Index

Note: Page numbers followed by f refer to figures, by t to tables, and by b to boxes.

AAbdomen

fluid in, 105finfection in, 327, 328f–329f, 342–343,

342f–343fAbscess. See also Infection scintigraphy

abdominal, 327–328, 329fBrodie, 334hepatic, 342–343, 343fperitoneal, 342, 342f

Accelerator, 1–2ACE inhibitor renography. See Angiotensin-

converting enzyme (ACE) inhibitor renography

Achalasia, 288, 291f–292fAdenoma

hepatic, 155, 155tparathyroid, 90, 428. See also

Hyperparathyroidismthyroid, 79–81, 80b, 80f, 234–235, 234f

Adenosine, in myocardial perfusion scintigraphy, 388–390, 389f, 390t

Adrenal scintigraphy, 269–271methodology for, 269–270, 270b, 270tin neuroblastoma, 271, 273fin pheochromocytoma, 270–271, 271f–272fradiopharmaceuticals for, 269–271, 269f, 269t

Adult respiratory distress syndrome, 225Adverse reaction, 12Air kerma, 35Alcoholic liver disease, 162, 162fAlpha decay, 27, 28fAluminum, in Mo-99/Tc-99m generator

system, 5Alzheimer dementia, 357, 358f–359f, 436b

amyloid and, 370–371, 370fAmino acids, radiolabeling of, 20Amyloid imaging, 370–371, 421–422

C-11 Pittsburgh B compound for, 370F-18 agents for, 370–371, 370f

Aneurysmaortic, 312–314, 316fventricular, 438

Anger logic, 43–44Angina, unstable, 406Angiogenesis, 21Angiography

in gastrointestinal bleeding, 308in pulmonary embolism, 204–205

Angioplasty, 407Angiotensin-converting enzyme (ACE)

inhibitor renography, 184–185interpretation of, 186–188, 187f–188fmethodology for, 185–186, 186breporting for, 188

Ångström (Å), 25tAntibodies, 271, 274f

HAMA, 12, 271–274monoclonal. See Monoclonal antibody

imagingAntineutrino, 27–28Aortic aneurysm, 312–314, 316fAortic arch, on F-18 FDG PET, 234Apoptosis, 22

Arginine-glycine-aspartic acid (RGD), 21Arterial graft infection, 344–345Arteriovenous graft infection, 333fArthritis, 127–128, 129fArtifact

attenuation, 394, 396f–397fbeam hardening, 238–240, 238f, 240frespiratory motion, 239–240, 239fring (bull’s-eye), 59, 60fstar, 86, 88fstarburst, 59, 59f

Ascites, 105fAspiration, salivagram of, 294, 294fAsplenia, 164Atom, 24, 25fAtomic mass (A), 24Atomic mass unit (U), 25tAtomic number (Z), 1, 2b, 2f, 24Attenuation artifact, in myocardial perfusion

scintigraphy, 394, 396f–397fAttenuation correction, 55, 433

analytic, 55CT-based, 55in gastric motility scintigraphy, 303–304,

304f–305f, 434in myocardial perfusion scintigraphy, 437b,

437b, 394–395, 398f, 437bAuger electron, 25t, 26Autoclaving, 13Avogadro’s number, 25t

BBarrett esophagus, 320Beam hardening artifact, 238–240, 238f, 240fBecquerel (Bq), 30, 31bBeta-blockers, in Graves disease, 84Beta decay, 27–28, 28fBile ducts, 133f, 134, 135f–136f

atresia of, 146–151cholescintigraphy in, 146–151, 150f–151f,

431SPECT/CT in, 146–148, 151f

carcinoma of, 258diversion surgery on, 152leaks from

postoperative, 152, 153fposttraumatic, 153

obstruction of, 144–146, 431high-grade, 144, 144b, 431

cholescintigraphy in, 144, 145fimaging diagnosis of, 144partial, 144, 431

after cholecystectomy, 153, 154fcholescintigraphy in, 144–146, 146b,

146f–148f, 148btrauma to, cholescintigraphy after, 153

Bile reflux, 156, 157fBiliary scintigraphy. See CholescintigraphyBillroth procedures, cholescintigraphy after, 152Bladder

carcinoma of, 262, 263fin renal scintigraphy, 179

441

Bleeding, gastrointestinal. See Gastrointestinal bleeding

Bone cyst, 112tBone infarction, 121–122, 121b. See also

OsteonecrosisBone infection. See OsteomyelitisBone islands, 111, 112tBone marrow

on F-18 FDG PET, 236, 237fTc-99m SC scan of, 124, 126f, 336, 341f

Bone mineral mass, 128–130Bone pain, palliation of, 285–287, 285t, 286fBone scan, 98–103

in aneurysmal bone cyst, 112tin bone islands, 111, 112tin Charcot joint, 124, 126fafter chemoradiation, 105fin child abuse, 115–117in children, 101, 102fin chondroblastoma, 112tcold areas on, 98, 99f, 106, 106b, 108fin complex regional pain syndrome, 117–118,

118fin diskitis, 340dynamic (three-phase), 100, 100b, 118f–119f,

430in osteomyelitis, 124, 124b, 125f, 126b

in enchondroma, 111–112, 112tin eosinophilic granuloma, 112tvs. F-18 FDG PET, 104–105, 237f, 262, 433F-18 NaF for, 226, 126–128, 128f–129fin fibrous dysplasia, 112, 112t, 113b, 113fflare phenomenon on, 106, 107fin florid hypertrophic osteoarthropathy, 107,

109fin giant cell tumor, 112tin hemangioma, 112tin heterotopic bone formation, 121, 121fin histiocytosis, 110in hyperparathyroidism, 112–113, 115b, 115t,

117fin iatrogenic trauma, 114–115after joint replacement, 124–126, 128f, 341in Legg-Calvé-Perthes disease, 122, 122fin leukemia, 110in lymphoma, 110in malignant ascites, 105fmetastatic disease on, 99f, 101f, 103–105,

106b, 429in breast cancer, 101f, 102–103, 107,

107f–108f, 429cold lesions on, 99f, 106, 106b, 108fflare phenomenon in, 106, 107f, 429vs. injection-site extravasation, 429in lung cancer, 107, 109fmultiple lesions and, 105, 106bin neuroblastoma, 108, 110fvs. osteoarthritis, 429in prostate cancer, 99f, 106–107in sarcoma, 108–110, 111fsensitivity for, 104–105, 429bsolitary lesions and, 105, 106tsuperscan pattern and, 106, 106b, 429,

429b

442  Index

Bone scan (Continued)multiple lesions on, 105, 106bin multiple myeloma, 110in necrosis, 121–122, 121b, 122f–123fin nonossifying fibroma, 112tnormal, 98f, 101–103, 102fin osteoarthritis, 102, 102f, 429in osteochondroma, 111, 112tin osteoid osteoma, 111, 112f, 112tin osteomalacia, 115f, 115tin osteomyelitis, 123–126, 123f, 124b, 125f,

126b, 127f, 336, 336t, 337f–339fin osteoporosis, 102, 103f, 117fin Paget disease, 112, 114fpearls and pitfalls of, 429pinhole collimator in, 100–101protocol for, 99–101, 100brenal disease on, 103, 104bin renal osteodystrophy, 112–113, 115t, 116fin rhabdomyolysis, 121, 121fin sarcoma, 108–110, 110f–111fin shin splints, 119, 120fin sickle cell anemia, 122, 123fsoft tissue analysis with, 103, 105fsolitary lesions on, 105, 106tSPECT/CT, 100–101, 101fin spondylolysis, 119, 120fspot-view, 100, 101fin steroid-induced osteonecrosis, 122in stress fracture, 118–119, 119f–120f, 119tin stroke, 105fsuperscan pattern on, 106, 106bTc-99m MDP for, 98–99

dosimetry with, 99, 99tpreparation of, 98uptake of, 98–99, 98f–99f

in trauma, 102–103, 104f, 113–121, 117f–118f, 118t

in unicameral bone cyst, 112twhole-body, 100, 101f

Brainanatomy of, 350–351, 351f–352fimaging of. See Cerebral scintigraphy;

CisternographyTc-99m MAA uptake in, 211, 212f

Brain death, 436scintigraphy for, 365–368, 366f, 367b, 436

Brain tumor, 366–368F-18 FDG PET in, 366–367, 367fMRI in, 367, 367f–368fSPECT in, 368, 368f

Breast attenuation, in myocardial perfusion scintigraphy, 394, 397f

Breast cancer, 46–47, 254–256, 254b, 254tdiagnosis of, 255F-18 FDG PET in, 280, 255–256, 255f–256f,

279F-18 FLT imaging in, 19–20, 19flymph node evaluation in, 255, 255f–256f,

281, 283, 434mammography in, 280t, 255, 278metastatic

bone scan in, 101f, 102–103, 106–107, 107f–108f, 128f, 429

F-18 NaF PET in, 127–128, 128fMRI in, 278–279PET mammography in, 255, 279Tc-99m sestamibi scintigraphy in, 281t,

278–281, 279f, 280bBremsstrahlung radiation, 26, 31–32Brodie abscess, 334Bronchoalveolar lavage, in sarcoidosis, 346–347Brown fat, on F-18 FDG PET, 232–234, 233fBudd-Chiari syndrome, 163, 164fBull’s eye artifact, 59, 60f

CCaffeine, 389f, 438Calcium score, 407Calibrations, 44

in PET, 63–64in SPECT, 59–61, 60f

Calorie (Cal), 25tCancer, 265b. See also at specific cancers

bone metastases in. See Bone scan.metastatic disease on

bone pain in, 285–287, 285t, 286fF-18 FDG PET in, 227–264, 228t, 229f, 241b

artifacts on, 238–240, 238f–240fbackground activity on, 240vs. benign patterns, 231–240, 231f–234f,

232b, 232tvs. benign thymic uptake, 236, 238fin bladder carcinoma, 262, 263fin breast carcinoma, 280t, 254–256,

255f–256f, 279in cervical carcinoma, 262, 263fafter colony-stimulating factor therapy,

236, 237fin colorectal carcinoma, 256–258, 259fdosimetry in, 229, 229tin esophageal carcinoma, 256, 257fvs. fracture, 235, 235fin gastrointestinal stromal tumor, 258,

260fin head and neck carcinoma, 245–246,

245f, 246t–247t, 247f–248fvs. inflammation, 235–236, 235finterpretation of, 230–241limitations of, 433in lung carcinoma, 248–254, 248b,

249f–250f, 253f–254fin lymphoma, 241–242, 242b, 242f–244fin melanoma, 243–244, 244fmetal artifact on, 238, 238fmethodology for, 229–230, 230bmotion artifact on, 239–240, 239fin multiple myeloma, 242necrosis on, 240, 240fvs. normal distribution, 230–231, 231fin ovarian carcinoma, 259–262, 261b, 261f,

