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 onse

t 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

1 h 2 h 4 h

6 h 24 h 48 h

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

Thyroid scintigraphy Thyroid nodule Congenital hypothyroidism Thyroid cancer follow up

131I treatment

I 131

Parathyroid scintigraphy Detection and localization of

parathyroid adenoma

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

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 : 99mTcO4

-

Gastric empty time

Liver-spleen scan

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 biliary obstruction, D.D. of biliary atre

sia 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)

24 h6 h

1 h

4 h

30 m15 m5 m

2 h

24h7h2h 4h

1h30m15m5m

Skeletal imaging 99mTc-MDP (bone hydroxyapatite crystal) Regional blood flow, tissue extraction, o

steoblastic 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 wid

e variety of malignant neoplasms and their metastases

Inflammatory image Detection and staging of Hodgkin’s diseas

e, non-Hodgkin’s 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 func

tion Lasix : ddx of non-obstructive dilatati

on & mechanical obstruction, Capoten : renovascular hypertension

Renal scan (99mTc-DMSA) Children APN, renal scarring, renal i

nfarct, 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 pulmo

nary embolism after anti-coagulant 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

99mTcO4-

Symmetric gland accumulation, drainage, increased or decreased function.

Salivary gland function, dry mouth, Sjogren’s syndrome, parotid tumor, NPC post radiation therapy…

Lymphoscintigraphy 99mTc-sulfur colloid Lymphatic obstruction Detect sentinel lymph node (melano

ma, 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,60 土 30min; liquid meal, 30 土 15min) Gastric outlet obstruction or function ob

struction, DM gastroparesis, s/p vagotomy, gastrinoma…

Follow up and evaluation of the effectiveness of treatment.