nuclear medicine in general practice

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

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

  1. Nuclear medicine in general practice Dr Reza Garzan MD, FRACP, FAANMS

  2. • Myocardial perfusion study • Bone scans in general practice • Thyroid scans in general practice

  3. Gamma camera

  4. Detection of gamma rays

  5. Myocardial perfusion Imaging

  6. How is it performed? Rest/Stress protocol : Radiopharmaceutical injected at rest and then post stress. Same day or two day protocol

  7. 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)

  8. 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

  9. 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

  10. 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

  11. Ischemic cascade

  12. 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

  13. Cardiac planes

  14. • 67-year-old-man, with episodes of chest pain at rest

  15. • 74- year-old, with DM and exertional chest and throat pain, unable to complete exercise stress test

  16. • Moderate to large amount of reversible ischemia in LAD territory

  17. Small MI in distal LAD territory

  18. 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

  19. • Bone Scans

  20. • 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 ( osteoblastic activity)

  21. 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

  22. Normal whole body bone scan

  23. Case 1 • 50 year old female, pain in bilateral hands , history of fall 4 days back on outstretched hands. Xray : normal

  24. Blood flow and blood pool images

  25. Delayed images

  26. SPECT/CT

  27. • Fracture of bilateral trapezium

  28. Case 2 • 76 year-old female, active walker, pain in the left foot since 3/52, ? Stress Fx

  29. Blood flow and blood pool images

  30. Blood pool images

  31. SPECT/CT

  32. • Active arthritis of tarsometatarsal joint

  33. Case 3 • 85-year-old female, Chronic ulcer in the left foot, close to 1 st MTP joint.

  34. Blood pool images

  35. Delayed images

  36. SPECT/CT

  37. • Osteomyelitis of the distal left 1 st metatarsal bone

  38. Case 4 • 47 -year-old male, right 2 nd metatarsal pain after a long walk

  39. Blood flow and blood pool images

  40. Delayed images

  41. SPECT/CT

  42. • Stress fracture of distal right 2 nd metatarsal

  43. Case 5 • 52 year old female, with back pain for investigation

  44. Delayed SPECT/CT images

  45. • 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.

  46. Case 6 • 68-year-old man with right foot and heel pain after long walk.

  47. • Right Achilles tendon enthesopathy

  48. Thyroid scans • Thyrotoxicosis • Assessment of thyroid nodules

  49. Radiopharmaceutical : Tc-99m Pertechnatate ( TcO4)

  50. • 69 year-old man presenting with thyrotoxicosis

  51. • Hot autonomous functioning nodule

  52. • 65 year-old female, presenting with thyrotoxicosis

  53. • Graves’ disease • Positive TSH receptor antibodies can confirm the diagnosis

  54. • 30-year-old female presenting with post- partum hyperthyroidism

  55. Thank you!


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