Contents
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Part¢ñ¡¡Basic Principles
Chapter 1 Physics of Nuclear Medicine ........................................................................................................................ 3 RADIoACTIvITY AND RADIoACTIvE DECAY ............................................................................................................. 3 INTERACTIoNS BETWEEN RADIATIoN AND MATTER ............................................................................................ 7 SUGGESTED READING ....................................................................................................................................................... 12
Chapter 2 Radiopharmaceuticals .................................................................................................................................. 13
ElEMENTS, RADIoNUClIDES, AND RADIoPHARMACEUTICAlS ...................................................................... 13 PRoDUCTIoN oF RADIoNUClIDES .............................................................................................................................. 14 RADIoNUClIDE GENERAToRS ...................................................................................................................................... 15 TECHNETIUM CHEMISTRY AND RADIoPHARMACEUTICAl PREPARATIoN ................................................ 16 QUAlITY ASSURANCE oF TECHNETIUM-99M¡ªlABElED RADIoPHARMACEUTICAlS ............................. 16 SINGlE-PHoToN RADIoPHARMACEUTICAlS oTHER THAN TC-99M .............................................................. 17 DUAl PHoToN RADIoPHARMACEUTICAlS FoR PoSITRoN EMISSIoN ToMoGRAPHY ........................... 18 DISPENSING RADIoPHARMACEUTICAlS ................................................................................................................... 18 SUGGESTED READING ....................................................................................................................................................... 19
Chapter 3 Radiation Detection and Instrumentation .......................................................................................... 20
CHARATERISTICS oF A RADIATIoN DETECToR ...................................................................................................... 20 TYPES oF RADIATIoN DETECToRS ............................................................................................................................... 21 ANCIllARY EQUIPMENT ................................................................................................................................................. 22 NUClEAR MEDICINE IMAGING ..................................................................................................................................... 23 SUMMARY ............................................................................................................................................................................. 27 SUGGESTED READING ....................................................................................................................................................... 28
Chapter 4 Single-Photon Emission Computed Tomography, Positron Emission Tomography, and Hybrid Imaging ...................................................................................................................................... 29 IMAGE RECoNSTRUCTIoN .............................................................................................................................................. 29 SINGlE-PHoToN EMISSIoN CoMPUTED ToMoGRAPHY ..................................................................................... 35 PoSITRoN EMISSIoN ToMoGRAPHY ........................................................................................................................... 35 HYBRID PoSITRoN EMISSIoN CoMPUTED ToMGRAPHY, SINGlEPHoToN CoMPUTED ToMoGRAPHY WITH CoMPUTED ToMoGRAPHY, AND PoSITRoN EMISSIoN ToMoGRAPHY WITH MAGNETIC RESoNANCE ................................................................................................................................. 36 SUGGESTED READING ....................................................................................................................................................... 37
Chapter 5 Molecular Imaging ......................................................................................................................................... 38
IMAGING TECHNIQUES .................................................................................................................................................... 38 BIoMARkERS ........................................................................................................................................................................ 39 REPoRTER GENE IMAGING AND GENE THERAPY ................................................................................................... 42 SUGGESTED READING ....................................................................................................................................................... 43
Part ¢ò¡¡Clinical Nuclear Medicine
Chapter 6 Central Nervous System .............................................................................................................................. 47 CEREBRAl ANAToMY ....................................................................................................................................................... 47 CEREBRAl BlooD FloW AND METABolISM ........................................................................................................... 48 ClINICAl APPlICATIoNS FoR CEREBRAl PERFUSIoN IMAGING ..................................................................... 51 MovEMENT DISoRDERS ................................................................................................................................................... 62 AMYloID IMAGING ........................................................................................................................................................... 63 CISTERNoGRAPHY ............................................................................................................................................................. 64 SUGGESTED READING ....................................................................................................................................................... 68
Chapter 7 Cardiac System ................................................................................................................................................ 69
MYoCARDIAl PERFUSIoN SCINTIGRAPHY ............................................................................................................... 69 PoSITRoN EMISSIoN ToMoGRAPHY oF THE HEART ............................................................................................ 97 RADIoNUClIDE vENTRICUloGRAPHY .................................................................................................................... 104 MYoCARDIAl INFARCT AND AMYloIDoSIS IMAGING ...................................................................................... 111 SUGGESTED READING ..................................................................................................................................................... 111
Chapter 8 Endocrine System ......................................................................................................................................... 113 THYRoID SCINTIGRAPHY AND UPTAkE STUDIES ................................................................................................. 113 PARATHYRoID SCINTIGRAPHY ................................................................................................................................... 121 SUGGESTED READING ..................................................................................................................................................... 124
Chapter 9 Oncology: Positron Emission Tomography ...................................................................................... 125
BACkGRoUND ................................................................................................................................................................... 125 IMAGE INTERPRETATIoN .............................................................................................................................................. 127 ClINICAl USES oF PoSITRoN EMISSIoN ToMoGRAPHY IN oNColoGY .................................................... 134 SUGGESTED READING ..................................................................................................................................................... 151
Chapter 10 Oncology: Non¨CPositron Emission Tomography ........................................................................ 152