262tin pancreatic cancer, 258, 260fpearls and pitfalls in, 432–433vs. postoperative changes, 235–236, 237fpostpleurodesis, 235–236, 237fpostradiation, 235–236, 236fin prostate carcinoma, 262in renal carcinoma, 262sensitivity of, 433standard uptake value in, 240–241, 241tin testicular carcinoma, 262thymic rebound on, 236in thyroid carcinoma, 246–248

Ga-67 scintigraphy in, 279t, 281, 281t, 282flymphoscintigraphy in, 281–283, 282fpeptide receptor imaging in, 265–269, 266f,

268fTc-99m sestamibi scintigraphy in, 278–281,

279f, 279t, 280bTl-201 imaging in, 434b, 279t, 281, 281ttumor hypoxia in, 20–21, 21f

Capital femoral epiphysis, avascular necrosis of, 122, 122f

Carbon-11 (C-11), 3t, 227, 228tCarbon-11 (C-11) acetate imaging, 20, 407t,

423Carbon-11 (C-11) choline imaging, 20Carbon-11 (C-11) methionine imaging, 20Carbon-11 (C-11) Pittsburgh B compound,

370

Carbon-13 (C-13), 3tCarcinoid, 267, 268fCardiac imaging. See Myocardial perfusion

scintigraphy; VentriculographyCardiotoxicity, 420–421, 420bCaroli disease, 146, 149fCenter of rotation calibration, 60Cerebral scintigraphy, 351–354

in Alzheimer dementia, 357, 358f–359f, 370f, 436b

in brain death, 365–368, 366f, 367bin cerebrovascular disease, 363–364,

364f–365f, 436bin dementia, 354–363, 356b, 436in epilepsy, 359–363, 362f–363f, 436–437in frontotemporal dementia, 357–358,

360f–361findications for, 350bin Lewy body disease, 357, 359fin movement disorders, 368–370, 368f–369fpearls and pitfalls of, 436radiopharmaceuticals for, 351, 351t, 436

dosimetry for, 353, 353tF-18 FDG, 351, 353, 353b, 355f–356fTc-99m ECD, 353Tc-99m HMPAO, 351–354, 354b

in tumor, 366–368, 367f–368fin vascular dementia, 358–359, 361f

Cerebrospinal fluid (CSF), 371, 371f. See also Cisternography

leak of, 375–376, 375f–376f, 376bCerebrovascular disease, 105f, 363–364,

364f–365fCervical carcinoma, F-18 FDG PET in,

262, 263fCharcot joint, 124, 126fChest pain, 406, 406f. See also Myocardial

perfusion scintigraphyChest radiography, in pulmonary embolism,

204Child abuse, 115–117Children

acute pyelonephritis in, 199, 200fbiliary atresia in, 146–151, 150fbone scan in, 101, 102fcholedochal cyst in, 146, 149fgastroesophageal reflux in, 294hepatitis in, 146, 150fLegg-Calvé-Perthes disease in, 122, 122flong bones of, 335fneuroblastoma in, 108, 110fosteomyelitis in, 123–124, 123f, 334, 335fradiopharmaceutical use in, 10–11, 11trenal scintigraphy in, 175fventilation perfusion scintigraphy in, 206, 438vesicoureteral reflux in, 201

Cholangiocarcinoma, 258Cholangiography, in choledochal cyst, 149fCholecystectomy

leaks after, 152, 153fpain after, 153, 154b, 154fsphincter of Oddi obstruction after, 154fstricture after, 153, 154f

Cholecystitisacalculous

acute, 141–142, 141b, 431cholescintigraphy in, 141–142, 141t,

142bradiolabeled leukocyte study in, 142

chronic, 142–144, 142bcholescintigraphy in, 148–151gallbladder ejection fraction in,

148–151sincalide cholescintigraphy in, 142–144,

143f, 151t

Cholecystitis (Continued)calculous

acute, 138–141cholescintigraphy in, 139–141, 139b,

139tmorphine augmentation with, 138f,

140, 140t, 430–431rim sign in, 140–141, 141f, 430

clinical presentation of, 138–139pathophysiology of, 138, 139bultrasonography in, 139, 139t

chronic, 142cholescintigraphy in, 139

Choledochal cyst, 149fCholescintigraphy, 131–156

in acute acalculous cholecystitis, 141–142, 141t

in acute calculous cholecystitis, 139–141, 139b, 139t–140t, 141f

in biliary atresia, 146–151, 150f, 431biliary clearance on, 134, 135f–136fafter biliary diversion surgery, 152in biliary leaks, 152, 153fin biliary obstruction, 144–146, 144b, 151tafter Billroth procedures, 152blood flow on, 134, 135f–136fcholecystokinin in, 135–138in choledochal cyst, 146, 149fin chronic acalculous cholecystitis, 142–144,

143f, 148–151in chronic calculous cholecystitis, 142clinical review before, 133in enterogastric bile reflux, 156, 157ffasting before, 133fatty meal in, 135–138in focal nodular hyperplasia, 155, 155t, 157fgallbladder filling on, 134, 137fin hepatic adenoma, 155, 155thepatic function on, 134, 135f–136fhepatic morphology on, 134in hepatic tumors, 155–156, 155tin hepatocellular carcinoma, 155t, 156, 157fin high-grade biliary obstruction, 144, 144b,

145findications for, 132bafter liver transplantation, 152–153methodology of, 133–134, 134bmorphine sulfate in, 134, 138f, 430–431in neonatal hepatitis, 146, 150fnormal, 134, 135f–137fopiate discontinuation before, 133in partial biliary obstruction, 144–146, 146b,

146f–148f, 148bpatient preparation for, 133pearls and pitfalls of, 430pharmacological interventions in, 134–138in postcholecystectomy pain syndrome,

153–155, 154b, 154fpostoperative, 151–156, 153fposttraumatic, 153radiopharmaceuticals for, 131, 131t–132t,

132f–133f, 430dosimetry for, 133, 133t

sincalide in, 133, 135–138, 138b, 151, 152b, 430, 431b

in sphincter of Oddi dysfunction, 153–155, 155f, 156b

after Whipple procedure, 152Chondroblastoma, 112tChondrosarcoma, 108–111Choriocarcinoma, 78Chronic obstructive pulmonary disease

(COPD), 224, 225fCimetidine, in Meckel scan, 318Cirrhosis, 162, 162f

Cisternography, 371–376in CSF leak, 375–376, 375f–376fin hydrocephalus, 372, 372t, 373f–375f, 374bmethodology for, 371, 371bnormal, 372, 373fradiopharmaceuticals for, 371, 437

dosimetry for, 372, 372tpharmacokinetics of, 371–372

Clavicle, osteomyelitis of, 123fClinical trials, in drug development, 23, 23fCobalt-57 (Co-57), 3tCollimator, 44–46, 44f–46f, 426

selection of, 57–58Colon, transit scintigraphy of, 306, 307fColorectal carcinoma, 258t

F-18 FDG PET in, 256–258, 258b, 259fhepatic metastases in, 160f, 163f, 166f–167f

Complex regional pain syndrome, 117–118, 118f

Compton scattering, 32–33, 34f, 42, 42f, 425–426, 433

Computed tomography arteriography (CTA), in pulmonary embolism, 204–205

Congenital heart disease, 421, 422fContrast media, thyrotoxicosis with, 78Converging-hole collimator, 46, 46fConversion electron, 25tCopper-64 (Cu-64) diacetyl-bis(N4-

methylthiosemicarbazone) (Cu-ATSM), 21Coronary artery bypass graft (CABG), 407Coronary artery disease

perfusion imaging in. See Myocardial perfusion scintigraphy

ventriculography in, 420Count-to-activity conversion factor, 63Craniotomy, bone scan after, 114–115Crohn disease, leukocyte scintigraphy in,

343–344, 343f–344fCurie (Ci), 30, 31b, 425Cyclotron, 1–2Cystic duct sign, 139, 140fCystography, 201–203, 201b, 202f–203f, 202t,

432

DDecay constant, 425Deep venous thrombosis (DVT), 204, 225–226,

226fDelta rays, 32Dementia, 354–363, 356b, 436

Alzheimer, 357, 358f–359f, 436bfrontotemporal, 357–358, 360f–361fLewy body, 357, 359fvascular, 358–359, 361f

Diabetes mellitusmalignant external otitis in, 348osteomyelitis in, 334, 338, 338f–340f

Diaphragmatic attenuation, 394, 396f, 398fDipyridamole, in myocardial perfusion

scintigraphy, 388–390, 389f, 396f, 400f–401f, 437

Diuresis renography, 180, 180binterpretation of, 180–183, 181b, 181f–184fmethodology for, 180, 180b

Diverticulum. See Meckel diverticulumDobutamine, in myocardial perfusion

scintigraphy, 390Dose, 35Dose calibrator, 13, 40–41

accuracy of, 13geometric test of, 13linearity test of, 13precision (constancy) test of, 13

Index  443

Dose equivalent, 35Dosimetry, 14–15, 14t, 34–36

quality factors in, 35, 36tDoxorubicin cardiotoxicity, 420–421, 420bDrug(s). See also Radiopharmaceuticals

cardiotoxicity of, 420–421, 420bdevelopment of, 23, 23fgastroparesis with, 297, 297tpulmonary reactions to, 348, 348bin renal transplantation, 188–191, 189tin stress testing, 388–390, 388t, 389f

Dual-energy x-ray absorptiometry (DXA), 128–130

Dynamic imaging, 49. See also specific dynamic imaging techniques

list-mode acquisition in, 49–50, 50fmatrix-mode acquisition in, 49time activity curve in, 50

EEffective dose, 15Effective renal plasma flow (ERPF), 168,

191–194Ejection fraction, 417–419Electromagnetic spectrum, 24–26Electron(s), 24, 25f, 25t

binding energy of, 425–426ionization of, 32linear energy transfer and, 32matter interactions of, 31–32radiative losses and, 31–32range of, 32stopping power and, 32in x-ray production, 26

Electron volt (eV), 25, 25t, 26fElement, 1, 2bEnchondroma, 111–112, 112tEndocarditis, 344, 345fEnergy calibration, 44Enthesopathy, activity-induced, 119Eosinophilic granuloma, 112tEpilepsy, 359–363, 362f–363fEpoetin alfa, F-18 FDG PET and, 236Equivalent dose (rem), 15Esophageal carcinoma, 256, 257fEsophageal motility, 288–290

anatomy of, 288, 288fbarium examination of, 288–289disorders of, 288–290, 288btransit scintigraphy of, 289–290

accuracy of, 289dosimetry for, 289–290, 292t–293tinterpretation of, 289, 290f–292fmethodology for, 289, 289bnormal, 290f, 292fradiopharmaceuticals for, 289

Esophageal spasm, 288, 292fEsophagus, 288, 288f

motility of. See Esophageal motilityin thyroid scintigraphy, 74, 74f

Euler number (e), 25tEwing sarcoma, 108–110Exercise stress testing. See at Myocardial

perfusion scintigraphy, SPECTExophthalmos, Graves, 84Exposure, 34–35External otitis, malignant, 348, 348f

