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Nuclear Medicine

Dr. Deniz BEDEL


in

Workflow
Radioactivity is given to the patient
orally/i.v

These are either the radioactive forms of the elements that


are used in the body or organ specific agents
The half life of these radiopharmaceuticals
are short and eliminated from the body in
hours

When the agents are accumulated or caught


by the target organ, images are obtained by
the gamma cameras

What is Nuclear Medicine ?


Images obtained with gamma cameras when
radioactivity is given to the patients

Bone scintigraphy: Dark areas are


the bone metastases.

Why Do We Use This Method?


Non-invazive

Radiology can give information on


anatomical details but not function

Functional Evaluation

Tumors and Radiopharmaceuticals


Primary tumor

Radiopharmaceutical

Differentiated thyroid carcinoma

123

Medullary thyroid carcinoma

99m

I or

99m

Tc-pertechnetate

Tc-V-DMSA

Lymphoma

67

Neuroendocrine tumors

111

Neural crest tumors

123

Breast carcinoma

99m

Tc-MIBI

Primary bone tumors

99m

Tc-MDP

Ga citrate
In-octreotide
I-MIBG

Differentiated Thyroid Cancer


Radiopharmaceuticals
I-123
I-131

Whole body imaging is used for


detection of residual thyroid tissue and
metastases.

I-131

Lymphoma imaging using


Gallium-67

Lymphoma imaging using FDG

Gastroenteropancreatic
Neuroendocrine Tumors (GEP-NET)
Radioactive somatostatin analogues ( In-111
octreotide, Lu-177 DOTA-TATE) is used
because of the presence of somatostatin
receptors

Primary gastrinoma
In-111 octreotide

Neural Crest Tumors


I-131 MIBG resembles noradrenaline
Whole body imaging enables multifocal
or extraadrenal tumor detection

Pheocromacytoma -MIBG

Neuroblastoma imaging using


I-131-MIBG
MIBG

Bone scan

Bone metastases Detection


Generally seen as increased radioactivity on bone
scintigraphy
Rarely (2%) cases may show photopenic lesions
(renal cell ca, melanoma)
Rutine bone scintigraphy

Prostate Ca
Breast Ca
Lung Ca

Multiple metastases

Sentinel lymph node detection


It is the first lymph node where the
tumor drains
Colloidal particle injection
Drainage images
Intraoperative gamma probe

Sentinel node

Sentinel node intraoperative

PET
Positron emission tomography
Functional and whole body imaging
Evaluation of tumor metabolism via
radioactive glucose or aminoacids

PET

Tumor
localisation ,
Differentiation
between benign /
malign
Detection of
tumour viability
after treatment

18F-florodeoxyglucose

(FDG)

Cell
FDG
Hexokinase

FDG-6-fosfat

FDG PET

FDG

Glucose
Transporter

FDG

Hexokinase

Glucose-6-isomerase

FDG-6-PO4
Glucose-6Glycolysis
phosphatase

PET/CT

PET
Shorter
Less radiation
Better resolution
Better lesion detection

RADIONUCLIDE
THERAPY

Radionuclide Therapy
Therapy
Differentiated thyroid cancer

Radiopharmaceutical
I-131

Neuroblastoma stage III-V


Malign pheochromacytoma

I-131 MIBG

GEP-NET Tumors

In-111 octreotide,Y-90 DOTATOC,


Lu-177 DOTA-TATE

Painful bone metastases

P-32, Sr-89, Sm-153 EDTMP,


Re-186 HEDP

Myeloproliferative diseases (polistemia


vera)

P-32

Radionuclide Synovectomy

P-32, Re-186, Sm-153, Re-188,


Au-198

Radio-iodine Threapy
Differentiated thyroid cancer
Post-op.
Ablation of functional thyroid tissue
100-200 mCi
In-patient

MIBG therapy
Pheocromacytoma and neuroblastoma
Rarely medullary thyroid cancer
Pre or post-op
Pallation or curative

Lymphoma imaging using 111InAnti-CD20 (Zevalin)


Anterior gamma camera scans

Abdominal SPECT

4
hours

66
hours

139
hours

Abdominal CT
Wiseman et al. Cancer 2002;94:13491357

Gastroenteropancreatic
Neuroendocrine Tumours (GEP-NET)
Lu-177 DOTA-TATE

Treatment of Painful Bone


Metastases
Alternative to analgesics, non-steroidal antiinflamatuary treatment, radiotherapy,
chemotherapy or hormone therapy

32

153

P and 89Sr (beta)


Sm-EDTMP (beta and gamma)

Radionuclide Synovectomy
Radiolabeled colloids
Intra articular injection
Combination of glucocorticoids
Hemophilic Arthritis
Rheumatoid Arthritis
Intra articular pigmented villonodular synovitis
(PVNS)