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Dr Hussein Farghaly PSMMC

Radionuclide Brain Imaging. Lecture 6. Dr Hussein Farghaly PSMMC. Master Watermark Image: http://williamcalvin.com/BrainForAllSeasons/img/bonoboLH-humanLH-viaTWD.gif. New tracer for PET Carbon-11 (C-11)-labeled Pittsburgh compound B (PiB), Ab—or amyloid PET

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Dr Hussein Farghaly PSMMC

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  1. Radionuclide Brain Imaging Lecture 6 Dr Hussein Farghaly PSMMC Master Watermark Image: http://williamcalvin.com/BrainForAllSeasons/img/bonoboLH-humanLH-viaTWD.gif

  2. New tracer for PET Carbon-11 (C-11)-labeled Pittsburgh compound B (PiB), Ab—or amyloid PET [F-18]florbetapir, achieved approval by the U.S. Food and Drug Administration in April 2012 Targets amyloid beta senile plaques and neurofibrillary tangles Long retention times in hippocampus AmyloidPET imaging

  3. Parkinsonism • results from the deterioration of neurons in the region of the brain called the substantia nigra. These neurons normally produce the neurotransmitter dopamine, which sends signals to the basal ganglia, a mass of nerve fibres that helps to initiate and control patterns of movement.

  4. Targets for dopaminergic ligands Tyrosine Dopamine synthesis L-DOPA DA Pre-synaptic terminal Vesicles Glial cell Dopamine MAO-B Transporters COMT D2 Receptors Post-synaptic cell

  5. Targets for dopaminergic ligands Tyrosine L-DOPA F18-Dopa DA Pre-synaptic terminal Glial cell Vesicles MAO-B COMT I123 IBZM or epidepride I123 FPCIT or ß-CIT *** Post-synaptic cell

  6. Normal Dopamine Transporter (DATSCAN) images Body of Caudate Head of Caudate MRI Putamen DATSCAN SPECT

  7. A PD image with DaTSCAN Medial part of SN projects to caudate Lateral part of SN projects to putamen In PD the lateral part of SN always degenerates first preferential loss in putamen relative to caudate

  8. Diagnosis and staging of Parkinson’s Disease Clinical diagnosis Imaging diagnosis Even on first presentation SPECT shows loss of 50% of neurones Objective measurement of progression in assessment of therapy Normal PD: 1 PD: 2 PD: 3

  9. CISTERNOGRAPHY

  10. CISTERNOGRAPHY CSF CIRCULATION • CSF flows from lateral ventricles through interventricular foramina (of Monro), into third ventricle, through cerebral aqueduct (of Sylvius), into fourth ventricle, through median aperture (foramen of Magendie) and lateral apertures (foramina of Luschka) into cisterna magna. CSF enters subarachnoid space, circulating around brain and spinal cord before being absorbed in arachnoid granulations over cerebral hemispheres

  11. Hydrocephalus Hydrocephalus is abnormal enlargement of the CSF spaces resulting from abnormalities of CSF production, circulation, or absorption (Table 13-4). MRI and CT are most often used to select patients who might benefit from intervention, whereas radionuclide cisternography is generally reserved for situations that remain unclear

  12. Cisternography: Protocol Summary

  13. Normal cisternogram. Anterior and lateral images 4 and 24 hours after intrathecal radiotracer injection show normal transit up over the convexities with no ventricular reflux. NUCLEAR MEDICINE: THE REQUISITES

  14. Communicating normal pressure hydrocephalus at 24 hours (top row), 48 hours (middle row) and 72 hours (bottom row) in anterior (left), right lateral (middle) and left lateral (right) projections. Ventricular reflux (closed arrowhead) is present,as is very delayed flow over the convexities (open arrowhead). The intracerebral activity at 72 hours was caused by transependymal uptake. NUCLEAR MEDICINE: THE REQUISITES

  15. Surgical Shunt Patency A variety of diversionary CSF shunts (ventriculoperitoneal, ventriculoatrial, ventriculopleural, lumboperitoneal) have been used to treat obstructive hydrocephalus. Complications may include catheter blockage, infection, thromboembolism, subdural or epidural hematomas, disconnection of catheters, CSF pseudocyst, bowel obstruction, and bowel perforation. The diagnosis of shunt patency and adequacy of CSF flow can often be made by examination of the patient and inspection of the subcutaneous CSF reservoir. When this assessment is uncertain, radionuclide studies with In-111 DTPA or Tc-99m DTPA are useful for confirming the diagnosis.

  16. Shunt Patency: Protocol Summary

  17. Ventriculopleural shunt with normal radiotracer flow through the shunt into the pleural space which decreases over time. Obstructed cerebrospinal shunt. After injection of Tc-99m DTPA into the reservoir, good reflux into the ventricles is seen, consistent with patency of the proximal limb of the shunt.However, no distal drainage occurs over 60 minutes from obstruction. Cerebrospinal shunt patency evaluation. A,Ventriculoperitoneal shunt at 10 min (left) shows activity in the reservoir port and distal limb of the shunt moving down the neck and chest. Intraventricular activity is also seen. By 30 minutes (middle), activity is in the abdomen with free flow in the peritoneum (right). NUCLEAR MEDICINE: THE REQUISITES

  18. Common sites of cerebrospinal fluid leakage NUCLEAR MEDICINE: THE REQUISITES

  19. Cerebrospinal Fluid Leak Placement of pledgets for cerebrospinal fluid leak study. The labeled cotton pledgets are placed by an otolaryngologist at various levels within the anterior and posterior nares to detect leakage from the frontal, ethmoidal, and sphenoidal sinuses. NUCLEAR MEDICINE: THE REQUISITES

  20. Positive radionuclide CSF leak study. In-111 DTPA left lateral views show increasing radioactivity over time originating from the nares and leaking into the nose and mouth (arrowheads). NUCLEAR MEDICINE: THE REQUISITES

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