Ff-factor, 35, 35fFatty acid synthase, in tumors, 20

444  Index

FDG. See Fluorine-18 fluorodeoxyglucose (F-18 FDG)

Fetus, radioiodine I-131 effects on, 70Fever of unknown origin, 349Fibrous dysplasia, 112, 112t, 113b, 113fFilgrastim, F-18 FDG PET and, 236Filter, 53, 427Filtered backprojection, 53, 54fFission moly, 3Fissure sign, 212–214, 215fFlare phenomenon, 106, 107f, 429Fleischner sign, 204Fluorine-18 (F-18), 3t, 14tFluorine-18 amyloid agents, 370–371, 370fFluorine-18 choline, 20Fluorine-18 DOPA (F-18 DOPA), 20Fluorine-18 fluorodeoxyglucose (F-18 FDG),

9, 18, 18tFluorine-18 fluorodeoxyglucose positron

emission tomography (F-18 FDG PET)aortic arch on, 234artifacts with, 238–240, 238fbone marrow evaluation on, 236, 237fbrown fat on, 232–234, 233fin cancer, 227–229, 228t, 229f. See also

Cancer, F-18 FDG PET incerebral, 351, 353, 353b, 353t, 355f–356ffracture on, 235, 235fin infection, 328t, 331–332, 334f, 338, 340inflammation on, 235–236, 235f–236fmuscle activity on, 231–232, 232fmyocardial, 407t, 410t, 412, 412f, 412t, 413b,

414fnormal, 230–231, 231fpleurodesis effect on, 235–236, 236fradiation-related uptake on, 235–236, 236fin sarcoidosis, 347, 347fthymic uptake on, 236, 238fthyroid uptake on, 234–235, 234fvocal cord paralysis on, 231–232, 232fwound healing–related uptake on, 235–236,

237fFluorine-18 16α-17β-fluoroestradiol (F-18

FES), 22Fluorine-18 fluoroethyltyrosine (F-18 FET), 20Fluorine-18 16β-fluoro-5α-dihydrotestosterone

(F-18 FDHT), 22Fluorine-18 fluoromisonidazole (F-18 FMISO),

20–21, 21fFluorine-18 fluorothymidine (F-18 FLT),

18–20, 18t, 19f–20fFluorine-18 galacto-RGD, 21Fluorine-18 sodium fluoride positron emission

tomography (F-18 NaF PET), 126–128in benign disease, 127–128, 129fin cancer, 229dosimetry of, 228t, 126–127in metastatic disease, 127–128, 128f, 433pharmacokinetics of, 126–127

Focal nodular hyperplasia, 155, 155t, 157f, 163, 164f

Foods, goitrogenic, 69–70, 69tFoot, diabetic, 338, 338f, 340fFourier analysis, 53, 420Fracture(s)

bone scan in, 113–121, 117f, 118t, 430cuneiform, 117fF-18 FDG PET in, 235, 235ffemoral neck, 117ffifth metatarsal, 117frib, 102–103, 104f, 235fsacral, 102, 103fstress, 118–119, 119f–120f, 119t, 430vertebral, 102, 103f

Frontotemporal dementia, 357–358, 360f–361f

GG

GGG

GGGGG

GGG

G

allbladdercancer of, 258cholecystokinin effects on, 135–138, 138bcontraction of, 135–138, 142bfilling of, 134, 137finflammation of. See Cholecystitismorphine sulfate effects on, 134, 138fTc-99m BrIDA scintigraphy of. See

Cholescintigraphyallbladder ejection fraction, 148–151allium-67 (Ga-67), 3t, 14tallium-67 citrate scintigraphy, 322–331, 323tabnormal, 325fin cancer, 279t, 281, 281t, 282fdosimetry for, 324, 326tfracture on, 325fafter joint replacement, 341methodology for, 322–324, 325b, 328tin osteomyelitis, 336–338, 336t, 338f, 340,

341fpharmacokinetics in, 322in sarcoidosis, 347uptake in, 322, 323t, 324f–325fallium-68 (Ga-68), 3tallium-68 DOTA-NOC, 21–22allium-68 DOTA-TOC, 21–22allstones. See Cholecystitisamma camera, 42–44, 43fcentral field of view of, 47count rate performance of, 48energy resolution of, 48energy window of, 426inhomogeneous flood field image in, 426multi-window registration of, 48quality control for, 47–48, 47f–48f, 49t,

60–61, 60fsensitivity of, 48spatial resolution with, 48, 48funiformity (flood) test for, 47–48, 47fuseful field of view of, 47amma rays, 25–26, 26f, 425–426astric antrum, retained, 320astric motility scintigraphy, 294–305alternative solid meals for, 301anatomy for, 294–295, 295fattenuation correction in, 303–304, 434

geometric mean method for, 304, 304f–305f

left anterior oblique method for, 304, 305f

decay correction in, 303delayed emptying on, 300–301,

300f, 303fdual-isotope dual-phase, 303emptying rate in, 295, 296bin gastric stasis syndromes, 295–297, 296b,

297t, 300findications for, 295, 296binterpretation of, 300–301, 300f–303fliquid meals for, 301–303, 302f–303f, 304b,

305methodology for, 297–305, 298bnormal, 299f, 302fpearls and pitfalls in, 434–435physiology for, 294–295, 295f–296fquantification of, 303–304, 304f–305fradiopharmaceuticals for, 297, 298fin rapid gastric emptying, 297, 297b, 300,

301fscatter correction for, 304standardization of, 297–301, 298b, 299f–300f,

304–305astric mucosa, heterotopic, 314–320. See also

Meckel diverticulum

Gastroesophageal reflux disease, 290–294diagnosis of, 290, 434scintigraphy (milk study) in, 290–294, 434

accuracy of, 294interpretation of, 292–294, 293fmethodology of, 292, 293b

Tuttle acid reflux test in, 290Gastrointestinal bleeding, 307–314

angiography in, 308Tc-99m RBC scintigraphy in, 308–314

accuracy of, 314, 317taortic aneurysm and, 316fascending colon bleed on, 312fdosimetry for, 310, 310tduodenal bleed on, 313ffalse positive, 312, 315fflow phase, 311, 311fimage acquisition for, 310–311, 310binterpretation of, 311–314, 311f–313f, 314bleft colon bleed on, 313fmethodology of, 309–310, 309b–310b,

309t, 434–435pitfalls of, 312–314, 314b, 315f–316f,

434–435rectal bleed on, 312, 315fin vitro method of, 309–310, 309b, 309t, 310fin vivo method of, 309, 309b, 309t

Tc-99m sulfur colloid scintigraphy in, 308, 308fGastrointestinal duplications, 319–320Gastrointestinal stromal tumor (GIST), 258, 260fGastroparesis, 295–297

acute, 295–297, 296bchronic, 295, 296bdiagnosis of. See Gastric motility scintigraphydrug-related, 297, 297tpharmacological treatment of, 297reversible causes of, 295–297, 296bsurgical treatment of, 297

Ge-68/Ga-68 generator system, 3tGene therapy, 23Geometric test, of dose calibrator, 13Giant cell tumor, 112tGlioma, 19–20, 20fGlomerular filtration rate (GFR), 191–194,

198f, 432Glucagon, in Meckel scan, 318Goiter

multinodular, 234fnontoxic, 75, 77ftoxic, 75, 76f

nodular, colloid, 80–81, 81fsubsternal, 81, 82f–83f

Graves disease, 70t, 71–72, 74–75, 75b, 75f, 75t, 428

treatment of, 84, 85btriiodothyronine suppression test in, 78

Gray (Gy), 35, 425

HHalf-life, 425, 427HAMA (human antimouse antibodies), 12,

271–274Hampton hump, 204Hashimoto disease, 75t, 76, 234fHead and neck cancer

F-18 FDG PET in, 245–246, 245f, 246t–247t, 247f–248f

PET/CT in, 246, 246fHeart. See Myocardial perfusion scintigraphy;

VentriculographyHeart failure

I-123 MIBG scan in, 422–423perfusion scintigraphy in, 407

Helicobacter pylori infection, 306–307urea breath test for, 306–307

Hemangiomabone scan in, 112thepatic, 156–159, 431–432

CT in, 158MRI in, 158pathology of, 156SPECT in, 159, 160f, 161tSPECT/CT in, 159, 161fTc-99m RBC scintigraphy in, 158–159,

159b, 159f–160f, 431ultrasonography in, 158

Hemochromatosis, 162fHepatic vein thrombosis, 163, 164fHepatitis, neonatal, 146, 150fHepatocellular carcinoma, 155t, 156

F-18 FDG PET in, 258Tc-99m HIDA scintigraphy in, 157ftransarterial chemoembolization in,

283–285methodology for, 284, 284f–285fradiopharmaceuticals for, 284, 284tresults of, 284–285, 285f

HER2 (ErB2) receptor, 22–23Herpes simplex virus type I (HSV1), in

reporter gene imaging, 22–23Heterotopic bone, 121, 121fHeterotopic gastric mucosa, 314–320. See also

Meckel diverticulumHip replacement, 124–126, 128fHistiocytosis, 110Hodgkin disease. See LymphomaHormone receptors, 22Human antimouse antibodies (HAMA), 12,

271–274Hydatidiform mole, hyperthyroidism with, 78Hydrocephalus, 372

cisternography in, 372, 372t, 373f–374fclassification of, 372tshunt patency in, 372–375, 374b, 375f

Hydronephrosis, 179–183. See also Urinary tract obstruction

nonobstructed, 180–181, 181f–182fobstructed, 180–181, 182f–183fposttransplantation, 191

Hyperparathyroidism, 90–92, 92t. See also Parathyroid scintigraphy

bone scan in, 112–113, 115b, 117fclinical presentation of, 92diagnosis of, 92primary, 90secondary, 90–92tertiary, 92treatment of, 92

Hypertension, renovascular. See Renovascular hypertension

Hyperthyroidism, 74. See also Thyrotoxicosisradioiodine I-131 therapy in, 90b

Hypertrophic osteoarthropathy, 107, 109fHypothyroidism

in Hashimoto disease, 75t, 76primary, 78radioiodine-131 therapy and, 84secondary, 78TSH stimulation test in, 78

Hypoxia, tumor, 20–21, 21fHypoxia-inducible factor 1 (HIF-1), 20

II-123. See Iodine-123 (I-123)I-131. See Iodine-131 (I-131)Idiopathic interstitial pulmonary fibrosis, 348

Imaging technique, 41–50. See also at specific imaging techniques

cold spot, 41–42collimator in, 44–46, 44f–46fdetector in, 42. See also Radiation detectorgamma camera in, 42–44, 43f, 47–48,

47f–48f, 49thot spot, 41–42image characteristics in, 48–50, 49f–50fpatient in, 41–42spatial resolution in, 45–46, 47f, 62–63wash in (uptake), 41–42wash out (clearance), 41–42

