Nuclear Medicine

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 onset 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

1h

2h

4h

6h

24 h

48 h

Endocrine imaging

Thyroid scan : Parathyroid

99mTcO - , 123I, 131I, 201Tl 4 99mTcO -/ 201Tl scan : 4 subtraction, 99mTc-MIBI

Adrenal cortex scan : NP-59 Adrenal medulla scan : 131I-MIBG

Thyroid scintigraphy

Thyroid nodule Congenital hypothyroidism Thyroid cancer follow up I treatment

131

I 131

Parathyroid scintigraphy

Detection and localization of parathyroid adenoma

Adrenal medulla scintigraphy

131

I-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

201Tl

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,

Subcutaneous radionuclide Venography

Subcutaneous radionuclide Venography

Gastrointestinal imaging

Liver-spleen scintigraphy : 99mTc-sulfur colloid Cholescintigraphy : 99mTc-DISIDA GI bleeding : 99mTc-RBC Ectopic gastric mucosal scan : 99mTcO4Gastric empty time

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

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 (>30 mins)

5m

15 m

30 m

1h

2h

4h

6h

24 h

5m

15m

30m

1h

2h

4h

7h

24h

Skeletal imaging
99m

Tc-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

67Ga, 201Tl, 99mTc-MIBI, 18FDG

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

67Ga

scan

67Ga

scan

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 function Lasix : ddx of non-obstructive dilatation & mechanical obstruction, Capoten : renovascular hypertension

Renal scan (99mTc-DMSA)

Children APN, renal scarring, renal infarct, 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 pulmonary embolism after anticoagulant therapy, perfusion change secondary to lung tumor, pre-operative evaluation for pneumonectomy, post-operative F/U

ANT

LEFT

LPO

POST

RPO

RIGHT

Salivary gland scintigraphy

99mTcO 4

Symmetric gland accumulation, drainage, increased or decreased function. Salivary gland function, dry mouth, Sjogrens syndrome, parotid tumor, NPC post radiation therapy

Lymphoscintigraphy

99mTc-sulfur

colloid Lymphatic obstruction Detect sentinel lymph node (melanoma, 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,6030min; liquid meal, 3015min) Gastric outlet obstruction or function obstruction, DM gastroparesis, s/p vagotomy, gastrinoma Follow up and evaluation of the effectiveness of treatment.