
Neurology imaging
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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
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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
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NPH : communicating hydrocephalus ,
a delay in CSF absorption over
the convexity
CSF leakage
1h
2h
6h
24 h
4h
48 h
Endocrine imaging
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Thyroid scan :
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Parathyroid
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99mTcO
- ,
4
123I, 131I, 201Tl
99m
scan :
TcO4 / 201Tl
subtraction, 99mTc-MIBI
Adrenal cortex scan : NP-59
Adrenal medulla scan : 131I-MIBG
Thyroid scintigraphy
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Thyroid nodule
Congenital hypothyroidism
Thyroid cancer follow up
I treatment
 131
I 131
Parathyroid scintigraphy
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Detection and localization of parathyroid
adenoma
Adrenal medulla scintigraphy
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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
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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
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Pharmacologic stress test :
Dipyridamole, Adenosine
Homogeneous, heterogeneous
Reversible redistribution
Fixed defect
Reverse redistribution
MUGA (radionuclide ventriculography)
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For evaluation of ventricular size, RVEF,
LVEF, regional wall motion
Angio-venography
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Lower extremities edema
Detection and route out DVT, venous
insufficiency, inflammation process,
varicose vein,
Subcutaneous radionuclide Venography
Subcutaneous radionuclide Venography
Gastrointestinal imaging
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Liver-spleen scintigraphy : 99mTc-sulfur
colloid
Cholescintigraphy : 99mTc-DISIDA
GI bleeding : 99mTc-RBC
Ectopic gastric mucosal scan : 99mTcO4Gastric empty time
Liver-spleen scan
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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
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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)
5m
15 m
30 m
1h
2h
4h
6h
24 h
5m
2h
15m
4h
30m
7h
1h
24h
Skeletal imaging
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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
Ga,
 67
201Tl, 99mTc-MIBI, 18FDG
67Ga
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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
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Glomerular agents : 99mTc-DTPA
Tubular agents : 99mTc-MAG3
Cortical agents : 99mTc-DMSA
Diuretic renography
Captopril renography
Renal scan (99mTc-DTPA)
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Baseline : GFR, quantitative renal
function
Lasix : ddx of non-obstructive dilatation
& mechanical obstruction,
Capoten : renovascular hypertension
Renal scan (99mTc-DMSA)
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Children APN, renal scarring, renal
infarct, renal trauma, horseshoe
kidney, ectopic kidney, renal cyst,
renal abscess, renal tumor.
Pulmonary imaging
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Perfusion image : 99mTc-MAA (10~90um)
Ventilation image : 133Xe, 99mTc-DTPA
aerosol
PIOPED interpretation criteria
V/Q mismatch
Pulmonary imaging
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pulmonary embolism, F/U
pulmonary embolism after anticoagulant therapy, perfusion
change secondary to lung tumor,
pre-operative evaluation for
pneumonectomy, post-operative
F/U…
ANT
POST
LEFT
RPO
LPO
RIGHT
Salivary gland scintigraphy
99m
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TcO4
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Symmetric gland accumulation,
drainage, increased or decreased
function.
Salivary gland function, dry mouth,
Sjogren’s syndrome, parotid tumor, NPC
post radiation therapy…
Lymphoscintigraphy
Tc-sulfur colloid
Lymphatic obstruction
Detect sentinel lymph node (melanoma,
breast cancer…)
 99m
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Testicular/scrotal scintigraphy
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99m-TcO4
D/D testicular torsion from epididymitis,
hydrocele, hematocele, abscess...
Gastric empty scintigraphy
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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.