Indium-111 (In-111), 3t, 8t, 9, 14tIndium-111 capromab pendetide scan

(ProstaScint), 277, 277f–278f, 434bIndium-111 oxine–labeled leukocyte

scintigraphy, 323t, 324–328in acalculous cholecystitis, 142cell volume for, 325–326in diabetic foot, 338, 338fdistribution in, 326, 327fdosimetry for, 326–328, 326tfalse negative, 328, 329bfalse positive, 329b, 330fin inflammatory bowel disease, 343–344, 344finterpretation of, 326t, 327–328, 328f–330fafter joint replacement, 341–342, 342fmethodology for, 327, 328b, 328t, 435–436,

436bin osteomyelitis, 124, 336, 336t, 338f–341f,

436bradiolabeling process for, 326, 326bin renal disease, 344, 344fsensitivity of, 328

Indium-111 pentetreotide imaging (Octreoscan), 21–22, 266–269

in carcinoid, 267, 268fdosimetry in, 266–267false negative, 267in gastrinoma, 268finterpretation of, 266f, 267–269, 268fmethodology for, 267, 267bin nodal metastasis, 268fnormal, 266fpharmacokinetics in, 266–267sensitivity of, 269b, 433

Infarctionbone, 121–122, 121b. See also Osteonecrosismyocardial. See Myocardial infarction;

Myocardial perfusion scintigraphyInfection. See also Infection scintigraphy

bone. See Osteomyelitisintraabdominal, 327, 328f–329f, 342–343,

342f–343fjoint prosthesis, 341–342, 342fpulmonary, 345–348, 346f. See also Sarcoidosisurinary tract. See Pyelonephritis

Infection scintigraphy, 322–349in cardiovascular disease, 344–345, 345fin fever of unknown origin, 349in idiopathic interstitial pulmonary fibrosis,

348in inflammatory bowel disease, 343–344,

343f–344fin intraabdominal infection, 342–343,

342f–343fin lymphoma, 347in malignant external otitis, 348, 348fin osteomyelitis, 334–336. See also

Osteomyelitispearls and pitfalls of, 435in prosthetic joint infection, 341–342, 342fin pulmonary drug reactions, 348, 348bin pulmonary infection, 345–348, 345b, 346f

I

I

IIII

II

I

I

I

II

I

I

IIIIIII

JJJ

Index  445

nfection scintigraphy (Continued)radiopharmaceuticals for, 322–333

F-18 FDG, 322b, 328t, 331–332Ga-67 citrate, 322–331, 322b, 323t,

324f–325f, 326t, 328tIn-111 oxine–labeled leukocytes, 322b,

323t, 324–328, 326b, 326t, 327f–331f, 328b, 328t, 331t

investigational, 332–333Tc-99m ciprofloxacin, 333Tc-99m fanolesomab, 332Tc-99m HMPAO–labeled leukocytes, 322b,

323t, 328t, 329–331, 331t, 332f–333fTc-99m sulesomab, 332

in renal disease, 344, 344fin sarcoidosis, 345–347, 346f–347f, 346t,

435bnflammation, 322, 323f. See also Infection

scintigraphyon F-18 FDG PET, 235–236, 235f–236f

nflammatory bowel disease, 343–344, 343f–344fnfrared rays, 26fntegrins, αvβ3, 21ntestinal transit scintigraphy, 305–306

large intestine, 306, 307fsmall intestine, 306, 307f

ntestine, F-18 FDG uptake in, 231, 231fntraabdominal infection, 327, 328f–329f,

342–343, 342f–343fodine

thyroid metabolism of, 66, 67fthyrotoxicosis with, 78

odine-123 (I-123), 3t, 8–9, 8t, 68dosimetry of, 14t, 68, 69tdrug interactions with, 69–70, 69tfood interactions with, 69–70, 69tphysics of, 68, 68tin thyroid scintigraphy, 72–73, 73b, 73f

odine-123 beta-methyl-p-iodophenyl-pentadecanoic acid (I-123 BMIPP), 423

odine-123 ioflupane, 368–369, 369b, 369fodine-123 meta-iodo-benzyl-guanidine (I-123

MIBG) scintigraphy, 269–271dosimetry for, 269, 270tin heart failure, 422–423methodology for, 269–270, 270b, 270tin myocardial infarction, 422–423in neuroblastoma, 273fnormal, 269, 269fin pheochromocytoma, 270–271, 271f–272f

odine-131 (I-131), 3t, 8–9, 8t, 24, 67–68dosimetry of, 68, 69tdrug interactions with, 69–70, 69tfood interactions with, 69–70, 69tphysics of, 67–68, 68tin thyroid scintigraphy, 73

odine-131 orthoiodohippurate (I-131 OIH), 170f–171f, 170t

odine-131 tositumomab, 274t, 276, 276tonization chamber, 426sobar, 24somer, 24sotone, 24sotope, 1, 2b, 24terative reconstruction, 54–55, 55f

od-Basedow phenomenon, 78oint replacement

bone scan after, 124–126, 128f, 341Ga-67 scintigraphy after, 341infection after, 341–342, 342fleukocyte scintigraphy after, 341–342, 342f

446  Index

KK shell, 24, 25fKα fluorescent x-rays, 26Kβ fluorescent x-rays, 26Kidneys. See also Renal disease; Renal

scintigraphy; Renal transplantationanatomy of, 168–169, 169fcarcinoma of, 108, 262function of, 168–169, 169f, 432Tc-99m MAA uptake in, 211, 212f, 432trauma to, 177f

Krypton-81m (Kr-81m), 8t, 9Kupffer cells, 131f, 161Kveim-Siltzbach test, 346–347

LLactation

radioiodine I-131 administration and, 70radiopharmaceutical use during, 10, 11t

Lambda sign, 346fLeft bundle branch block, 399, 437bLegg-Calvé-Perthes disease, 122, 122fLeukemia, 110Leukocytes, 324

radiolabeled. See Indium-111 oxine–labeled leukocyte scintigraphy; Tc-99m hexamethylpropyleneamine oxime (Tc-99m HMPAO)–labeled leukocyte scintigraphy

Lewy body disease, 357, 359fLinear energy transfer (LET), 32Linearity calibration, 44Linearity test, of dose calibrator, 13Liver

abscess of, 342–343, 343fadenoma of, 155, 155tanatomy of, 131f, 156, 158fbone scan and, 103carcinoma of. See Hepatocellular carcinomafocal nodular hyperplasia of, 155, 155t, 157f,

163, 164fhemangioma of, 156–159, 158f–161f,

431–432metastatic disease of, 160f, 163f, 164–166,

166f–167fTc-99m iminodiacetic acid scintigraphy of.

See CholescintigraphyTc-99m MAA arterial perfusion scintigraphy

of, 164–166, 166b, 166f–167fTc-99m RBC scintigraphy of, 156–159

accuracy of, 159, 161tanatomy on, 156, 158fdosimetry for, 158hemangioma on, 159, 159f–161f, 431methodology for, 158, 159bpharmacokinetics of, 158, 158f

Tc-99m sulfur colloid scintigraphy of, 161–163, 162b

decreased uptake on, 162, 162f–163fdosimetry for, 162increased uptake on, 162b, 163,

163f–164fmethodology for, 162, 162bpharmacokinetics of, 161preparation for, 161

transplantation of, 152–153trauma to, 153xenon-133 accumulation in, 211, 211f

Liver transplantation, 152–153Lumbar spine

osteomyelitis of. See Osteomyelitis, vertebral

spondylolysis of, 119, 120f

Lungs. See also Ventilation perfusion (V/Q) scintigraphy

cancer ofbone scan in, 105f, 107, 109fcerebral metastases in, 367fF-18 FDG PET in, 248–254, 249f–250f,

253f–254fnon–small cell, 105f, 248b, 250–253, 250b,

251tsmall cell, 248b, 254

drug-related injury to, 348, 348bGa-67 scintigraphy of, 345, 345bidiopathic interstitial fibrosis of, 348infection of, 345–348. See also Sarcoidosislymphoma of, 347Pneumocystis jiroveci infection of, 345, 346fsolitary nodule of, 248–250, 249f, 385fTl-201 uptake by, 394f, 399–401on ventriculography, 421

Lutetieum-177, in receptor expression imaging, 22

Lymph node(s). See also Lymphoscintigraphyin breast carcinoma, 255, 255f–256f, 434vs. brown fat, 232–234, 233fin colorectal carcinoma, 258, 258b, 258tin esophageal carcinoma, 256, 257fin head and neck carcinoma, 245–246,

245f–248f, 246t–247tin melanoma, 244f, 282f, 283in non–small cell lung cancer, 250–253, 250b,

251t, 252f–254fsentinel, 281–283, 282f

Lymphomabone scan in, 110F-18 FDG PET in, 241–242, 242b, 242f–244fGa-67 scintigraphy in, 242f, 281, 281t, 282fintracranial, 368, 368fmonoclonal antibody therapy in, 274–276

I-131 tositumomab for, 274t, 276, 276tY-90 ibritumomab tiuxetan for, 274–276,

274t–275tvs. sarcoidosis, 347

Lymphoscintigraphy, 281–283in breast cancer, 283dosimetry for, 281in melanoma, 244, 282f, 283, 433–434methodology for, 281–282radiopharmaceuticals for, 281

MMagnetic resonance angiography (MRA), in

pulmonary embolism, 204–205Magnetic resonance imaging (MRI)

of brain, 354, 355f–356fin brain tumor, 20f–21f, 367, 367f–368fin breast cancer, 255, 278–279diffusion, 17in hepatic hemangioma, 158in metastatic disease, 103–104, 433in osteomyelitis, 124, 127f, 335–336in osteonecrosis, 122in osteosarcoma, 111f

Magnetic resonance spectroscopy (MRS), 17Malignant ascites, 105fMalignant external otitis, 348, 348fMammography, 280t, 255, 278

PET, 255, 279Maximum intensity projection scan (MIPS), 56Maximum likelihood expectation maximization

(MLEM) algorithm, 54Meckel diverticulum, 317–320, 435

clinical manifestations of, 317diagnosis of, 317

Meckel diverticulum (Continued)epidemiology of, 317, 317bscintigraphy in, 317–319, 317b

accuracy of, 318–319cimetidine with, 318false positive, 319, 319b, 319f, 435bglucagon with, 318interpretation of, 318, 318fpentagastrin with, 318

Medical event, 11–12, 12b, 424Melanoma, lymphoscintigraphy in, 244, 281,

282f, 283, 433–434Metal, on F-18 FDG PET, 238, 238fMetastatic disease. See Bone scan, metastatic

disease on; Cancer, F-18 FDG PET in; Lymph node(s) and at specific cancers

Metformin, F-18 FDG uptake and, 231, 231fMethimazole therapy, 428MIBG scan. See Iodine-123 meta-iodo-benzyl-

guanidine (I-123 MIBG) scintigraphyMisadministration, 380Mo-99. See Molybdenum-99 (Mo-99)Molecular imaging, 16–23, 16b

biomarkers in, 18–22, 18tdiffusion MRI, 17drug development for, 23, 23fmodalities of, 16–18, 17tMRI, 17, 17toptical, 17–18, 17tradionuclide, 17, 17tultrasound, 17t, 18

