This book, now in its second edition, will serve as a quick reference that will help the reader to understand different diagnostic scintigraphic patterns and to select appropriate treatment modalities based on functional imaging. The book concisely describes relevant anatomic and physiologic considerations for each organ system and the pathophysiologic features of different relevant diseases and relates them to the scintigraphy of each system. It thereby provides an informative synopsis of the pathophysiologic basis of nuclear medicine and molecular imaging. The volume is divided into 13 chapters that feature basic pathophysiology, cell biology and biologic effects of ionizing radiation, radiopharmaceutical uptake and relevant anatomic and physiologic considerations for each organ system and the pathophysiologic features of different relevant diseases. The objective of this volume is to provide a brief, easy to-use but nonetheless comprehensive companion guide to “The Pathophysiology Basis of Nuclear Medicine” that will prove useful to undergraduates and postgraduates as well as to practitioners in clinical and research fields.
Author(s): Abdelhamid H. Elgazzar
Edition: 2
Publisher: Springer
Year: 2023
Language: English
Pages: 408
City: Cham
Preface to First Edition
Acknowledgment
Contents
1: Pathophysiology: General Principles
1.1 Introduction
1.2 Pathology
1.3 Definition of Disease
1.3.1 Homeostasis
1.3.2 The Genome
1.4 Physiology
1.5 Pathophysiology
1.6 Basic Major Principles of Pathophysiology
1.6.1 Cell Injury
1.6.1.1 Biochemical Cell Injury Mechanisms
1.6.1.2 Intracellular Accumulations
1.6.2 Cell and Tissue Response to Injury
1.6.2.1 Cell Adaptation
1.6.2.1.1 Atrophy
1.6.2.1.2 Hypertrophy
1.6.2.1.3 Hyperplasia
1.6.2.1.4 Metaplasia
1.6.2.1.5 Dysplasia
1.6.2.2 Cell Death
1.6.2.2.1 Necrosis (Nonregulated, Inflammatory Accidental Cell Death)
1.6.2.2.2 Apoptosis (Regulated, Noninflammatory Cell Death)
References
2: Ionizing Radiation: Biologic Effects and Essential Cell and Tissue Biology
2.1 Essential Cell and Tissue Biology
2.1.1 Cell Structure and Function
2.1.1.1 Plasma Membrane
2.1.1.2 Cytoplasm and its Organelles
2.1.1.2.1 The Endoplasmic Reticulum
2.1.1.2.2 The Golgi Complex
2.1.1.2.3 Lysosomes
2.1.1.2.4 Peroxisomes
2.1.1.3 Mitochondria
2.1.1.4 Ribosomes
2.1.1.5 Cytoskeleton
2.1.1.6 Nucleus
2.1.2 The Genetic Material and Gene Expression
2.1.2.1 The Genetic Material: DNA
2.1.2.1.1 DNA Structure
2.1.2.1.2 DNA Replication
2.1.2.1.3 DNA Mutation
2.1.2.1.4 DNA Recombination
2.1.2.2 Gene Expression and Protein Synthesis
2.1.2.3 Genetic Code
2.1.2.4 DNA Translation: Protein Synthesis
2.1.3 Cell Reproduction
2.1.3.1 The Cell Cycle
2.1.3.2 Mitosis and Cytokinesis
2.1.3.3 Rates of Cell Division
2.1.3.4 Chromosomes and Diseases
2.1.4 Cell Transformation and Differentiation
2.1.5 Normal and Malignant Growth
2.1.5.1 Normal Growth
2.1.5.1.1 Types of Cells and Tissue
2.1.5.1.2 MuscleTissue
Skeletal Muscle
Cardiac Muscle
Smooth Muscle
2.1.5.1.3 Nerve Tissue
2.1.5.1.4 Epithelial Tissue
2.1.5.1.5 Matrix
2.1.5.2 Indigenous Connective Tissue
2.1.5.2.1 Fibroblasts
2.1.5.2.2 Mast Cells
2.1.5.2.3 Fat Cells
2.1.5.2.4 Bone Cells
2.1.5.2.5 Cartilage Cells
