Indications for Nuclear Medicine Studies

Neuro  |  Cardiac  |  GU  |  GI  |  Pulmonary  |  Endocrine  |  Detection of Infection  |  Skeletal  |  Tumor Detection  |  Miscellaneous  |  THERAPEUTIC PROCEDURES

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Neuro-Nuclear Medicine:

CEREBRAL RADIONUCLIDE ANGIOGRAM AND BRAIN SCAN (PLANAR)
  1. Confirmatory evidence of brain death
  2. Evaluation of meningitis, encephalitis, and other intracranial infections; follow up of response to therapy.
  3. Detection of brain tumors, abscesses, and strokes when computed tomography and magnetic resonance imaging are not available.

CEREBRAL PERFUSION SPECT SCAN
  1. Diagnosis and conformation of Alzheimer's disease and other forms of dementia.
  2. Localization of electrical and nonelectrical seizure foci.
  3. Evaluation of location, size, and prognosis of cerebral ischemia and stroke patients.
  4. Evaluation of AIDS dementia.
  5. Changing brain perfusion during various types of interventions.
  6. Evaluation of brain injury.
  7. Evaluation of patients with psychiatric and mood disorders.
  8. Detection and localization of recurrent brain tumor (Tc-99m and Tl-201agents).
  9. Localization of Speech center
  10. Diagnosis of brain death.

RADIONUCLIDE CISTERNOGRAPHY
  1. Diagnosis of normal pressure hydrocephalus.
  2. Identification of cerebrospinal fluid (CSF) leaks.

Cardiac Nuclear Medicine:

MYOCARDIAL PERFUSION IMAGING

This study can be done with exercise stress and delayed (resting) views, at rest only, or with drug-simulated stress (dipyridamole = DPM, adenosine = ADN) in those unable to perform treadmill exercise for the assessment of myocardial perfusion in a variety of clinical settings:

  1. Suspected coronary artery disease (CAD) in patients with an abnormal ECG.
  2. Suspected CAD in asymptomatic patients with positive exercise ECG.
  3. Suspected myocardial infarction (Resting Thallium).
  4. Thallium-201 DPM/ADN study: for evaluation of myocardial perfusion in patients unable to exercise.
  5. In others requiring assessment of coronary perfusion (pre-op evaluation, evaluation of viability for by-pass, etc.).
  6. Unexplained chest pain.
  7. Detection of viable myocardial tissues.

EQUILIBRIUM GATED BLOOD POOL STUDY
  1. Assessment of cardiac function:
    1. Left Ventricular ejection fraction (LVEF).
    2. Right Ventricular ejection fraction (RVEF).
    3. Chamber size.
    4. Sequence of chamber contraction.
    5. Chamber wall motion, including detection of akinetic and dyskinetic segments.
  2. Detection of ventricular aneurysm.
  3. Prospective evaluation prior to cardiac medications or drugs known to affect myocardial function (i.e. Adriamycin). Follow-up post-treatment.
  4. Quantification of left-to-right intracardiac shunt (only with first pass technique).
  5. Measurement of diastolic dysfunction.
  6. Evaluation of valvular disease

MYOCARDIAL INFARCT SCAN
  1. Detect myocardial damage when enzyme determination and the electrocardiogram are inconclusive.
  2. To differentiate acute from old infarction.
  3. Localize and estimate the size of myocardial infarcts and contusions.
  4. Peri-operative infarct detection.

GU Nuclear Medicine:

DYNAMIC RADIONUCLIDE RENAL STUDY
  1. Evaluation of renal perfusion and function.
  2. Evaluation of renal trauma.
  3. Diagnosis of renovascular hypertension.
  4. Detection and evaluation of renal collecting system obstruction.
  5. Diagnosis of acute tubular necrosis.
  6. Renal evaluation in those with allergy to radiographic contrast.
  7. Evaluation of renal transplant patients

RADIONUCLIDE CYSTOGRAM
  1. Evaluation of ureterovesical reflux.
  2. Urinary bladder residual volume.

TESTICULAR SCAN
  1. Used to differentiate acute testicular torsion from other causes of testicular pain/swelling.
  2. Differentiate epididymitis from torsion.
  3. Evaluate scrotal mass.

GI Nuclear Medicine:

LIVER - SPLEEN SCAN
  1. Evaluation of size, shape, and position of liver and spleen.
  2. Detection of space-occupying lesions: abscesses, cysts, and primary tumors.
  3. Evaluation of hepatic metastasis (pre and post-therapy).
  4. Evaluation of diffuse hepatic disease such as cirrhosis or hepatitis.
  5. Evaluation of patients with suspected liver or spleen rupture or hematoma.
  6. Detection of accessory splenic tissue or asplenia.
  7. Patients unable to undergo CT or MRI.
  8. Diagnosis of focal nodular hyperplasia.

