Uploaded byTONY SCARIA
Nuclear medicine radiology revision notes
Nuclear medicine uses radiopharmaceuticals and imaging techniques like PET and SPECT scans to assess organ function and detect diseases. Some key applications include using F-18 FDG PET scans to identify cancer metastases based on increased glucose metabolism in malignant cells, Tc-99m sestamibi scans to detect myocardial ischemia, Tc-99m DMSA renal scans to assess kidney function, and somatostatin receptor imaging with radiolabeled octreotide to localize neuroendocrine tumors. PET provides superior detection of bone metastases compared to bone scans or whole-body MRI. Important considerations for nuclear medicine exams include selecting the appropriate radiotracer and ensuring normal blood glucose levels for oncology FDG PET scans
More Related Content
Similar to Nuclear medicine radiology revision notes
More from TONY SCARIA
Nuclear medicine radiology revision notes
- 1.
- 2. nuclear medicine • Toassess function using radiopharmaceuticals • Using • Nuclear scan / isotope scan • PET scan • SPECT scan
- 3. Scintigraphy / radioisotopicstudies Tc99 PET • F18 • 11C • 13N SPECT • Single photon emission tomography
- 4. Nuclear scan /isotope scan • Using Tc99m (m metastable) • T1/26 hours • Emits γ rays detected by γ camera 143 KeV
- 5. Gamma camera isused to • Measuring the radioactivity • It is also called as scintillation camera or anger camera
- 6. Gamma camera isuded to detect radioactivity
- 7. Tc99m bound toligands for delivery to target organ Tc99m ligand MDP Bone imaging HIDA scan • a/c cholecystitis • To exclude biliary atresia
- 8. Bone scan • Mcinvestigation for bone metastasis • IOC is PET scan Osteoblastic activity Osteoclastic activity • Increased uptake hot uptake • Decreased uptake cold uptake • Osteoblastic 2* • Pagets disease • Osteroid osteoma • Osteomyelitis • Osteitis deformans • OA (subchondral sclerosis ) • Enchondroma • Osteochondroma • Multiple myeloma • Fibrous cortical defect • Non ossifying fibroma • Bone island • Osteopoikilosis
- 10.
- 11. Abnormal bone scane Superscan • In diffuse metastatic ds of bone • In diffuse metabolic ds of bone • Renal failure OM • Increased uptake in all 3 phases of bone scan Mickey mouse sign • Pagets ds Hot bone scan • Increased uptake in site where there is increased uptake - neoplasm trauma infection avscular necrosis Cold scan • In multiple myeloma • Histiocytosis • Neuroblastoma • RCC • Thyroid carcinoma
- 12. Super scan • Increaseduptake in skeleton • No background radiotracer activity • But kidneys are not visualised • In diffuse metastatic ds of bone • In diffuse metabolic ds of bone • Renal failure
- 13. Mickey mouse signin pagets disease • d/t increased uptake in pedicles & spinous process
- 15. Big black beard/ linoln sign in pagets disease • Increased condylar to condylar uptake in bone scan
- 16. For infections ofbone / osteomyelitis • Gallium scan • Indium labelled WBC scan (except in case of respiratory tract infections ) • Increased uptake in all 3 phases
- 17. Nuclear medicine inheart
- 18. Nuclear medicine inheart Myocardial perfusion studies • Thallium 201 (MC used) • Tc99m tetrophosmin • Tc99m sestamibi (MIBI scan)area of infarct appears cold Myocardial infarct imaging • Tc99 pyrophosphate (area of infarct appears hot) MUGA scan • Tc99m labelled RBC are used
- 19. Myocardial perfusion scan •SPECT scan is used To assess blood flow (perfusion ) • Using thallium 201 / Tc99 labelled tetrofosmin /Tc 99m labelled sestamibi • Low perfused area appears cold (d/t decreased uptake of radioactive material)
- 20. Stress thallium study •Stress is given by physiologically / with dobutamine • At peak of stress inject thallium • Uptake by normal myocardium with normal blood flow hot areas • Ischemic myocardium cold areas Reversible ischemia Ischemia on exercise but not on rest Irreversible ischemia Ischemia both @ rest & execise
- 21. Myocardial infarct scintigraphy •Using Tc pyrophosphate • Uptake by infarcted myocardium • Infarct hot areas • Blood flow is not assessed by this scan
