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Nuclear Medicine

Nuclear Medicine. General concept. Radiopharmaceutics mCi, MBq (1mCi = 37MBq) Planar image and SPECT image Clinical presentation. Neurology imaging. 99m Tc-HMPAO : cross to BBB and fix in the brain proportionally to perfusion 18 FDG : glucose metabolism

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Nuclear Medicine

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  1. Nuclear Medicine

  2. General concept • Radiopharmaceutics • mCi, MBq (1mCi = 37MBq) • Planar image and SPECT image • Clinical presentation

  3. 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

  4. 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

  5. Radionuclide Cisternography • NPH : communicating hydrocephalus , a delay in CSF absorption over the convexity • CSF leakage

  6. 2 h 4 h 1 h 48 h 6 h 24 h

  7. 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

  8. Thyroid scintigraphy • Thyroid nodule • Congenital hypothyroidism • Thyroid cancer follow up • 131I treatment

  9. I 131

  10. Parathyroid scintigraphy • Detection and localization of parathyroid adenoma

  11. 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

  12. 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

  13. 201Tl

  14. Myocardial perfusion scintigraphy • Pharmacologic stress test : Dipyridamole, Adenosine • Homogeneous, heterogeneous • Reversible redistribution • Fixed defect • Reverse redistribution

  15. MUGA (radionuclide ventriculography) • For evaluation of ventricular size, RVEF, LVEF, regional wall motion

  16. Angio-venography • Lower extremities edema • Detection and route out DVT, venous insufficiency, inflammation process, varicose vein,

  17. Subcutaneous radionuclide Venography

  18. Subcutaneous radionuclide Venography

  19. Gastrointestinal imaging • Liver-spleen scintigraphy : 99mTc-sulfur colloid • Cholescintigraphy : 99mTc-DISIDA • GI bleeding : 99mTc-RBC • Ectopic gastric mucosal scan : 99mTcO4- • Gastric empty time

  20. 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

  21. 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)

  22. 30 m 1 h 5 m 15 m 2 h 4 h 24 h 6 h

  23. 5m 15m 30m 1h 24h 2h 4h 7h

  24. Skeletal imaging • 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

  25. Three phase bone scan

  26. Oncologic imaging • 67Ga, 201Tl, 99mTc-MIBI, 18FDG

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