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Oncologic (Glucose and Oxygen utilization of tumors measured)

  1. Lung cancer and pancreatic cancer
  2. Differentiation of incidentalomas from metastasis in adrenals
  3. Breast cancer
  4. Colon cancer recurrence
  5. LN metastasis from head and neck cancer
     
    Quantification of myocardial blood flow & ischemic heart disease (cardiology)
Neurology
  1. Brain tumour
    1. Residual/recurrent tumour versus neurosis                
    2. Response to chemoradiation
    3. Prediction of patient's average survival in it                  
    4. ​Lymphoma staging
  2. Quantification of cerebral blood flow
  3. Functional imaging of brain.
 
Cardiology
  1. myocardial Perfusion of the heart using Rubidium-82 tracer
  2. myocardial Perfusion of the heart using Ammonia N-13 tracer
  3. Myocardial Viability using FDG
    1. The identification of patients with partial loss of heart muscle movement or hibernating myocardium is important in selecting candidates with compromised ventricular function to determine appropriateness for revascularization.
    2. Distinguish between dysfunctional but viable myocardial tissue and scar tissue in order to affect management decisions in patients with ischemic cardiomyopathy and left ventricular dysfunction
Exrra Edge
  1. Fluorodeoxyglucose (FDG) positron emission tomography (PET) changes the surgical management of patients in up to 40% of cases.
  2. In some cases, distant metastases or restaging indicates that the cancer is inoperable, thus preventing surgery that would have not been useful. In as many as 20% of patients, PET shows that enlarged nodes that may have prevented surgery from being considered were actually benign, so that surgery can be performed.

 Only radiological modality with which metabolic imaging is possible is PET. Q



Note:

QHalf Life Of Important Radionuclides:

 

 Nuclide

 Half-Life

 I131               

 8 days

 I132               

 2.3 hours

 Co60              

 5.2 years

 Tc99               

 6 hours

 P32         

 14 days

 Thallium

 3 days

 Gallium   

 3 days

 Rn22              

 3 days

 Carbon-II

 20.3 min

 Cesium-137

 30 yr

 Chromium-51

 27.8 day

 Cobalt-57

 270 day

 Cobalt-58

 71.3 day

 Cobalt-60

 5.26 yr

 Fluorine-I 8

 109min

 Gadolinium-I 53

 240 day

 Gallium-67

 78.1 hr

 Indium-III

 67 hr

 lodine-I 23

 13 hr

 lodine-I 25

 60 day

 lodine-I 31

 8.06 day

 Krypton-81m

 13 see

 Molybdenum-99

 66.7 hr

 Nitrogen-I 3

 IOmin

 Oxygen-IS

 124 see

 Phosphorus-32

 14.3 day

 Rhenium-I 86

 90 hr

 Rubidium-82

 1.3 min


Radiopharmaceuticals Commonly used for a Range of Clinical Problems
Clinical problem Imaging technique Radiopharmaceutical Biological behaviour
1. Head      
Cerebrovascular accident Cerebral perfusion SPECT 99mTc HMPAO Uptake proportional to blood flow
Hydrocephalus
 
     
CSF rhinorrhoea Cerebrospinal fluid (CSF) study 111In DTPA (intrathecal) Marker of CSF flow.
Encephalitis Blood–brain barrier (BBB) study 99mTc HMPAO Passage across disrupted BBB
Dementia Cerebral perfusion SPECT 99mTc HMPAO Uptake proportional to blood flow
    Cerebral metabolism PET 18F fluorodeoxyglucose Marker of glucose metabolism
Epilepsy (presurgical localization) Ictal SPECT 99mTc HMPAO Uptake proportional to blood flow
    Interictal PET 18F fluorodeoxyglucose Marker of glucose metabolism
2. Neck      
Thyrotoxicosis     123I sodium iodide Active uptake (123I and 99mTc) followed by organification (123I)
Thyroid nodule  
Thyroid scintigraphy 99m Tc pertechnetate  
Ectopic thyroid      
Hyperparathyroidism (presurgical localization) Parathyroid scintigraphy 99mTc MIBI Differential expression of p-glycoprotein between parathyroid adenoma and thyroid
Dry mouth (connective tissue disease) Salivary gland study 99mTc pertechnetate Secretion in saliva
3. Musculoskeletal system      
Tumour  


     
Fracture      
Avascular necrosis Bone scintigraphy 99mTc polyphosphate compounds Osteoblastic response (+ vascularity on early phases)
Arthropathy      
Metabolic bone disease
 
 
     