- 22. • Gold standardfor myocardial viability PET scan • Best investigation to differentiate b/w myocardial scar & hibernating myocardium PET Cardiac PET uses Myocardial metabolism FDG PET scan Myocardial perfusion • radioactive ammonia (NH3) • H20 • Rubidium 82 Rubidium 82 non cyclotron isotope used in PET scan
- 23. MUGA scan • methodfor assessment of LV functionmeasure ejection fraction • ECHO can also be used • most accurate is MRI • 99mTc-labelled albumin or red cells that are uniformly distributed throughout the blood volume /
- 24. Tc 99m labelledRBC is used for • Haemangioma • GI bleeding • Splenic disease • Cardiac ventriculography
- 25. Nuclear medicine inGIT Tc99m labelled RBC • Minimal lower GI Bleeding • Sensitive test (0.1ml/min) Tc99m pertechnate • Pertechnate is taken up by gastric mucosa to detect ectopic gastric mucosa Tc99m sulphur colloid • Taken by RE cell • To detect Focal nodular hyperaplasia (FNH) also used in accessory spleen & abscess • IOC for upper GI bleed endoscopy • IOC in lower GI bleed mesenteric angiography / Tc99 RBC
- 26. Lower GI bleed Mesentericangiography Tc 99 RBC Can detect 0.5 ml/min blood loss Can detect 0.1 ml/min blood loss
- 27. Uses of Tc99mlabelled pertechnate • Thyroid scintigraphy • Salivary gland scintigraphy • Meckels diverticulum
- 28. Renal radionuclide imaging •Dynamic renal scintigraphy functional imaging Static renal scintigraphy Tc99 DTPA GFR estimation Tc99m DMSA • To assess cortical function / corticomedullary differentiation/ functional mass / scarring of VUR Tc99 MAG 3 best for dynamic renal scintigraphy I123 –OIH effective renal plasma flow
- 29. Dynamic renal scintigraphy Tc99mDTPA GFR estimation Tc99m MAG3 • DTPA neither reabsorbed / secreted • Used to measure GFR • Demonstration of VUR • Differentiate obstruction from stasis by diuretic DTPA scan • To assess transplanted kidney • MAG3 is secreted as well as filtered • Best study for renal function • Glomerular + tubular function Captopril DTPA is used for detecting reno vascular HTN
- 30. Ventilation perfusion scan VentilationUsing inert gases like krypton or xenon Perfusion Tc99m microaggreagtes of albumin Tc99m labelled RBC • V/Q scan to detect Pulmonary thromboembolism in pregnancy & In iodine allergy contrast cant be used • IOC in PTE MDCT with contrast
- 31. To localise parathyroidadenoma in primary hyperparathyroidism • 99_Tc sestamibi scan. • After one hour of injection, uptake is done by both thyroid and parathyroid gland. • After 3 hrs uptake evidence is there only in parathyroid. So by computer subtraction adenoma is located. • Tc – thallium substraction scan can also be used
- 32. Radioactive iodine T1/2 Uses I1318 days • Systemic therapy of thyroid metastasis • Emits both β&γ rays • β rays killing thyroid cells I 125 60 days • Radioimmunoassay • Brachytherapy of prostate I124 4 days • Used in PET scanning I 123 13 hrs • Functional thyroid scintigraphy • Not available in india done by Tc99 pertechnetiate • Radioactive iodine uptake Stable isotope of iodine I 127
- 33. • In caseof neuroendocrine tumours carcinoid , glucaganoma , VIPoma • Somatostatin receptor scintigraphy • Octreotide scintigraphy • insulinoma • IOC EUS • As somatostatin receptor is negative
- 34. HIDA scan • HepaticIminodiacetic acid scan (HIDA Scan)is a biliary scintigraphic scan. • Applications & indications include: • 1. Acute cholecystitis (investigation of choice) • 2. Congenital biliary atresia • 3. Biliary leak evaluation • 4. Biliary – enteric fistula • 5. Chronic GB dysfunction
- 35. Thyroid Scan Hot noduleCold thyroid nodule Adenoma & thyroid Carcinoma (extremely rare) Inflammatory mass, Benign tumor & Malignant tumor
- 36. SPECT scan • Singlepositron emission computed tomography • 360 * revolving γ scanner • Also uses Tc99m
- 37. HMPAO SPECT •Lipophilic compound • cross BBB • For cerebral perfusion • Alzheimers d/s decrease perfusion in temporoparietal • Picks ds decrease perfusion in frontotemporal Ictal SPECT with HMPAO • Hypermetabolic foci localise epileptogenic foci • For lesions not localised Interictal SPECT with FDG • Hypometabolic seizure
- 38.
