A Concise Guide to Nuclear Medicine

162 Pages·2020·8.975 MB·English

by  Abdelhamid H. Elgazzar, Saud Alenezi

A Concise Guide to
NNNNuuuucccclllleeeeaaaarrrr MMMMeeeeddddiiiicccciiiinnnneeee
Abdelhamid H. Elgazzar
Saud Alenezi
Second Edition
123
A Concise Guide to Nuclear Medicine
Abdelhamid H. Elgazzar • Saud Alenezi
A Concise Guide
to Nuclear Medicine
Second Edition
Abdelhamid H. Elgazzar Saud Alenezi
Department of Nuclear Medicine Department of Nuclear Medicine
Kuwait University Kuwait University
Safat Safat
Kuwait Kuwait
ISBN 978-3-030-26063-7 ISBN 978-3-030-26064-4 (eBook)
https://doi.org/10.1007/978-3-030-26064-4
© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface to Second Edition
With high admiration and respect, we remember Professor Henry Wagner who
wrote the foreword to the first edition of this concise book. He passed away after
leaving a wealth of knowledge and contribution for the field of Nuclear Medicine.
The second edition of this book continues to provide a simple presentation for
the principles of nuclear medicine and molecular imaging. It includes updates in the
areas of imaging as well as in therapeutic applications of nuclear medicine. It pro-
vides essential information for young professionals in the field including physicians
and technologists. It has also been simplified to be a quick reference for the refer-
ring physicians. Furthermore, it should be valuable for medical students who are
being prepared for personalized medicine.
The book starts with a chapter on basic principles familiarizing the reader with
the basis of nuclear medicine, its scope, and applications. The remaining chapters
deal with updated uses and value of the clinical applications of nuclear medicine
in different systems in correlation with other imaging modalities. The last chapter
is dedicated to the current therapeutic uses of radionuclides, which has been
expanded further since the first edition, particularly in the area of Theranostics,
which has revolutionized therapy in certain clinical areas such as in the treatment
of prostate cancer.
We hope that this edition will benefit medical students, referring physicians,
young nuclear medicine physicians, radiologists, and nuclear medicine and radiol-
ogy technologists for whom it is essential to acquire enough knowledge not only in
techniques but also in clinical applications to help provide better outcome of each
diagnostic and therapeutic procedure.
Safat, Kuwait Abdelhamid H. Elgazzar
Safat, Kuwait Saud A. Alenezi
May 10, 2019
v
Acknowledgement
Our thanks and gratitude goes to all who supported and helped in updating this
book to produce its second edition, particularly, Dr. Khalid Khalafallah. Our thanks
is also extended to Mrs. Reham Haji, Dr. Esraa Elkasby, Mrs. Heba Issam,
Miss Aseel Alkandary, Miss Samar Almutairy, Dr. Shorouk Dannon, Dr. Naheel
Alnafisi, Prof. Abdullatif Albader, Dr. Salwa Shams and Mrs. Reem Alsalem for
their help and support through the preparation.
vii
Contents
1 Basic Principles of Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Nuclear Medicine and Molecular Imaging . . . . . . . . . . . . . . . . . . . . 1
1.2 Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Scientific Basis of Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3.1 Atomic Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3.2 Isotopes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3.3 Radioactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3.4 Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.4 Technical Principles of Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . 7
1.5 Scope of Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5.1 Diagnostic Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5.2 Therapeutic Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . 10
1.6 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2 Nuclear Medicine in the Genitourinary System . . . . . . . . . . . . . . . . . . . 13
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.2 Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.3 Dynamic Renal Scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.3.1 Imaging Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.3.2 Renovascular Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.3.3 Urinary Tract Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.3.4 Evaluation of Renal Transplant Complications . . . . . . . . . . . 18
2.4 Cortical Renal Scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.4.1 Imaging Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.4.2 Urinary Tract Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.5 Vesicoureteral Reflux Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.6 Testicular Imaging Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.7 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3 Nuclear Medicine in the Digestive System . . . . . . . . . . . . . . . . . . . . . . . 31
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.2 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.3 Evaluation of Esophageal Transit Time . . . . . . . . . . . . . . . . . . . . . . . 31
ix
x Contents
3.4 Detection of Gastroesophageal Reflux . . . . . . . . . . . . . . . . . . . . . . . . 32
3.5 Evaluation of Gastric Emptying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.6 Lower Gastrointestinal Bleeding Localization . . . . . . . . . . . . . . . . . 35
3.7 Diagnosis of Meckel’s Diverticulum . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.8 Diagnosis and Follow-Up of Inflammatory Bowel Disease . . . . . . . 37
3.9 Diagnosis of Hepatic Hemangioma . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.10 Diagnosis of Hepatobiliary Diseases . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.10.1 Diagnosis of Acute Cholecystitis . . . . . . . . . . . . . . . . . . . . . . 40
3.10.2 Diagnosis of Common Bile Duct Obstruction . . . . . . . . . . . . 41
3.10.3 Evaluation of Neonatal Hyperbilirubinemia . . . . . . . . . . . . . 42
3.10.4 Diagnosis of Hypokinesis Syndrome . . . . . . . . . . . . . . . . . . . 42
3.10.5 Evaluation of Complications After Hepatobiliary
Surgery and Liver Transplantation . . . . . . . . . . . . . . . . . . . . . 42
3.11 Protein Loss Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
3.12 Scintigraphic Nonimaging Procedures . . . . . . . . . . . . . . . . . . . . . . . 46
3.12.1 Carbon-14 Breath Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3.13 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4 Nuclear Medicine in the Endocrine System . . . . . . . . . . . . . . . . . . . . . . 49