Molybdenum-99 (Mo-99), 3tdecay of, 29, 31, 31flegal limit for, 424

Molybdenum-99 (Mo-99)/technetium-99m (Tc-99m) generator system, 3, 3t, 4f–5f

aluminum levels in, 5daughter purity in, 4–5, 5t–6toperation of, 4, 4f–5fparent contamination in, 4–5, 424

Monoclonal antibody imaging, 271–278, 274f, 274t

in lymphoma, 274–276, 274t–276t, 275fin prostate cancer, 276–278, 277f–278f

Morphine sulfate, in cholescintigraphy, 134, 138f, 430–431

Movement disorders, 368–370, 368f–369fMRI. See Magnetic resonance imaging (MRI)Multihole collimator, 45–46, 45f–46fMultiple endocrine neoplasia, 90, 265, 266tMultiple myeloma

bone scan in, 110F-18 FDG PET in, 242, 244f

Muscles, on F-18 FDG PET, 231–232, 232fMyocardial infarction. See also Myocardial

viabilityC-11 acetate scintigraphy in, 423emergency room presentation of, 406, 406fI-123 BMIPP scintigraphy in, 423I-123 MIBG scintigraphy in, 422–423non–ST elevation, 406perfusion scintigraphy in, 395–399, 399t. See

also Myocardial perfusion scintigraphyST elevation, 406Tc-99m pyrophosphate scintigraphy in,

421–422, 422fMyocardial ischemia

calcium score in, 407PET perfusion scintigraphy in, 408f–409f,

410–412, 411fSPECT perfusion scintigraphy in, 385–387,

386f, 395–399, 399t, 400f–401f, 406–407. See also Myocardial perfusion scintigraphy

ventriculography in, 420

Myocardial perfusion scintigraphy, 378–407PET, 407–413

accuracy of, 410C-11, 407t, 423in coronary artery disease, 410–412, 438F-18 FDG, 407t, 410t, 412, 412f, 412t,

413b, 414fmyocardial viability on, 412–413, 412t,

414f–415fN-13, 407–409, 407t, 408f–409f, 410t, 412f,

412tO-15, 407t, 410pearls and pitfalls of, 437quantitative, 411–412Rb-82, 407t, 409–410, 410t, 411f, 412t,

414f–415fplanar, 381, 381f–382f, 391b

anatomy on, 393lung uptake on, 393, 394f

SPECT, 378–407accuracy of, 401acquisition arc in, 58, 58fin acute infarction with ST elevation, 406in acute ischemic syndromes, 406anatomy and, 381, 382f–383f, 383t,

393–395, 394fafter angioplasty, 407attenuation artifacts in, 394, 396f–397fattenuation correction in, 394–395, 398f,

437, 437bbreast attenuation in, 394, 397fcalcium scoring with, 407in chronic ischemic syndromes, 406–407after coronary artery bypass grafting, 407diaphragmatic attenuation in, 394, 396f,

398fin emergency room chest pain, 406, 406fexercise stress testing with, 387–388,

387f–388fadenosine, 388–390, 389f, 390tBruce protocol for, 388, 388tcontraindications to, 387bdipyridamole, 388–390, 389f, 437dobutamine, 390drug interference in, 388, 388tdual-isotope protocol for, 391–393endpoints for, 387bfailure of, 387, 388b, 437bnormal, 394protocols for, 390–393, 390t, 391bRegadenoson, 388–390, 389f, 390tTc-99m sestamibi, 390–391, 390b–391b,

390t, 438Tc-99m tetrofosmin, 390–391,

390b–391b, 390t, 438termination of, 388, 389bTl-201, 391–393, 391b, 392fventricular dilation after, 399, 403f

extracardiac uptake in, 395, 399fgated, 383–385, 385f, 395, 400f–401f, 405,

438in heart failure, 407image reformatting in, 56, 56fin infarction, 395–399, 399tinstrumentation for, 57, 381–383, 383finterpretation of, 383, 383t, 384f, 393–404in ischemia, 385–387, 386f, 395–399, 399t,

400f–401f, 406–407, 438in left bundle branch block, 399methodology for, 381–383, 382f–383fmultiple defects on, 399–401, 402f–403fmyocardial stunning on, 404myocardial viability on, 399t, 401,

404f–405fin non–ST elevation infarction, 406

Myocardial perfusion scintigraphy (Continued)normal, 381f, 384f, 393normalcy rate in, 405patient motion during, 393, 393fpearls and pitfalls of, 437after percutaneous coronary intervention,

407pharmacological stress testing with,

388–390drugs for, 388–390, 388t, 389fpatient preparation for, 383t, 389side effects of, 390

postoperative, 407prognosis and, 399–407, 405bquality control for, 393quantitative analysis of, 400f–402f,

404–405radiopharmaceuticals for, 378–381

Tc-99m sestamibi, 378, 379f, 379t–380tTc-99m teboroxime, 381Tc-99m tetrofosmin, 378–379, 379f,

379t–380tTl-201, 379–381, 379f–380f, 379t–380t

rest, 381f, 385, 386f, 393in right ventricular hypertrophy, 395frisk stratification with, 405–407in sarcoidosis, 407sensitivity and specificity of, 405terminology in, 399tthymoma on, 399fTl-201, 379–381, 379f–380f, 379t–380t

lung uptake on, 394f, 399–401myocardial viability on, 380f, 401–404,

404f–405fin transient ischemic dilation, 399in unstable angina, 406

SPECT/CT, 385, 385fnormal, 394

Myocardial scar, 399t, 412–413, 415fMyocardial viability

F-18 FDG PET for, 412–413, 412f, 413b, 414f

PET for, 412–413, 412t, 414f–415fSPECT for, 399t, 401, 404f–405f

Myocardiumhibernating, 399t, 401, 404f–405f, 412, 414fmetabolic-perfusion mismatch in, 412–413,

414fstunned, 399, 399t, 404, 404f

Myositis ossificans, 121, 121f

NNanotechnology, 22Necrosis

bone. See Osteonecrosistumor, 240, 240f

Neuroblastomabone scan in, 108, 110fI-123 MIBG scan in, 271, 273f

Neuroendocrine tumors, 265–266, 266f, 266t. See also Indium-111 pentetreotide imaging (Octreoscan)

Neutrino, 28–29Neutron, 24Neutron number (N), 24Nitrogen-13 (N-13), 227, 228t

in myocardial perfusion scintigraphy, 407–409, 407t, 408f–409f, 410t, 412f, 412t

Non-Hodgkin lymphoma. See LymphomaNormalcy rate, in myocardial perfusion

scintigraphy, 405Nuclear reactor, 1–2Nuclear Regulatory Commission, 11, 89–90

Index  447

Nucleon, 24Nuclide, 1, 24. See also Radionuclide(s)

daughter, 26–27, 424parent, 26–27, 424stable, 26–27, 27funstable, 27, 27f

Nutcracker esophagus, 288

OOctreotide

In-111 labeling of, 266–269, 267t. See also Indium-111 pentetreotide imaging (Octreoscan)

somatostatin receptor binding by, 266, 266fOncology. See CancerOptical imaging, 17–18, 17tOrbit, in SPECT, 58, 58fOropharynx, F-18 FDG uptake in, 231, 231fOsteoarthritis, 102, 102f, 429Osteochondroma, 111, 112tOsteochondrosis, 122, 122fOsteoid osteoma, 111, 112f, 112tOsteomalacia, 113, 115fOsteomyelitis, 334–336

acute, 334, 335fbone scan in, 123–126, 123f, 124b, 125f,

126b, 127f, 336, 336t, 337f–339fclinical diagnosis of, 335in diabetes mellitus, 338, 338f–340fdirect extension in, 334direct inoculation in, 334–335distal phalanx, 339fF-18 FDG imaging in, 338Ga-67 scintigraphy in, 336–338, 336t, 338fIn-111 oxine–labeled leukocyte scan in, 336,

336t, 338f–341f, 436bbone marrow scan with, 336–338, 341fin diabetic foot, 338, 338f, 340f

metatarsal, 339fMRI in, 124, 127f, 335–336pathophysiology of, 334radiography in, 335, 341fscintigraphy in, 336–338, 336bSPECT/CT in, 336, 337f, 340fTc-99m HMPAO–labeled leukocyte scan in,

336, 336t, 339fTc-99m SC marrow scan in, 124, 126f, 336,

341fvertebral, 124, 127f, 338–340

bone scan in, 340in diabetes mellitus, 334F-18 FDG PET/CT in, 332, 334f, 340Ga-67 scintigraphy in, 338f, 340, 341b, 341fIn-111 oxine–labeled leukocyte scan in,

340, 341fOsteonecrosis, 121–122

causes of, 121, 121bin Legg-Calvé-Perthes disease, 122, 122fin sickle cell anemia, 122, 123fsteroid-induced, 122

Osteopenia, 129Osteoporosis

bone scan in, 102, 103f, 117fdual-energy x-ray absorptiometry in, 129type I, 129type II, 129

Osteosarcoma, 108–110, 110f–111fOtitis, external, malignant, 348, 348fOvary (ovaries)

carcinoma of, 259–262, 261bF-18 FDG PET in, 261–262, 261b, 261f,

262tteratoma of, 78

448  Index

Oxygen-15 (O-15), 3t, 227, 228tin myocardial perfusion scintigraphy, 407t,

410

PPaget disease, 112, 114fPair production, 32, 34fPancreatic cancer, 258, 260fPanda sign, 346fParaaminohippurate (PAH), 168, 170bParallel-hole collimator, 45–46, 45fParathormone (PTH), 90. See also

HyperparathyroidismParathyroid glands. See also Parathyroid

scintigraphyadenoma of, 90, 428. See also

Hyperparathyroidismanatomy of, 90, 91fectopic, 90, 91fembryology of, 90

Parathyroid scintigraphy, 90–97accuracy of, 97interpretation of, 94methodology for, 70, 92–94, 93fplanar, 93, 93f, 97sensitivity of, 97, 97fSPECT/CT, 94, 95f–97fSPECT, 93, 94fTc-99m sestamibi for, 93f, 92–94, 93f–94f,

428thyroid imaging with, 92, 93ftwo-phase, 93–94, 93f

Parkinson disease, 368–370, 368f–369f, 369bPatient motion

in F-18 FDG PET, 238f–239f, 239–240, 433bin myocardial perfusion scintigraphy, 393,

393f, 437, 437bin SPECT, 59

Pentagastrin, in Meckel scan, 318Peptide receptor imaging, 265–269

in multiple endocrine neoplasia, 265, 266tPerchlorate discharge test, 78Percutaneous coronary intervention (PCI), 407Periodic table, 1, 2fPeritoneal scintigraphy, 320, 320b, 321fPeritonitis, 342–343, 342fPET. See Positron emission tomography (PET)Phantom check, in PET, 64, 64fPheochromocytoma, 270–271, 271f–272f, 428Phosphorus-32 (P-32), in bone pain palliation,

285–286, 285tPhotoelectric effect, 32–33, 33f–34fPhotoelectron, 25t, 32Photomultiplier tube (PMT), 43–44, 43fPhotons, 26f, 426

matter interactions of, 32–34, 33f–34fPhysics, 24–36, 425

atomic structure and, 24, 25f, 25telectromagnetic radiation and, 24–26, 26fradiation–matter interactions and, 31–36,

33f–35fradioactivity and, 26–31, 27f–31fx-ray production and, 26

Pick disease, 357, 360f–361fPinhole collimator, 44–45, 44f, 426b

in bone scan, 100–101parallax effect with, 72–73in renal cortical scintigraphy, 199, 200fin thyroid scintigraphy, 72, 72f

Planck’s constant, 25tPleural effusion, 212, 215f, 240, 321fPleurodesis, F-18 FDG PET and, 235–236,

236f

Plummer disease, 75, 76f–77fPneumocystis jiroveci infection, 345, 346fPolycystic kidney disease, 172f, 344, 344fPolymyositis, esophageal dysmotility in, 288Positron decay, 28–29, 29f, 425bPositron emission tomography (PET), 51–65.