GASTROESOPHAGEAL REFLUX
  1. Detection and quantitation of gastro-esophageal reflux
  2. Suspected aspiration pneumonia.

GASTROINTESTINAL BLEEDING STUDY

Detection of active gastrointestinal and non-gastrointestinal bleeding sites Localization provides approximatelocation only. Although detection of gastric bleeding has been reported, this study is mainly limited to bleeding beyond the ligament of Treitz and is most sensitive for lower GI bleeding.

HEPATOBILIARY STUDY
  1. Diagnosis of acute cholecystitis.
  2. Evaluation of patency of hepatobiliary system.
  3. Biliary leaks: Post-op evaluation.
  4. Detection of biliary reflux.
  5. Diagnosis of biliary atresia and other congenital anomalies of the biliary tract.
  6. Evaluation of transplanted livers.

ESOPHAGEAL TRANSIT STUDY

Evaluate and quantitate esophageal motility.

GASTRIC EMPTYING

Diagnosis of functional gastric obstruction/dysmotility.

MECKEL'S SCAN
  1. Detection and localization of a Meckels diverticulum containing functioning (bleeding) gastric mucosa.
  2. Detection of Barrett's esophagus

Pulmonary Nuclear Medicine:

LUNG SCAN - PERFUSION
  1. Diagnosis of pulmonary embolism.
  2. Evaluation of regional pulmonary perfusion.
  3. Evaluation of pulmonary perfusion after treatment with anticoagulants.
  4. Pre-op evaluation of lung function for thoracotomy. In this case, the study should be ordered as quantitative.
  5. Assessment of congenital pulmonary abnormalities and cardiac shunts.
  6. Evaluation of regional function in acquired pulmonary disease (COPD, asthma, carcinoma, etc.).
  7. In the work-up for primary pulmonary hypertension

LUNG SCAN - VENTILATION
  1. Improve in the diagnose of suspected pulmonary embolism (P.E.).
  2. Evaluation of obstructive lung disease.
  3. Evaluation of regional ventilatory function.
  4. Pre-operative evaluation. This should be ordered as quantitative study.
  5. Follow-up post therapy for P.E.

Endocrine Nuclear Medicine:

THYROID SCAN
  1. Determination of thyroid size, function, and position.
  2. Evaluation of functional status of thyroid nodules.
  3. Evaluation of thyroid and neck masses.
  4. Evaluation of patients with history of head and neck irradiation.
  5. Quantitative thyroid uptake (I-131 uptake).
  6. Detection of ectopic thyroid tissues such as substernal or sublingual locations of thyroid tissue (I-123).
  7. Treatment for hyperthyroidism, neoplasm (I-131).
  8. Detection of thyroid metastases and assessment of response to therapy (I-131).

PARATHYROID SCAN

Detect and localize hyperfunctioning parathyroid adenomas.

NEUROECTODERMAL/NOREPINEPHRINE STUDY

I-131-MIBG

Identification and localization of tumors of neuroectodermal tissues:

  1. Benign and malignant pheochromocytomas.
  2. Neuroblastomas.
  3. Carcinoid tumors.
  4. Medullary thyroid tumors.
  5. Paragangliomas.
  6. Chemodectomas.

SOMATOSTATIN RECEPTOR IMAGE

OctreoScan

Functional imaging, detection, follow-up and monitoring tumors that contain somatostatin receptors such as carcinoids, islet cell tumors, small cell lung tumors, CNS (neuroendocrine tumors) and some thyroid carcinomas.

Radionuclide Detection of Infection:

GALLIUM SCAN
  1. Detection, localization, and follow-up of infection (sepsis with or without localized signs/symptoms, and FUOs).
  2. Detection and localization of tumors (staging and follow-up of the following:
  3. Lymphoreticular neoplasms (esp. Hodgkin's, histiocytic lymphoma).
    1. Bronchogenic Ca.
    2. Hepatocellular Ca.
    3. Testicular Ca.
    4. Malignant melanoma.
  4. Evaluation of interstitial and chronic lung disease as well as sarcoid.
  5. Evaluation of patients with acquired immunodeficiency syndrome (AIDS).
  6. Evaluation of extent and/or effect of therapy in granulomatous (e.g., sarcoidosis).

LABELED WBC STUDY
  1. Evaluation of inflammatory bowel disease.
  2. Detection of abscess or acute (<4-6 weeks) infection.
  3. Fever of unknown origin.
  4. Acute osteomyelitis (particularly useful in diabetics).
  5. Prosthesis infection, graft infections.