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.2 Thyroid Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.2.1 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.2.2 Thyroid Imaging Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
4.2.3 Thyroid Uptake Measurement . . . . . . . . . . . . . . . . . . . . . . . . 53
4.3 Parathyroid Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
4.3.1 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
4.3.2 Preoperative Parathyroid Localization . . . . . . . . . . . . . . . . . . 59
4.3.3 Intraoperative Parathyroid Localization . . . . . . . . . . . . . . . . . 61
4.4 Adrenal Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.4.1 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.4.2 Adrenal Cortex Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.4.3 Adrenal Medulla Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
5 Nuclear Medicine in Soft-Tissue Infection and Inflammation . . . . . . . 67
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
5.2 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
5.3 Diagnosis of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
5.4 Imaging of Soft-Tissue Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
5.4.1 Localizing Signs Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
5.4.2 No Localizing Signs Present . . . . . . . . . . . . . . . . . . . . . . . . . 74
5.5 Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
5.6 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Contents xi
6 Nuclear Medicine in the Respiratory System . . . . . . . . . . . . . . . . . . . . . 79
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
6.2 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
6.3 Diagnosis of Pulmonary Embolism . . . . . . . . . . . . . . . . . . . . . . . . . . 80
6.4 Pulmonary Sarcoidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
6.5 Idiopathic Pulmonary Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
6.6 Pneumocystis carinii (jirovecii) Pneumonia . . . . . . . . . . . . . . . . . . . 85
6.7 Alveolar Permeability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
6.8 Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
6.9 Preoperative Quantitative Ventilation/Perfusion Studies . . . . . . . . . . 89
6.10 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
7 Nuclear Medicine in the Musculoskeletal System . . . . . . . . . . . . . . . . . 91
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
7.2 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
7.2.1 Non-neoplastic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
7.2.2 Neoplastic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
7.3 Non-neoplastic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
7.3.1 Imaging of Skeletal Infections . . . . . . . . . . . . . . . . . . . . . . . . 94
7.3.2 Avascular Necrosis (Osteonecrosis) . . . . . . . . . . . . . . . . . . . . 98
7.3.3 Trauma and Related Conditions . . . . . . . . . . . . . . . . . . . . . . . 98
7.3.4 Metabolic Bone Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
7.4 Diagnosis of Neoplastic Bone Disease . . . . . . . . . . . . . . . . . . . . . . . 105
7.4.1 Imaging of Primary Bone Tumors . . . . . . . . . . . . . . . . . . . . . 106
7.4.2 Imaging of Metastatic Bone Disease . . . . . . . . . . . . . . . . . . . 108
7.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
8 Nuclear Medicine in the Cardiovascular System . . . . . . . . . . . . . . . . . . 115
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
8.2 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
8.3 Evaluation of Cardiac Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
8.4 Evaluation of Myocardial Perfusion and Metabolism . . . . . . . . . . . . 116
8.4.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
8.4.2 Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
8.4.3 Follow-Up After Acute Myocardial Infarction . . . . . . . . . . . 120
8.4.4 Follow-Up After Revascularization Procedures . . . . . . . . . . . 120
8.4.5 Preoperative Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
8.4.6 Viability Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
8.5 Soft-Tissue Hemangioma Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
8.6 Lymphoscintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
8.7 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
xii Contents
9 Nuclear Medicine in the Nervous System . . . . . . . . . . . . . . . . . . . . . . . . 125
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
9.2 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
9.3 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
9.4 Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
9.5 Seizure Localization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
9.6 Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
9.7 Parkinsonism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
9.8 Cerebrospinal Fluid Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . 132
9.9 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
10 Nuclear Medicine in Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
10.2 Clinical Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
10.3 Diagnosis of Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
10.4 Staging of Malignant Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
10.5 Detection of Residual or Recurrent Disease . . . . . . . . . . . . . . . . . . 139
10.6 Evaluating Response to Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
10.7 Radiotherapy Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
10.8 Sentinel Lymph Node Localization . . . . . . . . . . . . . . . . . . . . . . . . . 143
10.9 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
11 Therapeutic Applications of Nuclear Medicine . . . . . . . . . . . . . . . . . . . 147
11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
11.2 Clinical Uses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
11.3 Treatment of Hyperthyroidism and Other Benign
Thyroid Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
11.4 Treatment of Differentiated Thyroid Cancer . . . . . . . . . . . . . . . . . . 149
11.5 Treatment of Pain Secondary to Skeletal Metastases . . . . . . . . . . . 150
11.6 Treatment of Neuroendocrine Tumors . . . . . . . . . . . . . . . . . . . . . . . 150
11.7 Treatment of Prostatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
11.8 Radioimmunotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
11.9 Radionuclide Synovectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
11.10 Peptide Receptor Radionuclide Therapy . . . . . . . . . . . . . . . . . . . . . 153
11.11 Treatment of Hepatocellular Carcinoma and Liver Metastases . . . . 154
11.12 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157