See also Fluorine-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET)

annihilation coincidence detection in, 51, 61, 61f, 63

calibrations for, 63–64in cancer. See Cancer, F-18 FDG PET incount-to-activity conversion factor in, 632D mode of, 52, 623D mode of, 52, 62daily detector quality control in, 63detector materials for, 62image acquisition for, 63image reconstruction in, 51–56

attenuation correction and, 55filtered backprojection and, 53, 53f–54ffrequency space and, 52–53iterative reconstruction and, 54–55projection data and, 51–52, 52freformatting and, 55–56spatial (real) space and, 52–53

instrumentation for, 61f–62f, 62line of origin in, 51, 52fMedicare coverage for, 228tmonthly quantitative accuracy check in,

63–64pearls and pitfalls in, 426–427quarterly quality phantom check in, 64, 64fradiopharmaceuticals for, 9–10, 9bray sum in, 51spatial resolution in, 62–63standard uptake value in, 63–64time-of-flight, 63uniformity correction for, 63

Positron emission tomography–computed tomography (PET/CT), 64–65, 230

in Alzheimer dementia, 359fartifacts with, 239–240, 239f–240fin head and neck cancer, 246, 246fin lung cancer, 253f–254fin vertebral osteomyelitis, 332, 334f, 340

Positron emission tomography–magnetic resonance (PET/MR), 65

Postcholecystectomy pain syndrome, 153–155, 154b, 154f, 431

Precision (constancy) test, of dose calibrator, 13Pregnancy

Graves disease and, 84radioiodine I-131 and, 70radiopharmaceutical use during, 10ventilation perfusion scintigraphy during,

206Propylthiouracil therapy, 428

perchlorate discharge test during, 78Prostate cancer

bone scan in, 99f, 106–107F-18 FDG PET in, 262In-111 capromab pendetide scan

(ProstaScint) in, 277, 277f–278fProsthetic graft, 333f, 344–345Protein-losing enteropathy, 306Proton, 24Pulmonary arteriography, 204–205Pulmonary embolism, 204–205

arteriography in, 204–205clinical diagnosis of, 204, 204bCTA in, 204MRA in, 204–205PIOPED criteria for, 214b, 216–224, 217t

Pulmonary embolism (Continued)radiography in, 204ultrasonography in, 204ventilation perfusion scintigraphy in,

205–206. See also Ventilation perfusion (V/Q) scintigraphy

arterial anatomy and, 212, 213fhigh-probability scan on, 213f, 216b, 217,

217t, 218f–219f, 224t, 439intermediate probability scan on, 216b,

217t, 220–221, 220f, 221t, 224tinterpretation of, 209–224, 217t, 219b,

221t, 224tlow-probability scan on, 216b, 217t, 221,

221f–223f, 224tsegmental anatomy and, 212, 214fsensitivity and specificity of, 205, 224ttemporal aspects of, 215, 217, 219ftriple matches on, 216, 220–221, 221tvery low probability scan on, 217t,

221–222, 224tWells criteria for, 204, 204b

Pyelonephritis, 432acute, 199

cortical scintigraphy in, 199–200, 199b, 200f

Pyrogen testing, 13

QQuantitative computed tomography (QCT),

129

RRadiation absorbed dose (rad), 14–15, 35–36,

425Radiation detector, 37–38, 37f–38f, 426

gas, 38–39, 38fscintillation, 39–40, 40fsemiconductor, 39–40

Radiation exposureaccidental spills and, 12–13, 12b, 424–425annual limits of, 11–12, 12b

Radiation meter, 40Radiation safety

accidental spills and, 12–13, 12b, 424–425radiation exposure limits and, 12bradioiodine I-131, 89–90, 90bradiopharmaceutical, 10, 10b, 13–14, 13t–14t

Radiation therapybone scan after, 105f, 109f, 115F-18 FDG PET after, 235–236, 236f

Radiation thyroiditis, 84Radio waves, 26fRadioactive decay, 27–29, 425

alpha, 27, 28fbeta, 27–28, 28fbeta plus, 28–29, 29fdefinition of, 26–27electron capture, 29, 29fequilibrium in, 30isomeric transition with, 29, 29f, 31ftransient equilibrium in, 31, 31f

Radioactivity, 26–31Radiobiological effectiveness (RBE), 35Radiography

in fibrous dysplasia, 113fin metatarsal fracture, 117fin osteoid osteoma, 112fin osteomyelitis, 335–336, 341fin pulmonary embolism, 204in sarcoidosis, 346, 346t

Radioiodine I-131. See also Iodine-131 (I-131)in Graves disease, 84, 85bin neuroblastoma, 271safety for, 89–90, 90bin thyroid cancer, 89–90in thyrotoxicosis, 81, 83bin toxic nodule disease, 80, 84

Radionuclide(s), 1, 2bdecay of, 29–31, 30fdefinition of, 26–27generator systems for, 2–5

dry, 4, 5foperation of, 4, 4fquality control for, 4–5, 5twet, 4, 4f

production of, 1–2, 3tRadiopharmaceuticals, 1–15. See also at specific

radiopharmaceuticalsadministration route for, 41–42adverse reactions with, 12carrier-free, 1commercial kits for, 6, 7fdefinition of, 1dispensing of, 10–12

accidental spills with, 12–13, 12b, 424–425adverse reactions with, 12authorized user for, 11, 12bfor children, 10–11, 11terrors in, 11–12, 12bexposure limits in, 11–12, 12blactation and, 10, 11tpregnancy and, 10regulation of, 11safety procedures for, 10, 10b

dosage of, 14–15, 14tas low as reasonably achievable concept

for, 11pediatric, 10–11

dose calibrator for, 13dual photon, 9–10, 9blocalization mechanisms of, 1, 2tmedical events with, 11–12, 12bnon–Tc-99m, 8–9, 8tpackaging of, 13, 13t–14tpearls and pitfalls of, 424pyrogen testing of, 13quality control for, 13receipt of, 13–14, 13t–14tspecific activity of, 1sterility of, 13Tc-99m, 5–7, 6t, 7f

quality assurance for, 7–8, 8fRamp filter, 53, 54fRayleigh scattering, 32Rb-82. See Rubidium-82 (Rb-82)Receptors, 21–22

hormone, 22somatostatin, 21–22

Rectal bleeding, 312, 315fRed blood cells, Tc-99m–labeled

gastrointestinal. See Gastrointestinal bleeding, Tc-99m RBC scintigraphy in

hepatic. See Liver, Tc-99m RBC scintigraphy of

ventricular. See VentriculographyRegadenoson, in myocardial perfusion

scintigraphy, 388–390Rem (roentgen equivalent in man), 15, 425Renal artery stenosis, 190Renal cell carcinoma, 108, 262Renal disease

on bone scan, 103, 104bdynamic scintigraphy in, 177–178, 179f.

See also Renal scintigraphy, dynamichyperparathyroidism with, 90–92, 97f

R

RR

R

RR

enal disease (Continued)In-111 oxine–labeled leukocyte imaging in,

344, 344fiodide clearance and, 70polycystic, 172f, 344, 344f

enal osteodystrophy, 112–113, 116fenal scintigraphy, 168–203bladder in, 179cortical, 194–200, 199b

normal, 173, 175fin polycystic disease, 172fin pyelonephritis, 199–200, 199b, 200fTc-99m DMSA in, 173–174, 432

dynamic, 173f–174f, 175–191, 175bclearance phase of, 178–179computer processing in, 176–179cortical function phase of, 178, 179fdifferential function in, 436, 177–178,

177f, 432dose for, 176flow phase of, 178–179, 178fimage acquisition in, 176patient positioning for, 176patient preparation for, 175time-activity curve in, 176–178, 176f

indications for, 168, 168bnormal, 172fpearls and pitfalls of, 432radiopharmaceuticals for, 170–175, 170b,

170f–171f, 170t, 432dosimetry for, 175, 175tTc-99m DMSA, 173–174, 175f, 175tTc-99m DTPA, 170–173, 170f–171f, 170t,

175tTc-99m MAG3, 170, 170f–174f, 170t, 173,

175tin renal transplantation evaluation, 171f,

188–191, 192f–198fin renovascular hypertension, 184–188, 185f,

186b, 187f–188fin urinary tract obstruction, 179–183,

180b–181b, 181f–184fenal transplantation, 188–191, 189fchronic allograft nephropathy after, 189t,

190–191, 196f–197fcomplications of, 189–191, 189tcyclosporine toxicity after, 189t, 190–191donor for, 188fluid collections after, 190–191, 198fimmunosuppression for, 188–191, 189trejection after

acute, 189t, 190–191, 191t, 192f, 195faccelerated, 189–190, 189t

chronic, 189t, 190–191, 196f–197fhyperacute, 189, 189tIn-111 oxine–labeled leukocyte

scintigraphy in, 328, 331frenal artery stenosis after, 190scintigraphy after, 171f, 190

interpretation of, 172f–179f, 190–191, 191t

surgical complications of, 189t, 190–191, 198fthrombosis after, 190–191, 197fureteral obstruction after, 190urinary leak after, 191, 198fvasomotor nephropathy after, 189–191, 189t,

191t, 193f–194fenal vein thrombosis, 190–191, 197fenographyACE inhibitor, 184–186, 186b

interpretation of, 186–188, 187f–188freporting for, 188

diuresis, 180, 180b, 432accuracy of, 432interpretation of, 180–183, 181b, 181f–184f