PEPTIDE RECEPToR IMAGING ...................................................................................................................................... 152 ADRENAl SCINTIGRAPHY ............................................................................................................................................. 154 MoNoCloNAl ANTIBoDY IMAGING AND THERAPY ......................................................................................... 156 NoNSPECIFIC BINDING TUMoR AGENTS ................................................................................................................. 160 lYMPHoSCINTIGRAPHY: THE SENTINEl lYMPH NoDE .................................................................................... 162 INTRAARTERIAl RADIoACTIvE MICRoSPHERES .................................................................................................. 164 BoNE PAIN PAllIATIoN ................................................................................................................................................ 165 SUGGESTED READING ..................................................................................................................................................... 167
Chapter 11 Skeletal Scintigraphy ................................................................................................................................ 169
BoNE SCAN ......................................................................................................................................................................... 169 ClINICAl APPlICATIoN oF SkElETAl SCINTIGRAPHY ..................................................................................... 176
BoNE INFARCTIoN AND oSTEoNECRoSIS .............................................................................................................. 191 oSTEoMYElITIS ................................................................................................................................................................. 193 FloURINE-18 SoDIUM FlUoRIDE PoSITRoN EMISSIoN ToMoGRAPHY ....................................................... 196 BoNE MINERAl MEASUREMENT ................................................................................................................................ 197 SUGGESTED READING ..................................................................................................................................................... 198
Chapter 12 Pulmonary System ..................................................................................................................................... 199
PUlMoNARY EMBolISM ............................................................................................................................................... 199 vENTIlATIoN PERFUSIoN SCINTIGRAPHY ............................................................................................................. 199 RADIoPHARMACEUTICAlS .......................................................................................................................................... 200 IMAGE INTERPRETATIoN .............................................................................................................................................. 203 vENTIlATIoN-PERFUSIoN INTERPRETATIoN CRITERIA .................................................................................... 207 oTHER ADDITIoNAl v/Q INTERPRETATIoN CRITERIA ..................................................................................... 212 SUGGESTED READING ..................................................................................................................................................... 212
Chapter 13 Infection and Inflammation ................................................................................................................... 213
RADIoPHARMACEUTICAlS .......................................................................................................................................... 213 ClINICAl APPlICATIoNS FoR INFECTIoN SCINTIGRAPHY .............................................................................. 218 SUGGESTED READING ..................................................................................................................................................... 226
Chapter 14 Gastrointestinal System ........................................................................................................................... 227
ESoPHAGEAl MoTIlITY ................................................................................................................................................ 227 GASTRoESoPHAGEAl REFlUX DISEASE .................................................................................................................. 230 GASTRIC MoTIlITY SCINTIGRAPHY ........................................................................................................................... 231 INTESTINAl TRANSIT SCINTIGRAPHY ...................................................................................................................... 237 PRoTEIN-loSING ENTERoPATHY ............................................................................................................................... 239 HElICoBACTER PYloRI INFECTIoN .......................................................................................................................... 239 GASTRoINTESTINAl BlEEDING .................................................................................................................................. 239 HETERoToPIC GASTRIC MUCoSA .............................................................................................................................. 245 SUGGESTED READING ..................................................................................................................................................... 248
Chapter 15 Hepatobiliary System ............................................................................................................................... 249
CHolESCINTIGRAPHY .................................................................................................................................................... 249 TECHNETIUM-99M RED BlooD CEll lIvER SCINTIGRAPHY ............................................................................ 267 TECHNETIUM-99M SUlFUR ColloID lIvER AND SPlEEN IMAGING ............................................................ 270 SPlEEN SCINTIGRAPHY .................................................................................................................................................. 272 TECHNETIUM-99M MACRoAGGREGATED AlBUMIN HEPATIC ARTERIAl PERFUSIoN
SCINTIGRAPHY ............................................................................................................................................................. 274 SUGGESTED READING ..................................................................................................................................................... 275
Chapter 16 Genitourinary System .............................................................................................................................. 277
RENAl ANAToMY AND FUNCTIoN ........................................................................................................................... 277 RENAl RADIoPHARMACEUTICAlS ........................................................................................................................... 278 DYNAMIC RENAl IMAGING TECHNIQUES .............................................................................................................. 283 MEASURING RENAl FUNCTIoN:EFFECTIvE RENAl PlASMA FloW(ERPF)AND GloMERUlAR
FIlTRATIoN RATE (GFR) ............................................................................................................................................ 292 RENAl CoRTICAl IMAGING ......................................................................................................................................... 292
SUGGESTED READING ..................................................................................................................................................... 294
Part ¢ó¡¡Radionuclide Therapy Chapter 17 Nuclear Medicine Therapy .................................................................................................................... 297
RADIoIoDINE THEARPY FoR HYPERTHYRoIDISM ............................................................................................... 297 MANAGEMENT oF HYPERTHYRoIDISM DUE To ToXIC MUlTINoDUlAR GoITER AND ToXIC ADENoMA ...................................................................................................................................................................... 300 MANAGEMENT oF GD IN CHIlDREN AND ADolESCENTS ............................................................................... 301 CANCER RISk AND RADIATIoN SAFETY REGARDING RADIoIoDINE THEARPY FoR HYPERTHYRoIDISM .................................................................................................................................................... 301 RADIoIoDINE THERAPY FoR THYRoID CANCER ................................................................................................. 302 METASTATIC BoNE PAIN THERAPY ........................................................................................................................... 309 SUGGESTED READING ..................................................................................................................................................... 311