Painful prosthesis  
 
     
Osteomyelitis   99mTc polyphosphate Osteoblastic activity
    Bone scintigraphy + white cell or gallium scintigraphy 99mTc- or 111In-leucocytes Leucocyte migration
      67Ga gallium citrate Binds to transferrin and leaks into extravascular space
Lymphoedema Lymphoscintigraphy 99mTc nanocolloid Lymphatic uptake and trapping
4. Cardiovascular system      
Chest pain Myocardial perfusion scan 201Tl (thallous chloride) K+ analogue indicating perfusion (ischaemic heart disease) (delayed uptake reflects viability)
      99mTc isonitriles Cationic complexes taken up by myocytes in proportion to blood flow
      99mTc teboroxime Lipophilic compound which accumulates by diffusion
      99mTc phosphines Uptake proportional to blood flow
Cardiac failure Cardiac ventriculography (gated study) 99mTc red blood cells Blood pool label
    Myocardial viability study 18F fluorodeoxyglucose Demonstrates shift from metabolism of fatty acids to glucose
Pulmonary embolism Ventilation/perfusion (V/Q) scan 123I fatty acids  
      Perfusion: 99mTc albumin Pulmonary arteriole blockade
      Macroaggregates  
      Ventilation: 99mTc aerosols Distributes in lungs in proportion to gas regional ventilation
      133Xe gas, 81mKr gas  
Congenital heart disease Quantitative shunt study 99mTc red blood cells Blood pool label
5. Pulmonary system      
Solitary pulmonary nodule Tumour imaging 18F fluorodeoxyglucose Marker of glucose metabolism
Occult lung disease (alveolitis) Alveolar permeability study 99mTc DPTA aerosol Passage across alveolar membrane into blood
6. Gastrointestinal system      
Difficulty in swallowing Oesophageal transit and reflux 99mTc sulphur colloid Transit of labelled material
Gastrointestinal haemorrhage GI bleed study 99mTc sulphur colloid Blood pool label extravasating into bowel
 
      99mTc labelled red cells  
Ectopic gastric mucosa Meckel's diverticulum scintigraphy 99mTc pertechnetate Active uptake by ectopic gastric mucosa
Diarrhoea (inflammatory bowel disease) White cell scintigraphy 99mTc leucocytes Leucocyte migration
Vomiting (gastroparesis)     99mTc sulphur colloid in egg (solid phase)  
    Gastric emptying study   Compartmental localization of labelled material
Dumping     111In DTPA in orange juice (liquid phase)  
Focal liver lesion (haemangioma) Red blood cell study 99mTc labelled red blood cells Red cell pooling
Cholecystitis  
 
     
Biliary dyskinesia      
  Hepatobiliary study 99mTc iminodiacetic acid derivatives Uptake by hepatocytes and excretion into bile
Biliary atresia      
Bile leak (post-op)      
Abdominal sepsis     99mTc or 111In leucocytes Leucocyte migration
  White cell or gallium scintigraphy    
Pyrexia of unknown origin   67Ga gallium citrate Binds to transferrin and leaks into extravascular space
Ectopic splenic tissue Splenic scintigraphy Heat damaged 99mTc labelled red blood cells Splenic trapping of damaged cells
7. Urological, adrenal and genitourinary systems
Hypertension (renovascular disease) Captopril renography 99mTc MAG3 Captopril-induced change in renal transit time and/or function
Renal tract obstruction Diuresis renography 99mTc DTPA Glomerular filtration
      99mTc MAG3 Proximal tubular secretion
Renal scarring Static renal scintigraphy 99mTc DMSA Glomerular filtration and proximal tubular uptake
Vesicoureteric reflux Indirect micturating cystogram 99mTc MAG3 Compartmental localization
Adrenal medullary tumour Adrenal study 123I MIBG Uptake by noradrenaline transporter
Adrenal cortical tumour Adrenal study 123I iodocholesterol Incorporation into hormone metabolism
8. Cancer
Space occupying lesion in brain (SOL) Tumour imaging 201Tl (thallous chloride) K+ analogue indicating perfusion
      18F fluorodeoxyglucose Marker of glucose metabolism
Thyroid cancer Whole body iodine scintigram 131I sodium iodide Uptake by Na/I transporter
Skeletal metastases Bone scintigraphy 99mTc polyphosphate Osteoblastic response
Soft tissue mass (sarcoma) Tumour imaging 201Tl (thallous chloride) K+ analogue indicating perfusion
      18F fluorodeoxyglucose Marker of glucose metabolism
Tumour staging
 
     
Tumour recurrence Tumour imaging 18F fluorodeoxyglucose Tumour glucose metabolism
Tumour response assessment      
Insulinoma
 
Somatostatin receptor study 111In pentetreotide (Octreotide®) Binds to somatostatin receptors
Carcinoid tumour      
Neuroblastoma MIBG scintigram 123I MIBG Uptake by noradrenaline transporter
Tumour hypoxia Hypoxia imaging 18F fluoromisonidazole Trapped in hypoxic cells
Sentinel node detection Lymphoscintigraphy 99mTc nanocolloid Lymphatic uptake and trapping




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