- 40. PET • This techniquehas been used in the • evaluation of solitary pulmonary nodules and as • aid to staging lung cancer, • identification of mediastinal lymph node involvement by malignancy. • Radiation induced necrosis
- 41.
- 42. Based on principleof annhilation
- 44.
- 45. Annihilation • Positron emittedfrom photon emitting radionucleitide combine with electron to form gamma rays of energy 511 KeV • Gamma rays Are detected by PET scanners coupled to photomultiplier tubes
- 46. • Gamma photonare detected by PET Scanner composed of scintillation crystals made up of • Bismuth germinate • Cerium doped lutetium oxysilicate • Cerium doped gadolinium silicate
- 48. • PET • Itis increasingly being used to identify malignant lesions in the lung based on their increased uptake and metabolism of glucose. • The technique involves injection of a radiolabeled glucose analogue, 18f- fluoro-2-deoxyglucose (fdg), which is taken up by metabolically active malignant cells. However, fdg is trapped within the cell following phosphorylation, and the unstable fluorine 18 decays by emission of positrons, which can be detected by a specialized pet camera or by a gamma camera that has been adapted for imaging of positron-emitting radionuclides.
- 49. Cyclotron • Used toproduce artificial isotopes • F18 is produced in a cyclotron by bombarding O18 enriched water with high energy photons in a cyclotron • Other positron emitting C11 N13 & O15 can also be produced • 18FDG is most commonly used T1/2 Oxygen 2 minutes Nitrogen 10 minutes Carbon 20 minutes Flourine 110 minutes
- 50. Role of 18FDG in PET Scan • In oncology • Warburg effect in malignant cells • Aerobic glycolysis • Even in presence of O2 no TCA cycle • Malignant cells have increased glucose utilisation d/t upregulation of hexokinase activity • Increased glucose uptake increased 18 FDG uptake
- 51. Warburg effect intumour cells
- 52. 18 FDG entersglycolysis undergoes phosphorylation but donot undergo further metabolism
- 53. Uses of 18FDG PET • Staging of various tumours • Identifying metastasis • Rx response & follow up • Used to detect tumour recurrence • Differentiate post surgical scarring / post RTx fibrosis from tumour recurrence
- 54. 18 FDG PET Falsepositive (even in absence of malignancy) False negative • c/c infections (TB) • Brown adipose tissue • Bronchoalveolar carcinoma (low mitotic & metabolic activity) • Carcionid (low mitotic & metabolic activity) • Brain metastasis • In fasting & DM (increased uptake by all cells) Blood glucose should be normal before PET scanning
- 55. 18 FDG PETin brain • Greater uptake in brain & liver • Not useful to detect brain metastasis • 11C methinonine PET is better than 18 FDG PET to detect brain metastasis • Investigation of choice for brain metastasis is MRI • Investigation of choice for recurrent brain tumour PET scan (recurrence is seen against post surgical or post RTx scarring)
- 56. IOC for solitarypulmonary nodule on CT scan PET scan
- 57. Bone metastasis • IOCis PET • PET scan >>> whole body MRI >>>bone scan • Na + F- PET scan is better than 18 FDG • 18 FDG cannot detect brain & liver metastasis
- 58. PET scanning inheart • 2 types can be used • N13 ammonia PET • 18 FDG PET scan N 13 ammonia PET to detect myocardial perfusion 18 FDG PET to detect myocardial viability /metabolism Scar tissue -ve -ve Hibernating myocardium -ve +ve (ischemic heart preferentially uses glycolysis rather than fatty acids) • To differentiate hibernating myocardium form scar tissue • Only in hibernating myocardium stenting can be done & it is useless in case of scar tissue
- 59. IOC in pheochromocytoma Test Adrenalpheochromocytoma Light bulb appearance in MRI Extra adrenal pheochromocytoma 18F DOPA PET
- 60. Light bulb appearanceon MRI of adrenal pheochromocytoma
- 61. PET scan incarcinoid syndrome • Carcinoid syndrome low mitotic & low metabolic activity 18 FDG will be negative • Carcinoid syndrome octreotide PET & DOTATOC PET are used