2.1.5.2.6 Immigrant Cells
2.1.5.3 Neoplastic Growth
2.1.6 Cellular Metabolism
2.1.6.1 Role of ATP
2.1.6.2 Production of ATP
2.1.6.2.1 Glycolysis
2.1.6.2.2 Oxidative Phosphorylation
2.1.7 Transport through the Cell Membrane
2.1.7.1 Transport of Water and Solutes
2.1.7.1.1 Diffusion
2.1.7.1.2 Active-Mediated Transport
2.1.7.1.3 Transport by Vesicle Formation
2.1.7.1.4 Transport by Transmission of Electrical Impulses
2.1.8 Cell Death (See also Chaps. 1 and 12)
2.1.8.1 Imaging Cell Death
2.2 Biologic Effects of Ionizing Radiation
2.2.1 Ionizing Radiation
2.2.2 Mechanisms of Radiation Effects
2.2.2.1 Direct Effect
2.2.2.2 Indirect Effect
2.2.2.2.1 Bystander Effect
2.2.2.2.2 Genomic Instability
2.2.3 Factors Affecting Radiation Hazards
2.2.3.1 Factors Related to Ionizing Radiation
2.2.3.1.1 Types of Radiation
2.2.3.1.2 Mode of Administration
2.2.3.1.3 Dose Rate
2.2.3.2 Factors Related to Biological Target
2.2.3.2.1 Radiosensitivity
2.2.3.2.2 Repair Capacity of Cells
2.2.3.2.3 Cell Cycle Phase
2.2.3.2.4 Degree of Tissue Oxygenation
2.2.4 Radiation-Induced Cell Injury
2.2.5 Various Effects of Radiation
2.2.5.1 Early Radiation Effects
2.2.5.1.1 Acute Whole-Body Exposure Syndromes
Radiation Sickness
Hematopoietic (Bone Marrow) Syndrome
Gastrointestinal Syndrome
Central Nervous System Syndrome
2.2.5.1.2 Acute Regional Effects
2.2.5.2 Delayed Radiation Effects
2.2.5.2.1 Cancer
2.2.5.2.2 Genetic Effects
2.2.5.2.3 Effects on the Unborn Child
2.2.5.2.4 Other Delayed Somatic Effects
Cataract
Hypothyroidism
Aplastic Anemia
2.2.6 Psychological and Psychiatric Effects of Ionizing Radiation Exposure
2.2.7 Exposure from Medical Procedures
References
3: Basis of Radiopharmaceutical Localization
3.1 Radiopharmaceuticals
3.2 Mechanism(s) of Radiopharmaceutical Localization
3.2.1 Isotope Dilution
3.2.2 Capillary Blockade
3.2.3 Physicochemical Adsorption
3.2.4 Cellular Migration and Sequestration
3.2.5 Membrane Transport
3.2.5.1 Simple Diffusion
3.2.5.1.1 Simple Diffusion and Intracellular Metabolism/Binding
3.2.5.1.2 Simple Diffusion and Mitochondrial Binding
3.2.5.1.3 Simple Diffusion and Increased Permeability
3.2.5.2 Facilitated Diffusion
3.2.5.2.1 18F-Fluorodeoxyglucose (FDG)
3.2.5.2.2 Hepatobiliary Agents
3.2.5.3 Active Transport
3.2.5.3.1 Radioiodide and 99mTc-Pertechnetate Anions
3.2.5.3.2 201Thallous Chloride
3.2.5.3.3 Renal Agents
3.2.5.4 Phagocytosis
3.2.5.5 Receptor-Mediated Endocytosis
3.2.6 Metabolic Substrates and Precursors
3.2.6.1 Metabolic Trapping of FDG
3.2.6.2 Radiolabeled Amino Acids
3.2.7 Radiopharmaceuticals for Tissue Hypoxia Imaging
3.2.8 Cell Proliferation Radiopharmaceuticals
3.2.9 Specific Receptor Binding
3.2.9.1 Radiolabeled Peptides
3.2.9.1.1 Somatostatin Receptors
3.2.9.1.2 Radiolabeled SST Analogs
3.2.9.1.3 Vasoactive Intestinal Peptide (VIP) Receptors
3.2.9.2 Steroid Hormone Receptors
3.2.9.3 Adrenergic Presynaptic Receptors
3.2.9.4 LDL Receptors
3.2.9.5 Radiolabeled Antibodies
3.2.10 Imaging Gene Expression Mechanism
References
4: Inflammation
4.1 Definitions
4.2 Classification of Inflammation
4.3 General Pathophysiological Changes of Inflammation
4.3.1 Local Pathophysiological Changes of Inflammation
