The Common Vein copyright 2007

Definition

Nuclear medicine is an  imaging technique that uses radioactive substances to evaluate structure, function and disease and it is also used in the treatment of disease.

Principles

The radioisotopes are usually tagged onto to a carrier molecule that selectively attaches to a structure in the body. The radioisotope, (aka  radiopharmaceutical agent or tracer,emits gamma rays and these are detected by a gamma detector.  The level of activity can be Gamma rays are that emitted from the radioactive.  A computer is used to analyse the data and to produce images and measurements of organs, tissues, and lesions.

The radiopharmaceutical is usually excreted via the urinary system.

Necrotizing Granuloma
72372c03 60 female with long history of smoking lung nodule slow growth SUV 1.3 right lower lobe dx necrotizing granuloma Most necrotizing granulomas are related to infection. Wegener’s granulomatosis Churg-Strauss syndrome – vasculitis sarcoidosis usually non necrotizing CTscan PETscan Davidoff MD

HIDA scan Positive for Acute Cholecystitis

The scan was taken at 2 and half hours after administration of the radiosotope, and fails to show filling of the gallbladder.  This finding confirmins an obstruction of the cystic duct and the diagnosis of acute cholecystitis is highly likely.

04208 gallbladder non-filling HIDA scan dx acute cholecystitis imaging radiology nuclear medicine NMscan

Aim

To evaluate structure, function, and disease in the body, and sometimes used for targetted therapy.

Indications

Brain Scan

Endocrine System;  thyroid, parathyroid, octreotide (somatostattin receptor disease such as neuroendocrine tumors)

Lung Scan;  pulmonary embolism

Cardiac Imaging; blood flow, cardiac function at rest and excercise

Gastrointestinal system; GI bleeding, cholecystitis, liver tumors, bile duct patency

Genitourinary system; Assessment of renal blood flow

Musculoskeletal system; fractures, osteomyelitis, arthritis, tumor

Specific Disease Categories; infection, inflammation,malignancy

 

Acute GI bleed

46590 small bowel fx radioisotope leak into small bowel dx GI bleed hemorrhage Radioactibe labelled sulfur colloid Nuclear Medicine NMscan Davidoff MD

 

Contraindications

In pregnancy, studies during organogenesis within in the first trimester are contraindicated unless the mother’s life is threatened by the disorder.  In the remaining trimesters, studies are relatively contraindicated, and clinical prudence is necessary.

Advantages

The utility related to sensitivity, specificty, and accuracy for acute cholecystitis, bile duct leakage, toxic hyperactive goiter, and acute gastrointestinal bleeding for example are superior to any other studies available for these entities

Allergies to the radiopharmaceuticals are rare.

Disadvantages

Radiation exposure.  The radiopharmaceuticals do subject the patient to a small ampount of radiation but there are no known long term effects.

Nuclear medicine procedures are relatively long compared to most of the imaging procedures. Accumulation of the radiopharmaceutical can take from hours up to days  and would require two vists to the department. One for injection and the second for the imaging.  Imaging is also a fairly lenthy procedure and can take between 1 and 3 hours .hours to perform, depending on the study.

 

Method

Patient Preparation

There is no special preparation necessary  prior to a study.

 

For the evaluation of ther stomach though the patient should be fasting for 4 hours. 

 

For studies involving renal evaluation, the patient should drink extra water in order to flush the kidneys.

 

After the injection there may be a delay before imaging.  Some procedures require immediate imaging while in others, there is a delay of hours and sometimes even days after the injection.

 

Scanning times are relatively long – and usually run between 20-45 minutes during which time it is important to lie still.

 

The patient usually lies prone during the procedure.

 

Equipment

Camera that is housed metallic casing.  The design of the equipment tailored to the type of exam and the body part being imaged.  It can take the form of a ring, or a single unit suspended from a bracket in the ceiling overlying the examination table, under the table, or within a doughnut.

Technique

A small dose of radioactive material is usually administered intravenously but occasionally is given orally.

 Depending on the type of scan imaging will be performed either immediately, a few hours later, or several days after the injection. Imaging time varies, gbut enerally ranges from 20 to 45 minutes.

Results

Brain Scan

Endocrine System;  thyroid, parathyroid, octreotide (somatostattin receptor disease such as neuroendocrine tumors)

Lung Scan;  pulmonary embolism

Cardiac Imaging; blood flow, cardiac function at rest and excercise

Gastrointestinal system; GI bleeding, cholecystitis, liver tumors, bile duct patency

Genitourinary system; Assessment of renal blood flow

Musculoskeletal system; fractures, osteomyelitis, arthritis, tumor

Specific Disease Categories; infection, inflammation,malignancy

Potential Complications

The are no significant potential complications to the procedure

Conclusion

 Nuclear medicine offers a safe, and sometimes unique tool in medical imaging sometimees providing the only method of accurately diagnosing a disorder.  It plays a particular role in functional evaluation.  Of recent, PETscanning has been a major breakthrough in the evaluation of cancer.

 

Malignant Disease in the RUL with PET positive Left Adrenal Gland –

Stage 4

This is a patient with lung carcinoma presenting with a large mass in the right upper lobe with a lymphangitic pattern, adrenal metastasis and a PET positive scan for the mass and for the left adrenal gland. Courtesy Ashley Davidoff MD 32269b see 680249 code lungs pulmonary mass RUL neoplasm malignant primary lymphatics lymphangitis imaging plain film CXR CTscan PETscan

Cisternogram

49689.800 CSF flow brain cisternogram radioisotope injected into subarachnoid space via lumbar puncture and over 6.5 hours progresses to base of brain. This patient had a CSF leak in the cribiform plate. Hernose was plugged with cotton gauze and the gauze was scanned after 6 hours – The left and right were both positive for leak greater on the right nuclear medicine Courtesy Alan Ashare MD

Melanoma

49726c01.800 nodules lungs peritoneal cavity retropritoneum CT scan PET scan dx metastattic melanoma metastases Courtesy Ashley DAvidoff MD 49725.800 mets

Recent Myocardial Infarction

49688.800 bone heart uptake in ribs right posterior probably related to rib fractures. Finding of interest is the uptake in the heart which should not be seen with a bone scan and it indicates a recent myocrdial infarction NM radioisotope Courtesyt Alan Ashare MD