Nuclear medicine in general practice Dr Reza Garzan MD, FRACP, - - PowerPoint PPT Presentation

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Nuclear medicine in general practice Dr Reza Garzan MD, FRACP, - - PowerPoint PPT Presentation

Nov 30, 2023 968 likes •1.71k views

Nuclear medicine in general practice Dr Reza Garzan MD, FRACP, FAANMS Myocardial perfusion study Bone scans in general practice Thyroid scans in general practice Gamma camera Detection of gamma rays Myocardial perfusion Imaging How

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Nuclear medicine in general practice

Dr Reza Garzan MD, FRACP, FAANMS

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  • Myocardial perfusion study
  • Bone scans in general practice
  • Thyroid scans in general practice
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Gamma camera

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Detection of gamma rays

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Myocardial perfusion Imaging

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How is it performed?

Rest/Stress protocol : Radiopharmaceutical injected at rest and then post stress. Same day or two day protocol

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Radiopharmaceuticals

Tc-99m Sestamibi (MIBI)

  • Sestamibi (MIBI) : Lipophilic agent, diffuses from blood

into the myocardial cell and is retained in mitochondria

  • Tc-99m : Short physical half life of 6hrs , good energy

gamma rays ( better quality pictures)

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Radiopharmaceuticals

Thallium (TI-201):

  • Behaves physiologically much like K ion, and is transported

across the myocardial cell membrane via Na-K ATPase

  • Long half life and low energy photons, so much less commonly

used nowadays

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Modes of stress

  • Exercise
  • Pharmacologic
  • Vasodilator ( Adenosine, Dipyridamole) :

Dilate the coronary arteries, but the stenosed vessels are not able to dilate as much as normal coronary arteries are able to. Contraindicated in asthma and severe COPD.

  • Dobutamine : Sympathomimetic
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ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging

J Am Coll Cardiol. 2009;53(23):2201-2229. doi:10.1016/j.jacc.2009.02.013

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Ischemic cascade

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What information do we get from MPS?

  • Perfusion (rest and stress)
  • Wall motion (rest and stress), systolic

function, LVEF

  • Symptoms
  • If exercise, exercise capacity
  • ECG changes
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Cardiac planes

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  • 67-year-old-man, with episodes of chest pain

at rest

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  • 74- year-old, with DM and exertional chest

and throat pain, unable to complete exercise stress test

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  • Moderate to large amount of reversible

ischemia in LAD territory

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Small MI in distal LAD territory

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Prognostic value of normal ( low -risk) and moderately to severely abnormal (high-risk) myocardial perfusion SPECT in estimating annual rates of cardiac death and nonfatal myocardial infarction

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  • Bone Scans
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  • Radiotracer injected, ( Tc-99m HDP)
  • Early phase images immediately ( presence or

absence of hyperaemia/normal or abnormal vascularity)

  • Delayed phase images in about 3-4 hrs (
  • steoblastic activity)
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Common applications of bone scans in general practice

  • Stress fractures
  • Sports injuries
  • Suspected fractures with normal x-ray
  • Arthritis/assessment of facet joint arthropathy
  • Osteomyelitis
  • Staging and restaging of prostate, breast and

lung cancers

  • Metabolic bone disease e.g. Paget’s disease
  • Assessment of painful THR and TKR
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Normal whole body bone scan

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Case 1

  • 50 year old female, pain in bilateral hands ,

history of fall 4 days back on outstretched

  • hands. Xray : normal
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Blood flow and blood pool images

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Delayed images

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SPECT/CT

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  • Fracture of bilateral trapezium
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  • 76 year-old female, active walker, pain in

the left foot since 3/52, ? Stress Fx

Case 2

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Blood flow and blood pool images

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Blood pool images

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SPECT/CT

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  • Active arthritis of tarsometatarsal joint
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  • 85-year-old female, Chronic ulcer in the

left foot, close to 1st MTP joint.

Case 3

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Blood pool images

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Delayed images

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SPECT/CT

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  • Osteomyelitis of the distal left 1st

metatarsal bone

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  • 47 -year-old male, right 2nd metatarsal

pain after a long walk

Case 4

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Blood flow and blood pool images

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Delayed images

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SPECT/CT

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  • Stress fracture of distal right 2nd

metatarsal

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  • 52 year old female, with back pain for

investigation

Case 5

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Delayed SPECT/CT images

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  • Intensely increased radiotracer uptake in

the left L5/S1 facet joint, consistent with left L5/S1 facet joint arthropathy

  • Can be useful for investigation of cervical

facet joint arthropathy too.

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Case 6

  • 68-year-old man with right foot and heel pain

after long walk.

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  • Right Achilles tendon enthesopathy
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Thyroid scans

  • Thyrotoxicosis
  • Assessment of thyroid nodules
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Radiopharmaceutical : Tc-99m Pertechnatate ( TcO4)

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  • 69 year-old man presenting with

thyrotoxicosis

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  • Hot autonomous functioning nodule
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  • 65 year-old female, presenting with

thyrotoxicosis

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  • Graves’ disease
  • Positive TSH receptor antibodies can confirm

the diagnosis

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  • 30-year-old female presenting with post-

partum hyperthyroidism

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Thank you!