4.3.1.1 Acute Inflammation
4.3.1.1.1 Local Vascular Changes
4.3.1.1.2 Formation of Exudate
4.3.1.1.3 Local Cellular Events
4.3.1.2 Local Sequelae of Acute Inflammation
4.3.1.3 Chronic Inflammation
4.3.1.4 Abscess Formation
4.3.2 Systemic Pathophysiological Changes of Inflammation
4.3.3 Pathophysiological Changes of Healing
4.4 Pathophysiology of Major Soft Tissue Inflammation
4.4.1 Abdominal Inflammation
4.4.2 Chest Inflammation
4.4.2.1 Sarcoidosis
4.4.2.2 Pneumocystis Carinii (Jirovecii) Pneumonia
4.4.2.3 Idiopathic Pulmonary Fibrosis
4.4.3 Renal Inflammation
4.4.3.1 Acute Pyelonephritis
4.4.3.2 Chronic Pyelonephritis
4.4.4 Scrotal Inflammation
4.4.5 Cellulitis
4.4.6 Endocarditis
4.4.7 Thyroid Gland Inflammation
4.5 Pathophysiology of Major Skeletal Inflammations
4.6 Radiopharmaceuticals for Inflammation Imaging
4.7 Infection/Inflammation Imaging
4.7.1 Imaging of Soft Tissue Infections
4.7.1.1 Localizing Signs Present
4.7.1.1.1 Imaging Abdominal Infections
4.7.1.1.2 Imaging Chest Infections
4.7.1.1.3 Imaging Renal Infections
4.7.1.2 No Localizing Signs Present
4.7.2 Imaging of Skeletal Infection
References
5: Musculoskeletal System
5.1 Anatomical and Physiological Considerations
5.1.1 Bone Structure
5.1.2 Blood Supply
5.1.3 Bone Remodeling
5.1.4 Bone Marrow
5.1.5 Response of Bone to Injury
5.2 Bone Diseases
5.2.1 Nonneoplastic Bone Diseases
5.2.1.1 Skeletal Infection/Inflammation
5.2.1.1.1 Definitions
5.2.1.1.2 Classification of Osteomyelitis
5.2.1.1.3 Pathophysiological Changes
Acute Hematogenous Osteomyelitis
Chronic Osteomyelitis
Vertebral Osteomyelitis (Spondylodiskitis)
Diabetic Foot Osteomyelitis
Sickle Cell Disease Osteomyelitis
Periprosthetic Infections
Infectious (Septic) Arthritis
Chronic Nonbacterial Osteomyelitis
5.2.1.2 Multimodality Imaging of Skeletal Infections/Inflammation
5.2.1.2.1 Imaging Acute Osteomyelitis
5.2.1.2.2 Imaging Other Forms of Osteomyelitis
Diabetic Foot Osteomyelitis
Vertebra; Osteomyelitis
Chronic Active Osteomyelitis
Periprosthetic and Post-traumatic Infection
Osteomyelitis in Patients with Sickle Cell Disease
Infectious (Septic) Arthritis
5.2.2 Avascular Necrosis (Osteonecrosis)
5.2.2.1 Post-Traumatic Osteonecrosis
5.2.2.2 Legg-Calvé-Perthes Disease
5.2.2.3 Dysbaric Osteonecrosis
5.2.2.4 Sickle Cell Disease Necrosis
5.2.2.5 Idiopathic (Primary or Spontaneous) Osteonecrosis
5.2.2.6 Spontaneous Osteonecrosis of the Femoral Head
5.2.2.7 Spontaneous Osteonecrosis of the Knee
5.2.2.7.1 Spontaneous Osteonecrosis of the Knee (SONK)
5.2.3 Complex Regional Pain Syndrome-1 (CRPS-1)
5.2.4 Fibrous Dysplasia
5.2.5 Trauma
5.2.5.1 Fractures
5.2.5.1.1 Stress Fractures
5.2.5.1.2 Spondylolysis
5.2.5.2 Fracture Healing
5.2.6 Growth Plate Injury
5.2.7 Metabolic Bone Diseases
5.2.7.1 Paget’s Disease (Osteitis Deformans)
5.2.7.2 Osteoporosis
5.2.7.3 Osteomalacia and Rickets
5.2.7.4 Bone Changes of Hyperparathyroidism
5.2.7.4.1 Renal Osteodystrophy
5.2.7.5 Hypertrophic Osteoarthropathy
5.2.8 Arthropathy
5.2.8.1 Soft-Tissue Calcification
5.2.8.1.1 Dystrophic Calcification
5.2.8.1.2 Metastatic Calcification
5.2.8.1.3 Heterotopic Bone Formation
5.3 Neoplastic Bone Disease
5.3.1 Primary Bone Tumors
5.3.1.1 Osteogenic Tumors