Skeletal Nuclear Medicine:

BONE SCAN
  1. Screen for bone metastases in patients with known or suspected cancer.
  2. Infection (Osteomyelitis vs. cellulitis).
  3. Evaluation of suspected fracture, including stress fractures.
  4. To help determine age and metabolic activity in areas of aseptic necrosis and trauma.
  5. Evaluate response to therapy, chemotherapy or radiation treatment for cancer.
  6. Evaluation of prosthesis for loosening or infection.
  7. Location of biopsy site.
  8. Planning of radiation portals.
  9. Evaluation of nonspecific bone pain.
  10. Evaluation of nonspecific, abnormal roentgenographic appearance of bone.
  11. Metabolic bone disease
  12. Confirm the diagnosis of RSD

BONE MARROW SCAN
  1. Evaluation of regional bone marrow abnormalities in general.
  2. To identify marrow replacement by tumor.
  3. To define marrow distribution.
  4. To locate sites for biopsy.
  5. Assessment of suspected area of avascular necrosis.
  6. Diagnosis of osteomyelitis in conjunction with Labeled white blood cell imaging.

Tumor Detection in Nuclear Medicine:

LYMPHOANGIOSCINTIGRAPHY

(ALSO SEE GALLIUM IMAGING FOR IMAGING TUMORS)

Evaluation of primary and secondary lymph channels in patients with malignant melanoma and breast cancer.

GALLIUM SCAN
  1. Detection, localization, and follow-up of infection (sepsis with or without localized signs/symptoms, and FUOs).
  2. Detection and localization of tumors (staging and follow-up of the following:
  3. Lymphoreticular neoplasms (esp. Hodgkin's, histiocytic lymphoma).
    1. Bronchogenic Ca.
    2. Hepatocellular Ca.
    3. Testicular Ca.
    4. Malignant melanoma.
  4. Evaluation of interstitial and chronic lung disease as well as sarcoid.
  5. Evaluation of patients with acquired immunodeficiency syndrome (AIDS).
  6. Evaluation of extent and/or effect of therapy in granulomatous (e.g., sarcoidosis).

MONOCLONAL ANTIBODY TUMOR IMAGING STUDIES

Radiolabeled monoclonal antibodies (MoAbs) can be used for imaging of a number of different cancers. Several different procedures are available through the Section of Nuclear Medicine. Call the Section at 6-3966 for a consultation as to patient eligibility for a monoclonal antibody imaging study. APPROVED AGENTS:

  1. Detection of extrahepatic sites of primary and/or recurrent colorectal and ovarian cancer. Note that Tc-99m Anti-CEA is not approved for the detection of recurrent ovarian cancer. Positive antibody scans add important diagnostic information to that supplied by other imaging modalities.
  2. Certain subsets of colon cancer patients have been shown to benefit particularly from antibody imaging. For patients with one to three well-localized hepatic metastasis, RIS is the only method to detect evidence of spread in the extra hepatic abdomen. The second set of colon cancer patients who may benefit from an antibody study are the 16% to 25% of patients with primary colorectal cancer who have synchronous lesions at initial laparotomy.
  3. Women with suspected recurrent ovarian cancer.

Miscellaneous:

SHUNT PATENCY STUDY INDICATION

 Evaluation of ventriculoatrial or ventriculoperitoneal shunt patency.

RADIONUCLIDE VENOGRAM
  1. Evaluation of upper extremity central venous vein patency.
  2. Evaluation for deep venous thrombosis in patients in whom radiographic contrast material is contraindicated.
  3. Detection of embolic source in patients with recurrent pulmonary embolism.
  4. Patency study for IVC umbrella.
  5. Evaluation of possible superior vena cava (SVC) syndrome.

SCHILLING'S TEST
  1. Evaluation of patients with low serum Vitamin B12 levels.
  2. Diagnosis of pernicious anemia.
  3. Evaluation of small intestinal malabsorption.

RED CELL VOLUME MEASUREMENT

Diagnosis of polycythemia vera.

THERAPEUTIC PROCEDURES:

POLYCYTHEMIA VERA
  1. Erythrocytosis uncontrollable by phlebotomy alone.
  2. Excessive thrombocytosis with platelet counts approaching one million.
  3. Extramedullary hematopoiesis with painful spleen, hypersplenism, abdominal pain, or splenic infarct.
  4. Persistent symptoms such as pruritus or hyperuricemia not controlled by phlebotomies, allopurinol, or antihistamines.
  5. Cardiovascular problems contraindicating frequent phlebotomies.

STRONTIUM THERAPY FOR OSSEOUS METASTASES
  1. Palliation of painful multiple osseous metastases resistant to chemotherapy, hormonal therapy. and/or analgesics.
  2. Treatment of painful bone metastases in conjunction with, or instead of radiotherapy or chemotherapy.

I-131 THERAPY FOR THYROID CANCER
  1. Treatment of residual functioning thyroid cancer.
  2. Ablation of residual normal thyroid tissue post subtotal thyroidectomy in certain groups of patients.

I-131 THERAPY FOR PRIMARY HYPERTHYROIDISM
  1. Treatment of primary hyperthyroidism (Graves disease).
  2. Treatment of hyperthyroidism secondary to autonomous functioning nodule(s).