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Nuclear Medicine

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Page 1: Nuclear Medicine

Nuclear Medicine

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

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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

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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

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Radionuclide Cisternography NPH : communicating

hydrocephalus , a delay in CSF absorption

over the convexity CSF leakage

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1 h 2 h 4 h

6 h 24 h 48 h

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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

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Thyroid scintigraphy Thyroid nodule Congenital hypothyroidism Thyroid cancer follow up

131I treatment

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I 131

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Parathyroid scintigraphy Detection and localization of

parathyroid adenoma

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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

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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

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201Tl

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

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MUGA (radionuclide ventriculography) For evaluation of ventricular size,

RVEF, LVEF, regional wall motion

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Angio-venography Lower extremities edema Detection and route out DVT,

venous insufficiency, inflammation process, varicose vein,

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Subcutaneous radionuclide Venography

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Subcutaneous radionuclide Venography

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

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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

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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)

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24 h6 h

1 h

4 h

30 m15 m5 m

2 h

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24h7h2h 4h

1h30m15m5m

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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

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Three phase bone scan

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

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67Ga scan Bind to transferrin and accumulate in a wide variety of malignant neoplasms and their metastases Inflammatory image Detection and staging of Hodgkin’s disease, non-Hodgkin’s lymphoma, melanoma, lung cancer, hepatoma, leukemia, gastric cancer, esophageal cancer…

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67Ga scan

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67Ga scan

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Renal imaging Glomerular agents : 99mTc-DTPA Tubular agents : 99mTc-MAG3 Cortical agents : 99mTc-DMSA Diuretic renography Captopril renography

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Renal scan (99mTc-DTPA) Baseline : GFR, quantitative renal function Lasix : ddx of non-obstructive dilatation & mechanical obstruction, Capoten : renovascular hypertension

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Renal scan (99mTc-DMSA) Children APN, renal scarring, renal infarct, renal trauma, horseshoe kidney, ectopic kidney, renal cyst, renal abscess, renal tumor.

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Pulmonary imaging Perfusion image : 99mTc-MAA

(10~90um) Ventilation image : 133Xe, 99mTc-

DTPA aerosol PIOPED interpretation criteria V/Q mismatch

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Pulmonary imaging pulmonary embolism, F/U pulmonary embolism after anti-coagulant therapy, perfusion change secondary to lung tumor, pre-operative evaluation for pneumonectomy, post-operative F/U…

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ANT LEFT LPO

POST RPO RIGHT

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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…

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Lymphoscintigraphy 99mTc-sulfur colloid Lymphatic obstruction Detect sentinel lymph node (melanoma, breast cancer…)

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Testicular/scrotal scintigraphy 99m-TcO4- D/D testicular torsion from epididymitis, hydrocele, hematocele, abscess...

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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 obstruction, DM gastroparesis, s/p vagotomy, gastrinoma… Follow up and evaluation of the effectiveness of treatment.

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