5.3.1.1.1 Osteoid Osteoma
5.3.1.1.2 Osteoblastoma
5.3.1.1.3 Osteogenic Sarcoma
5.3.1.2 Chondrogenic Tumors
5.3.1.3 Collagenic Tumors
5.3.1.4 Myelogenic Tumors
5.3.1.4.1 Myeloma
5.3.1.4.2 Ewing’s Sarcoma
5.3.1.4.3 Giant Cell Tumor
5.3.1.4.4 Bone Hemangiomas
5.3.1.5 Imaging of Primary Bone Tumors
5.3.1.5.1 Imaging of Major Specific Tumors
Osteoid Osteoma
Hemangioma
Osteogenic Sarcoma
Myeloma
5.3.2 Metastatic Bone Disease
5.3.2.1 Methods of Tumor Cell Transport
5.3.2.1.1 Lymphatic Spread
5.3.2.1.2 Hematogenous Spread
Intraspinal Spread
5.3.2.2 Bone Response to Metastases
5.3.2.3 Distribution of Bone Metastases
5.3.2.4 Classification of Bone Metastases
5.3.2.5 Sources of Bone Metastases
5.3.2.5.1 Breast Cancer
5.3.2.5.2 Prostate Cancer
5.3.2.5.3 Lung Cancer
5.3.2.5.4 Renal Cell Carcinoma
5.3.2.6 Sequelae of Skeletal Metastases
5.3.2.7 Imaging of Metastatic Bone Disease
5.3.2.7.1 Appearance of Bone Metastases on Bone Scan
Imaging Metastases with Other Modalities
References
6: Endocrine System
6.1 The Thyroid Gland
6.1.1 Anatomical and Physiological Considerations
6.1.1.1 Anatomy
6.1.1.2 Physiology
6.1.1.3 Role of Iodine Metabolism in Thyroid Physiology
6.1.1.3.1 Effect of Iodine Insufficiency
6.1.1.3.2 Effect of Excessive Iodine
6.1.2 Radiopharmaceuticals for Thyroid Imaging
6.1.2.1 Technetium-99 M-Pertechnetate
6.1.2.2 Iodine-123
6.1.2.3 Iodine-131
6.1.2.4 Fluorine-18 Fluorodeoxyglucose (18F-FDG)
6.1.3 Major Thyroid Disorders
6.1.3.1 Pathophysiology
6.1.3.1.1 Nodular Thyroid Disease
Types of Thyroid Nodules
Nonneoplastic Nodules (Pseudo-Nodules)
Neoplastic Nodules
Micronodules
6.1.3.1.2 Thyroiditis
Acute Thyroiditis
Subacute Thyroiditis
Postpartum Thyroiditis
Amiodarone-Induced Thyroiditis
Interferon-Alpha Induced Thyroiditis
Autoimmune Thyroiditis (Hashimoto’s Disease). See Following Section
6.1.3.1.3 Autoimmune Thyroid Disease
Hashimoto’s Disease
Graves’ Disease
Autoimmune Interferon Induced Thyroiditis
6.1.3.1.4 Thyroid Cancer
6.1.3.2 Thyroid Scintigraphy
6.1.3.2.1 Nodular Disease
6.1.3.2.2 Thyroiditis
6.1.3.2.3 Graves’ Disease
6.2 Parathyroid Gland
6.2.1 Anatomic and Physiologic Considerations
6.2.2 Hyperparathyroidism
6.2.2.1 Primary Hyperparathyroidism
6.2.2.2 Secondary Hyperparathyroidism
6.2.2.3 Tertiary Hyperparathyroidism
6.2.2.4 Eutopic Parathyroid Disease
6.2.2.5 Ectopic Parathyroid Disease
6.2.3 Parathyroid Adenoma
6.2.3.1 Solitary Adenoma
6.2.3.2 Double or Multiple Adenomas
6.2.3.3 Cystic Adenoma
6.2.3.4 Lipoadenoma
6.2.3.5 Oncocytic Adenoma
6.2.4 Parathyroid Hyperplasia
6.2.5 Parathyroid Carcinoma
6.2.6 Hyperfunctioning Parathyroid Transplant
6.2.7 Consequences of Hyperparathyroidism
6.2.8 Preoperative Parathyroid Localization
6.2.9 Scintigraphic Localization
6.2.10 Atypical Washout of Radiotracer
6.2.11 Intraoperative Probe Localization
6.3 Adrenal Gland
6.3.1 Anatomical and Physiological Considerations
6.3.2 Adrenal Cortex
6.3.2.1 Pathophysiology
6.3.2.1.1 Primary Aldosteronism (Conn’s Syndrome)
6.3.2.1.2 Cushing’s Syndrome
6.3.2.1.3 Hyperandrogenism
6.3.2.2 Scintigraphy for Adrenal Cortex
6.3.2.2.1 Radiolabeled Cholesterol Analogs
6.3.2.2.2 Positron Emission Tomography Imaging
6.3.3 Adrenal Medulla
6.3.3.1 Pathophysiology