Index  449

Renovascular hypertension, 184–188ACE inhibitor physiology in, 184, 185fACE inhibitor renography in, 184–186, 186b

interpretation of, 186–188, 187f–188freporting for, 188

pathophysiology of, 184, 185fultrasonography in, 185

Reporter gene imaging, 22–23Residual volume, 432bRespiratory motion artifact, 239–240, 239fRetained gastric antrum, 320RGD (arginine-glycine-aspartic acid), 21Rhabdomyolysis, 121, 121fRhenium-186 hydroxyethylidene

diphosphonate (Re-186 HEDP), in bone pain palliation, 285t, 287

Rib(s)fracture of, 102–103, 104f, 235finfarctions of, 122, 123fmetastatic disease of, 101f, 102–103, 128f,

429osteomalacia of, 115fin renal osteodystrophy, 116fretraction of, 114–115rosary bead appearance of, 116f

Rickets, 113Riedel struma, 81Right ventricular hypertrophy, 393, 395fRim sign, 140–141, 141f, 430Ring artifact, 59, 60fRoentgen (R), 34, 425Roentgen equivalent in man (rem), 15, 425Rubidium-81 (Rb-81)/krypton-81m (Kr-81m)

generator system, 3tRubidium-82 (Rb-82), 3t, 10

in myocardial perfusion scintigraphy, 407t, 409–410, 410t, 411f, 412t, 414f–415f

SSacrum, insufficiency fracture of, 102, 103fSafety

accidental spills and, 12–13, 12b, 424–425radiation exposure limits and, 12bradioiodine I-131, 89–90, 90bradiopharmaceutical, 10, 10b, 13–14, 13t–14t

Salivagram, 294, 294fSamarium-153 (Sm-153), in bone pain

palliation, 285t, 286–287, 286fSarcoidosis, 345–347

bronchoalveolar lavage in, 346–347F-18 FDG imaging in, 235f, 347, 347fGa-67 scintigraphy in, 345, 346f, 347, 435bKveim-Siltzbach test in, 346–347myocardial perfusion scintigraphy in, 407radiography in, 346, 346t

Sarcomaosseous, 108–110, 110f–111fsoft tissue, 262–264

Scleroderma, esophageal dysmotility in, 288Seizures, 359–363, 362f–363f, 436–437Septal penetration, collimator-related, 45–46Shin splints, 119, 120f

vs. stress fracture, 430Sialoadenitis, after radioiodine I-131 therapy, 89Sickle cell anemia, 122, 123fSievert (Sv), 35Simple backprojection, 53, 53fSincalide, in cholescintigraphy, 133, 135–138,

138b, 142–144, 143f, 151t, 152b, 430, 431b

Single-photon emission computed tomography (SPECT), 51–65

calibrations for, 59–61, 60f

450  Index

camera quality control for, 60–61, 60fSingle-photon emission computed tomography

(SPECT) (Continued)center of rotation calibration for, 60image acquisition for, 57–59, 57b

angular sampling in, 58–59arc of acquisition in, 58–59, 58fcollimator selection in, 57–58imaging time in, 59matrix size in, 58–59orbit selection in, 58, 58fpatient factors in, 59, 59frotation motion in, 58–59

image reconstruction in, 51–56attenuation correction and, 55filtered backprojection and, 53, 53f–54ffrequency space and, 52–53iterative reconstruction and, 54–55, 55fprojection data and, 51–52, 52freformatting and, 55–56, 56fspatial (real) space and, 52–53

instrumentation for, 56–57, 57fline of origin in, 51, 52fmyocardial. See Myocardial perfusion

scintigraphy, SPECTpatient motion in, 59patient quality factors in, 59, 59f, 61, 61fpearls and pitfalls in, 426–427ray sum in, 51ring artifact in, 59, 60fsinogram of, 51–52, 52f, 61, 61fstarburst artifact in, 59, 59funiformity calibration for, 59, 60f

Single-photon emission computed tomography/computed tomography (SPECT/CT), 64–65

in biliary atresia, 146–148, 151fcystic duct sign on, 139, 140fin endocarditis, 344, 345fin hepatic hemangioma, 159, 161fin malignant external otitis, 348fin metastatic disease, 100–101, 101fin myocardial perfusion scintigraphy, 385,

385fin neuroendocrine tumors, 267, 268fin osteomyelitis, 336, 337f, 340f–341fin parathyroid scintigraphy, 94, 95f–97fin pheochromocytoma, 272fin prostate cancer, 277, 278fin skeletal scintigraphy, 100–101, 101fin splenic scintigraphy, 165f, 328, 330fin substernal goiter, 81, 83fin thyroid cancer, 86, 88f

Sinogram, 51–52, 52f, 61, 61f, 393, 393fSkeletal scintigraphy. See Bone scanSmall intestine, transit scintigraphy of, 306,

307fSoft tissues

bone scan and, 103, 105f, 108f, 113, 117f, 429

particle penetration of, 425sarcoma of, 262–264

Solitary pulmonary nodule, 248–250, 249f, 385f

Somatostatin receptors, 21–22, 265octreotide binding to, 266, 266f. See also

Indium-111 pentetreotide imaging (Octreoscan)

types of, 267Spatial resolution, 45–46, 47f–48f, 62–63

energy resolution and, 426SPECT. See Single-photon emission computed

tomography (SPECT)Sphincter of Oddi dysfunction, 153–155,

154f–155f, 156b, 431bSpills, 12–13, 12b, 424–425

Spinebone scan of, 99f, 102, 103finfection of. See Osteomyelitis, vertebralspondylolysis of, 119, 120f

Spleenabsence of, 164Tc-99m sulfur colloid scintigraphy of,

163–164, 165fSplenectomy, 163–164, 165fSplenosis, 163–164, 165fSplenules, 328, 330fSpondylolysis, 119, 120fStandard uptake value

in F-18 FDG PET, 240–241, 241tin PET, 63–64

Stannous ion, 424, 438Star artifact, 86, 88fStarburst artifact, 59, 59fSterility, of radiopharmaceutical, 13Steroid-induced osteonecrosis, 122Stomach

anatomy of, 294–295, 295fmotility scintigraphy of. See Gastric motility

scintigraphyphysiology of, 294–295, 295f–296f, 434radiopharmaceutical uptake in, 211, 211f

Stopping power, 32Stress fracture, vs. shin splint, 430Stress testing. See at Myocardial perfusion

scintigraphy, SPECTStripe sign, 215–216, 216f, 439Stroke, 363–364

acetazolamide SPECT in, 364, 365fbone scan in, 105fcarotid artery balloon occlusion test in, 363–364CT in, 363, 364fSPECT in, 363, 364f

Strontium-89 (S-89), in bone pain palliation, 285t, 286

Strontium-82 (Sr-82)/rubidium-82 (Rb-82) generator system, 3t, 10

Struma ovarii, 78Superior vena cava obstruction, 163, 163fSupersaturate potassium iodide (SSKI), 428Systemic lupus erythematosus (SLE),

esophageal dysmotility in, 288

TT-score, 129Tc-99. See Technetium-99 (Tc-99)Tc-99m. See Technetium-99m (Tc-99m)Technetium-99 (Tc-99)

carrier, 4half-life of, 4

Technetium-99m (Tc-99m), 5–7, 6t, 7f, 14tchemistry of, 5–7in children, 10–11, 11tdecay of, 5, 5t, 29–30, 29f–30fMo-99/Tc-99m generator system for, 3, 3t, 4f–5fpurity of, 4–5, 5t–6t, 424bradiopharmaceutical preparation with, 5–7,

6t, 7fquality assurance for, 7–8, 8f

Technetium-99m bromotriethyl iminodiacetic acid (Tc-99m BrIDA), 131, 132f–133f, 132t–133t

Technetium-99m ciprofloxacin, 333Technetium-99m

diethylenetriaminepentaacetic acid (Tc-99m DTPA)

in renal scintigraphy, 170–173, 170f–171f, 170t, 175t

in ventilation perfusion scintigraphy, 207–209, 207t–208t, 209b

Technetium-99m diispropyl iminodiacetic acid (Tc-99m DISIDA), 131, 132f–133f, 132t–133t

Technetium-99m dimercaptosuccinic acid (Tc-99m DMSA), 173–174, 175f, 175t, 432

Technetium-99m ethyl cysteinate dimer (Tc-99m ECD), in cerebral scintigraphy, 353–354, 353t, 354b

Technetium-99m fanolesomab, 332Technetium-99m hexamethylpropyleneamine

oxime (Tc-99m HMPAO), in cerebral scintigraphy, 351–354, 353t, 354b

Technetium-99m hexamethylpropyleneamine oxime (Tc-99m HMPAO)–labeled leukocyte scintigraphy, 323t, 329–331, 331t

in acalculous cholecystitis, 142distribution in, 331, 332f–333fdosimetry for, 326t, 331interpretation of, 329b, 331, 333fafter joint replacement, 126methodology for, 331, 333b, 435–436, 436bin osteomyelitis, 124, 126f, 336, 336t, 339fradiolabeling process for, 329

Technetium-99m HIDA radiopharmaceuticals, 131, 132f–133f, 132t

Technetium-99m macroaggregated albumin (Tc-99m MAA)

cerebral uptake of, 211, 212fin hepatic arterial perfusion scintigraphy,

164–166, 166b, 166f–167fin ventilation perfusion scintigraphy, 206,

208t, 209, 209f–210f, 210bTechnetium-99m mercaptoacetyltriglycine

(Tc-99m MAG3), 170, 170f–174f, 170t, 173, 175t

Technetium-99m methylene diphosphonate (Tc-99m MDP), 98–99. See also Bone scan

dosimetry with, 99, 99tpreparation of, 98uptake of, 98–99, 99f

Technetium-99m pertechnetate, 68–69, 72dosimetry of, 69, 69tmethodology for, 72pharmacokinetics of, 69physics of, 68, 68tin thyroid scintigraphy, 72–73, 73b, 427–428in thyroid uptake study, 72, 427–428

Technetium-99m pyrophosphate, in myocardial infarction imaging, 421–422, 422f

Technetium-99m red blood cell (RBC) scintigraphy

gastrointestinal. See Gastrointestinal bleeding, Tc-99m RBC scintigraphy in

hepatic. See Liver, Tc-99m RBC scintigraphy of

ventricular. See VentriculographyTechnetium-99m sestamibi

in breast cancer scintigraphy, 278–281, 279f, 279t, 280b

in myocardial perfusion scintigraphy, 381f, 390–391, 390b–391b, 390t

in parathyroid scintigraphy, 90, 92–94, 93f–94f, 428

Technetium-99m sulesomab, 332Technetium-99m sulfur colloid (Tc-99m SC)

in gastrointestinal scintigraphy, 308, 308fin hepatic scintigraphy, 161–163, 162b,

162f–164fin infection scintigraphy, 124, 126f, 336, 341fin splenic scintigraphy, 163–164, 165f