6.3.3.1.1 Pheochromocytoma
6.3.3.1.2 Neuroblastoma
6.3.3.1.3 Ganglioneuroma
6.3.3.2 Scintigraphy for Adrenal Medulla
6.3.3.2.1 Metaiodobenzylguanidine
6.3.3.2.2 Indium-111 Octreotide
6.3.3.2.3 Positron Emission Tomography Imaging
6.3.4 Incidental Adrenal Mass
References
7: Genitourinary System
7.1 Anatomic and Physiologic Considerations
7.1.1 Major Structures
7.1.2 Renal Vasculature
7.1.3 Juxtaglomerular Apparatus
7.1.4 Renal Function
7.2 Renal Radiopharmaceuticals
7.2.1 Rapidly Excreted Radiopharmaceuticals
7.2.2 Slowly Excreted Radiopharmaceuticals
7.3 Renal Scintigraphy
7.3.1 Principles of Interpretation
7.3.1.1 Dynamic Studies
7.3.1.1.1 Cortical Uptake
7.3.1.1.2 Cortical Retention
7.3.1.1.3 First Visualization of Collecting System
7.3.1.1.4 Time to Peak
7.3.1.2 Static Studies
7.4 Major Relevant Genitourinary Diseases
7.4.1 Renovascular Hypertension (RVH)
7.4.1.1 Pathophysiology
7.4.1.2 Scintigraphy for RVH
7.4.1.2.1 Basis
7.4.1.2.2 Interpretation
7.4.1.2.3 Factors Influencing ACE Inhibitor Scintigraphy
7.4.2 Urine Outflow Obstruction
7.4.2.1 Diuretic Renography
7.4.3 Urinary Tract Infection
7.4.3.1 Pathophysiology
7.4.3.2 UTI Scintigraphy
7.4.4 Renal Transplantation Complications
7.4.4.1 Surgical Complications
7.4.4.1.1 Urine Extravasation, Ureteral Obstruction
7.4.4.1.2 Hematoma, Lymphocele
7.4.4.1.3 Renal Artery Stenosis
7.4.4.2 Medical Complications
7.4.4.2.1 Acute Tubular Necrosis
7.4.4.2.2 Rejection
7.4.4.2.3 Nephrotoxicity of Drugs
7.4.5 Vesicoureteral Reflux
7.4.5.1 Pathophysiology
7.4.5.2 Reflux Scintigraphy
7.4.6 Testicular Torsion
7.4.6.1 Pathophysiology
7.4.6.2 Diagnosis
7.4.6.3 Scrotal Imaging
7.4.6.4 Scrotal Scintigraphy
References
8: Respiratory System
8.1 Anatomic and Physiologic Considerations
8.1.1 Respiratory Airways
8.1.2 Pulmonary Vasculature
8.1.3 Respiratory Function
8.1.4 Distribution of Ventilation and Perfusion
8.2 Pulmonary Embolic Disease
8.2.1 Pathogenesis and Risk Factors
8.3 Pulmonary Embolic Disease
8.3.1 Pathogenesis and Risk Factors
8.3.2 Deep Venous Thrombosis
8.3.3 Pulmonary Thromboembolism
8.3.3.1 Consequences
8.3.3.2 Resolution
8.3.3.3 Chronic Pulmonary Thromboembolism
8.3.3.4 Recurrence
8.3.3.5 Diagnosis
8.3.3.5.1 Imaging
8.3.3.5.2 Scintigraphic Agents
Ventilation Agents
Perfusion Agents
8.3.3.5.3 Interpretation of V/Q Scan
8.4 Pulmonary Hypertension
8.5 Pneumocystis carinii (jiroveci) Pneumonia
8.6 Idiopathic Pulmonary Fibrosis
8.7 Pulmonary Sarcoidosis
8.8 Obstructive Airway Disease
8.9 Pleural Effusions
8.10 Pneumonia
8.11 Bronchial Obstruction
8.12 Lung Cancer (see Chap. 12)
References
9: Circulatory System
9.1 The Heart
9.1.1 Anatomical Considerations
9.1.2 Physiological Considerations
9.1.2.1 Physiology of Coronary Blood Flow
9.1.2.2 Myocardial Contractility
9.1.3 Electrical Excitation
9.1.3.1 Contraction
9.1.3.2 Assessment of Left Ventricular Performance
9.1.3.2.1 Left Ventricular Function Curve
9.1.3.2.2 Ejection Fraction
9.1.3.2.3 Pressure–Volume Relationship Measurement
9.1.3.2.4 Regional Wall Motion Assessment
9.1.3.2.5 Diastolic Function
9.2 Pathophysiological Considerations
9.2.1 Heart Failure
9.2.2 Systemic Hypertension
9.2.3 Pulmonary Hypertension
9.2.4 Atherosclerosis
9.2.5 Ischemic Heart Disease
9.2.6 Cardiomyopathies
9.2.6.1 Dilated Cardiomyopathy
9.2.6.2 Hypertrophic Cardiomyopathy
9.2.6.3 Restrictive Cardiomyopathy
9.2.7 Pericardial Effusion
9.2.8 Correlative Scintigraphic Evaluation of Cardiac Diseases
9.2.8.1 Evaluation of Ventricular Function
9.2.8.2 Equilibrium Radionuclide Angiography
9.2.8.2.1 ECG-Gated Myocardial Perfusion SPECT
9.2.8.3 First-Pass Radionuclide Angiography
9.2.8.4 Evaluation of Myocardial Perfusion
9.2.8.5 Myocardial Perfusion SPECT Imaging
9.2.8.6 Stressors
9.2.8.6.1 Exercise
9.2.8.6.2 Pharmacologic Stress Testing
9.2.8.6.3 Adenosine
9.2.8.6.4 Dipyridamole
9.2.8.6.5 Dobutamine and Arbutamine
9.2.8.6.6 Regadenoson
9.2.8.6.7 Combined Pharmacological and Exercise Stress Testing
9.2.8.7 Radiopharmaceuticals for Myocardial Perfusion Imaging
9.3 Clinical Uses of Myocardial Perfusion Imaging
9.3.1 Uses of Myocardial Perfusion SPECT Imaging
9.3.2 Uses of Myocardial Perfusion PET Imaging
9.3.3 Evaluation of Myocardial Metabolism and Uses of Metabolic Imaging
9.3.3.1 Quantification of Myocardial Blood Flow
9.3.3.2 PET in Prognosis Assessment
9.3.3.3 PET in Assessment of Myocardial Viability
9.3.3.4 PET in Assessing Ventricular Function
9.3.3.5 PET in Endocarditis and Cardiovascular Prosthetic Infection
9.3.3.6 PET in Cardiac Sarcoidosis and Amyloidosis
9.3.3.7 Assessment of Myocardial Viability
9.3.3.8 Cardiac Shunt Evaluation
9.3.3.8.1 Left-to-Right Shunt
9.3.3.9 Right-to-Left Shunt
9.3.4 Lymphatic System
9.3.4.1 Anatomic and Physiologic Considerations
9.3.5 Pathophysiology of Relevant Lymphatic Disorders
9.3.5.1 Lymphedema
9.3.5.2 Lymph Nodes with Metastases
9.3.5.3 Sentinel Node
9.3.6 Scintigraphy of Lymphatic System
9.3.6.1 The Spleen Imaging
9.3.6.2 Lymph Nodes and Lymphatic Vessels
9.3.6.2.1 Detection and Follow-Up of Lymphedema
9.3.6.2.2 Detection of Lymph Node Metastases
9.3.6.2.3 Sentinel Node Detection
References
10: Digestive System
10.1 Gastrointestinal Tract
10.1.1 The Esophagus
10.1.1.1 Anatomical and Physiological Considerations
10.1.2 Esophageal Motility Disorders
10.1.2.1 Disorders of the UES and Cervical Esophagus
10.1.2.2 Disorders of Distal Esophagus and LES
10.1.2.2.1 Hypermotility Disorders
10.1.2.2.2 Hypomotility Disorders
10.1.2.2.3 Gastroesophageal Reflux Disease
10.2 The Stomach
10.2.1 Anatomical and Physiological Considerations
10.2.1.1 Anatomical Features
10.2.1.2 Overall Functions
10.2.1.3 Gastric Motor Physiology
10.2.2 Disorders of Gastric Emptying
10.2.3 Duodenogastric Reflux
10.3 The Intestines
10.3.1 The Small Intestine
10.3.1.1 Anatomical and Histological Considerations
10.3.1.2 Functional Considerations
10.3.1.3 Small Intestinal Dysmotility
10.3.1.4 Malabsorption
10.3.1.4.1 Protein-Losing Enteropathy
10.3.1.4.2 Vitamin B12 Malabsorption
10.4 The Colon
10.4.1 Anatomical and Functional Considerations
10.4.2 Relevant Colon Diseases
10.4.2.1 Inflammatory Bowel Disease
10.4.2.2 Acute Appendicitis
10.4.2.3 Colorectal Cancer
10.4.2.4 Gastrointestinal Bleeding
10.5 Salivary Gland
10.5.1 Anatomic and Physiologic Considerations
10.5.2 Pathophysiology of Relevant Disorders
10.5.3 Ascites
10.6 Gastrointestinal Scintigraphy