Technetium-99m teboroxime, in myocardial perfusion scintigraphy, 381

Technetium-99m Technegas, 207, 208tTechnetium-99m tetrofosmin, in myocardial

perfusion scintigraphy, 390–391, 390b–391b, 390t

Teratoma, ovarian, 78Testicular carcinoma, 262Thallium-201 (Tl-201), 3t, 9

in cancer imaging, 433b, 279t, 281, 281tdosimetry for, 14t, 380–381, 380tin myocardial perfusion scintigraphy, 380f,

391–393, 391b, 392f, 401–404, 403f–405f

Thrombosisdeep venous, 204, 225–226, 226fhepatic vein, 163, 164frenal vein, 190–191, 197f

Thymic rebound, 236, 238fThymoma, 399fThymus, 236, 238fThyroglobulin, 66

after thyroid ablation, 89Thyroid cancer, 84–90

F-18 FDG PET in, 89, 89f, 246–248, 433bmetastatic, 78, 86, 87f–89f, 89, 108

treatment of, 89–90radioiodine I-131 therapy in, 89–90, 90b

adverse effects of, 89–90scintigraphy in, 85–89

follow-up, 85I-123, 85–86, 86bI-131, 85, 86binterpretation of, 86, 86fmethodology for, 85–89

I-123, 85–86, 86bI-131, 85, 86b

patient preparation for, 85posttherapy, 86, 86f–88f, 89star artifact with, 86, 88fthyrogen administration and, 85after thyroidectomy, 85

SPECT/CT in, 86, 88fsurgery in, 85

Thyroid gland. See also Thyroid canceranatomy of, 66, 67fectopic, 66, 81, 83fon F-18 FDG PET, 234–235, 234fiodide trapping in, 66, 67flingual, 81, 83f, 427in parathyroid scintigraphy, 92, 93fphysiology of, 66, 67f–68f

Thyroid nodule(s), 79–81benign vs. malignant, 79–81cold, 79, 79f, 79t, 80bdiscordant, 80, 81ffine needle aspiration biopsy of, 79hot, 79–80, 79t, 80bindeterminate, 79t, 80multinodular, 79ttoxic, 76, 77f

treatment of, 80, 84ultrasonography of, 79warm, 79–80, 80b, 80f

Thyroid probe, 41Thyroid scintigraphy, 72–74, 72f, 427–428

in colloid nodular goiter, 80–81, 81fin ectopic tissue, 81, 83fesophageal activity with, 74, 74fin Graves disease, 75, 75fI-123, 72–73, 73b, 73fI-131, 73. See also Thyroid cancer,

scintigraphy inindications for, 70t, 78–81interpretation of, 73–74methodology of, 72–73, 72f, 73bin multinodular nontoxic goiter, 75, 77fin multinodular toxic goiter, 75, 76fin nodules, 79–81, 79f–81f, 79t, 80bnormal, 73–74, 73fin Riedel struma, 81in subacute thyroiditis, 77–78, 78f

Thyroid scintigraphy (Continued)in substernal goiter, 81, 82f–83fTc-99m pertechnetate, 72–73, 73bin toxic nodule, 76, 77f

Thyroid-stimulating hormone (TSH), 66, 68f

recombinant (Thyrogen), 85secretion of, 66, 68f

Thyroid-stimulating hormone (TSH) stimulation test, 78

Thyroid studies, 66–90. See also Thyroid scintigraphy; Thyroid uptake study

anatomy in, 66, 67fI-123 in, 68, 68t–69t, 428I-131 in, 67–68, 68t–69t, 428methodology of, 70–74perchlorate discharge test, 78physiology in, 66, 68fradiopharmaceuticals in, 67–70, 68f, 68t–69t,

427–428food interactions with, 69–70, 69tlactation and, 70medication interactions with, 69–70, 69tpregnancy and, 70selection of, 69, 69t

Tc-99m pertechnetate in, 68–69, 68t–69ttriiodothyronine suppression test, 78TSH stimulation test, 78

Thyroid uptake study, 70–72, 75t, 427–428in amiodarone-induced thyrotoxicosis, 78in euthyroidism, 75tin Graves disease, 74–75, 428in hashitoxicosis, 75t, 76in hypothyroidism, 75tindications for, 70, 70tin iodine-induced thyrotoxicosis, 78low values in, 428methodology of, 70–71, 71b, 71fin multinodular toxic goiter, 75normal values in, 71–72pharmacological diagnostic tests with, 78in subacute thyroiditis, 76–78, 77f, 428Tc-99m pertechnetate for, 72temporal aspects of, 67, 68fin thyrotoxicosis, 74–78, 75b, 75tin thyrotoxicosis factitia, 78in toxic nodule, 76

Thyroiditischronic, 78granulomatous, 76postpartum, 76radiation, 84Riedel struma, 81subacute, 75t, 76–78, 428

Thyroid–pituitary feedback, 66, 68fThyrotoxicosis, 74–78

amiodarone-induced, 78autonomously functioning nodule and, 76,

77fclinical diagnosis of, 74definition of, 74differential diagnosis of, 70, 70b–71b, 74–78,

75b, 75tetiology of, 70, 70tGraves disease and, 74–75, 75f, 75tHashimoto disease and, 75t, 76iodine-induced, 78multinodular toxic goiter and, 75, 76fovarian teratoma and, 78pituitary gland disorders and, 78radioactive iodine percent uptake study in,

70–72, 70b–71bcalculations for, 71methodology of, 70–71, 71fnormal values for, 71–72

radioiodine I-131 therapy in, 81, 83b

Index  451

Thyrotoxicosis (Continued)subacute thyroiditis and, 75t, 76–78, 77f–78fTc-99m pertechnetate uptake in, 72toxic nodule and, 80

Thyrotoxicosis factitia, 78Thyroxine (T4), 66, 67fTime activity curve (TAC), 50Tl-201. See Thallium-201 (Tl-201)Trachea, radiopharmaceutical uptake in, 211,

211fTransarterial chemoembolization, 283–285

methodology for, 284, 284f–285fradiopharmaceuticals for, 284, 284tresults of, 284–285, 285f

Traumabone, 102–103, 104f, 113–121, 117f–118f,

118t. See also Fracture(s)cholescintigraphy after, 153complex regional pain syndrome after,

117–118, 118fhepatic, 153renal, 177f

Triiodothyronine (T3), 66, 67fTriiodothyronine (T3) suppression test, 78Trophoblastic tumors, hyperthyroidism with, 78Tumors. See CancerTuttle acid reflux test, 290

UUltrasonography

in acute calculous cholecystitis, 139, 139tin deep venous thrombosis, 204in hepatic hemangioma, 158in molecular imaging, 17t, 18in pulmonary embolism, 204in renovascular hypertension, 185in thyroid nodules, 79in urinary tract obstruction, 180

Ultraviolet rays, 26fUniformity calibration, 44

in PET, 63in SPECT, 59, 60f

Uniformity (flood) test, 47–48, 47fUrea breath test, 306–307Urinary tract obstruction, 179–183

diuresis renography in, 180, 180binterpretation of, 180–183, 181b, 181f–184f

ultrasonography in, 180

VValence electron, 25t, 425Vascular dementia, 358–359, 361fVascular endothelial growth factor (VEGF), 21Vasomotor nephropathy, 189–191, 189t, 191t,

193f–194fVenography, in deep venous thrombosis,

225–226, 226fVentilation perfusion (V/Q) scintigraphy,

205–206in adult respiratory distress syndrome, 225in COPD, 224, 225fnormal, 205, 205fpatient position for, 439bpearls and pitfalls of, 438perfusion, 211–216

abnormalities of, 212–216, 212battenuation artifacts in, 212–214cerebral radiopharmaceutical uptake with,

211, 212fdefect size on, 215fissure sign on, 212–214, 215f

452  Index

Ventilation perfusion (V/Q) scintigraphy (Continued)interpretation of, 211–216, 212b, 212f–

216f, 214b, 439bnonsegmental defects on, 212–214, 214bnormal, 205f, 209f, 224pleural effusion effect on, 212, 215fradiopharmaceuticals for, 206, 207bsingle-lung defects on, 214–215, 214bsmall segmental (subsegmental) defects

on, 212–214stripe sign on, 215–216, 216f, 439terminology for, 213btriple matches on, 216, 220–221, 221t

quantitative, 224–225, 225fradiopharmaceuticals for, 206–209, 207b,

438in children, 206, 438dosimetry for, 207–208, 208tduring pregnancy, 206technetium-99m DTPA, 207–209,

207t–208t, 209btechnetium-99m MAA, 206, 208t, 209,

209f–210f, 210b, 438, 438b–439btechnetium-99m Technegas, 207, 208txenon-133, 207–208, 207t–208t, 208b,

209fshine-through on, 439bSPECT, 209terminology for, 213bventilation, 208–209

abnormalities on, 210–211, 210fhepatic radiopharmaceutical retention

with, 211, 211finterpretation of, 209–216, 210f–211fnormal, 205f, 209f

Ventilation perfusion (V/Q) scintigraphy (Continued)radiopharmaceuticals for, 206–207, 207b, 207t

dosimetry and, 207–208, 208tswallowed radiopharmaceutical on, 211, 211ftechnique of, 208–209, 208b–209b,

209f–210fterminology for, 213btriple matches on, 216

Ventriculography, 413–421akinesis on, 416–417in cardiotoxicity, 420–421, 420bin congenital heart disease, 421, 422fcontraindications to, 414–415, 419fin coronary artery disease, 420dyskinesis on, 416–417ejection fraction on, 417–419equilibrium gated blood pool study in,

414–416, 416f–418f, 418b, 421f, 438first-pass study in, 416, 419fFourier phase analysis in, 420functional analysis in, 420hypokinesis on, 416–417, 421finterpretation of, 416–420

qualitative analysis in, 416–417quantitative analysis in, 417–420

in pulmonary disease, 421radiolabeled RBCs for, 413, 416tradiopharmaceuticals for, 413–416tardokinesis on, 416–417

Vertebral osteomyelitis. See Osteomyelitis, vertebral

Vesicoureteral reflux, 173f–174f, 201, 201b, 202f–203f, 202t

Viral vectors, 22–23Vocal cord paralysis, 231–232, 232f

WWebster’s rule, 11Well counter, 41Westermark sign, 204Whipple procedure, 152Windowing filter, 53, 54fWound healing, 235–236, 237f

XX-rays, 25–26, 26f, 425

production of, 26Xenon-127 (Xe-127), 3t, 8t, 9Xenon-133 (Xe-133), 3t, 9, 14t

hepatic accumulation of, 211, 211fin ventilation perfusion scintigraphy,

207–208, 207t–208t, 208b, 209f

YYttrium-90 (Y-90)

in receptor expression imaging, 22in transarterial chemoembolization, 284,

284t, 285fYttrium-90 ibritumomab tiuxetan, 274–276,

274t–275t, 434b

ZZ-score, 129