10.6.1 Radionuclide Esophageal Transit Time Study
10.6.2 Gastroesophageal Reflux Study
10.6.3 Gastric Emptying Study
10.6.4 Duodenogastric Reflux Study
10.6.5 Gastrointestinal Bleeding Localization Study
10.6.6 Meckel’s Diverticulum Study
10.6.7 Imaging of Inflammatory Bowel Disease
10.6.8 Imaging of Appendicitis
10.6.9 Non-imaging Procedures
10.6.9.1 Carbon-14 Breath Tests
10.6.9.1.1 Helicobacter Pylori Infections
10.6.9.1.2 Lactase Deficiency
10.6.9.1.3 Malabsorption Secondary to Bacterial Overgrowth
10.6.9.2 Schilling’s Test
10.7 Hepatobilitary System
10.7.1 Anatomical and Physiological Considerations
10.7.2 Hepatobiliary Radiopharmaceuticals
10.7.3 Evaluation of Liver Diseases
10.7.3.1 Functional Hepatic Mass/Reserve
10.7.3.2 Primary Hepatic Neoplasms and Tumor-like Conditions
10.7.3.2.1 Hepatocellular Carcinoma
10.7.3.2.2 Hepatic Hemangioma
10.7.3.3 Focal Nodular Hyperplasia
10.7.3.4 Hepatocellular Adenoma
10.7.3.4.1 Hepatocellular Adenoma
10.7.4 Biliary Tract Diseases
10.8 Acute Cholecystitis
10.8.1 Imaging for Acute Cholecystitis
10.8.2 Chronic Acalculous Biliary Syndromes
10.8.2.1 Biliary Sphincter (Sphincter of Oddi) Stenosis/Obstruction
10.8.2.2 Interventions in Cholescintigraphy
10.8.2.3 Cholecysystokinin (CCK) Administration
10.8.3 CCK Pre-Cholescintigraphy Administration for the Diagnosis of Acute Cholecystitis
10.8.4 CCK Pre-Cholescintigraphy Administration for Suspected Biliary Sphincter (Sphincter of Oddi) Dysfunction
10.8.4.1 CCK Post-Cholescintigraphy Administration for Acalculous Biliary Syndromes
10.8.4.2 Morphine Augmentation
10.8.5 Hyperbilirubinemia
10.8.6 Common Bile Duct Obstruction
10.8.7 Neonatal Hyperbilirubinemia
10.8.8 Evaluation of Complications after Hepatobiliary Surgery
References
11: Central Nervous System
11.1 Anatomic and Physiologic Considerations
11.1.1 Anatomy
11.1.2 Physiology
11.1.2.1 Perfusion
11.1.2.2 Metabolism
11.1.2.3 Cerebrospinal Fluid (CSF)
11.2 Pathophysiology of Relevant Diseases
11.2.1 Cerebrovascular Disease
11.2.2 Dementia
11.2.2.1 Alzheimer’s Disease (AD)
11.2.2.2 Other Causes of Dementia
11.2.3 Epilepsy
11.2.4 Brain Tumors
11.2.5 Hydrocephalus
11.2.6 Cerebrospinal Fluid Leakage
11.2.7 Brain Death
11.3 Scintigraphic Evaluation of CNS Diseases
11.3.1 Radiopharmaceuticals
11.3.2 Scintigraphic Imaging Techniques
11.3.3 Major Clinical Applications of Scintigraphy
11.3.3.1 Cerebrovascular Disease
11.3.3.2 Alzheimer’s Disease
11.3.3.2.1 SPECT Imaging
11.3.3.2.2 18F-FDGPET Imaging
11.3.3.3 Vascular Dementia
11.3.3.4 Epilepsy: Epileptogenic Focus Localization Imaging
11.3.3.4.1 Ictal 99mTc-HMPAO or 99mTc-ECDSPECT
11.3.3.4.2 18F-FDG Brain PET Assessment in the Interictal State
11.3.3.5 Psychiatry and Learning Disabilities
11.3.3.6 Brain Death
11.3.3.7 Brain Tumors
11.3.3.8 Parkinsonism
11.3.3.9 Radionuclide Cisternography
References
12: Nuclear Oncology
12.1 Principles of Tumor Pathology and Biology
12.1.1 Tumor Pathology
12.1.1.1 Tumor Biologic Behavior
12.1.1.1.1 Benign Tumors
12.1.1.1.2 Malignant Tumors
12.1.1.2 Tumor Grading
12.1.1.3 Tumor Staging
12.1.1.4 Tumor Growth Rate
12.2 Tumor Biology
12.2.1 Cell Growth and Cell Cycle
12.2.2 Tumor Neovascularization (Angiogenesis)
12.2.3 Distinguishing Features of Tumor Cells
12.2.3.1 Loss of Contact Inhibition of Growth
12.2.3.2 Growth Regulatory Pattern
12.2.3.3 Ability to Escape Immune Surveillance Pathways (Immune Evasion)
12.2.3.4 Metabolic Alterations
12.2.4 Invasion and Metastasis
12.2.5 Carcinogenesis
12.2.5.1 Genetic Mutations and Cellular Oncogenes
12.2.5.2 Growth-Promoting Proto-Oncogenes
12.2.5.3 Growth Factor Receptors
12.2.5.4 Signal-Transducing Proteins
12.2.5.5 Nuclear Transcription Factors
12.2.5.6 Tumor Suppressor Genes and Tumor Progression
12.2.6 Apoptosis
12.2.7 Hereditary Cancer
12.2.7.1 Inherited Cancer Syndromes
12.2.7.2 Familial Cancers
12.2.7.3 Autosomal Recessive Syndromes of Defective DNA Repair
12.3 Tumor Imaging with Pathophysiological Correlation
12.3.1 Basis of Uptake of Tumor Radiopharmaceuticals
12.3.1.1 Conventional Radiopharmaceuticals
12.3.1.2 PET Radiopharmaceuticals
12.3.1.2.1 Glucose Metabolism Agents
12.3.1.2.2 Bone Seeking Agent
12.3.1.2.3 Proliferation Agents
12.3.1.2.4 Hypoxia Agents
12.3.1.2.5 Receptor Imaging Agents
12.3.1.2.6 Tumor Stroma Agents
12.3.1.2.7 Angiogenesis Imaging Agents
12.3.1.2.8 Apoptosis Detection Agents
12.3.1.2.9 Labeled Reporter Gene
12.3.2 Scintigraphic Imaging and its Clinical Uses
12.3.2.1 Tumor Detection
12.3.2.2 Staging and Restaging
12.3.2.3 Prediction of Prognosis
12.3.2.4 Prediction of Drug Resistance
12.3.2.5 Evaluation of Therapy and Detecting Recurrence
12.3.2.6 Radiotherapy (RT) Planning
References
13: Basis of Therapeutic Nuclear Medicine
13.1 Radionuclide Therapy
13.2 Treatment of Hyperthyroidism
13.2.1 Pathophysiology
13.2.2 Factors Affecting the Dose of I-131 Used for Therapy of Hyperthyroidism
13.3 Treatment of Differentiated Thyroid Cancer
13.4 Treatment of Pain Secondary to Skeletal Metastases
13.4.1 Radiopharmaceuticals
13.4.1.1 Strontium-89 Chloride (Sr-89 Chloride)
13.4.1.2 Samarium-153 Ethylenediaminetetra
13.4.1.3 Rhenium-186 Ethylene Hydroxy Diphosphonate (Re-186-EHDP)
13.4.1.4 Tin-117 M- Diethylenetriaminepentaacetic Acid (Sn-117m-DTPA)
13.4.1.5 Phosphorus-32 Orthophosphate
13.4.1.6 Rhenium-188 Dimercaptosuccinic Acid Complex [re-188(V)DMSA]
13.4.1.7 Radium-223 (Ra-223) Dichloride
13.4.2 Mechanism of Action
13.4.3 Choice of Radiopharmaceutical
13.4.4 Clinical Use
13.5 Treatment of Neuroendocrine Tumors
13.5.1 Neuroblastoma
13.5.2 Pheochromocytoma
13.5.3 Carcinoid Tumor
13.6 Radioimmunotherapy
13.7 Radionuclide Synovectomy
13.7.1 Radiopharmaceuticals for Synovectomy
13.7.1.1 Yttrium-90 Colloid (90Y)
13.7.1.2 Rhenium-186 Sulfide ([186Re] Colloid)
13.7.1.3 Erbium-169 Citrate [169Er] Colloid
13.7.1.4 Phosphorus-32 Chromic Sulfate (P-32)
13.7.1.5 Radioactive Gold Au-198
13.7.1.6 Rhenium-188 Colloid
13.7.1.7 Dysprosium-165 (Dy-165)
13.7.1.8 Ho-166-Ferric Hydroxide
13.7.2 Mechanism of Action
13.7.3 Choice of Radiopharmaceutical
13.7.4 Clinical Use
13.8 Treatment of Primary and Secondary Liver Malignancies
13.9 Peptide Receptor Radionuclide Therapy
13.10 Treatment of Malignant Effusions
13.11 Other Therapeutic Procedures
13.11.1 Treatment of Bone Tumors
13.11.1.1 Osteogenic Sarcoma
13.11.1.2 Multiple Myeloma
13.11.1.3 Metastatic Prostate Carcinoma
13.12 Combined Therapeutic Approach
References
Glossary
