VIVAMED - oddelenie nukleárnej medicíny

  • Vivamed - oddelenie nukleárnej medicíny
.
99mTc-MIBI (99mTc-Tetrofosmin) positive tumour diagnostics

Examination principle and procedure

The 99mTc-MIBI/Tetrofosmin radiopharmaceutical is accumulated in some tumours, depending on the viability of tumorous cells, which is used for the diagnostics and monitoring of the same.

 

Radiopharmaceutical  

  • 99mTc-MIBI - methoxy-isobutyl-isonitril
  • 99mTc-Tetrofosmin
  • Method of application - i.v.
  • Examination duration - approximately 30-60 minutes

 

Indications

  • thyroid ca (non-differentiated, medullar)
  • breast ca
  • adrenal gland tumours
  • pulmonary ca
  • other – malign lymphoma, tumours of bones and soft tissues (soft-tissue sarcoma)

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • no special requirements, patients can eat, drink, take their medications

 

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding.

Accumulation test of the radioactive iodine accumulation in thyroid prior to the therapy with radioactive iodine

Examination principle and procedure

This examination is indicated to evaluate the accumulation ability of the rest of the thyroidal tissue after total thyroidectomy prior to the therapy of a differentiated thyroid carcinoma with radioactive iodine and for the calculation of a therapeutic dose of radioactive iodine in the therapy of differentiated thyroid carcinoma. After oral administration of radioactive iodine 131I, the rate of its uptake in thyroid is detected for 24 hours and then compared with the amount of the administered radioactive iodine. The rate of uptake of the residual tissue after total thyroidectomy should not exceed 5-10%.

 

Radiopharmaceutical

  • 131I – sodium iodide

 

Method of application – orally in form of a solution

 

Examination duration

The measurements are carried out after 2, 5, 24 hours after the application of radioactive iodine. After 24 hours, a scintigraphy recording of the residual tissue is made.

 

Indications

  • Evaluation prior to the therapy of differentiated thyroidal carcinoma with radioactive iodine

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

Patients must come with an empty stomach. For a certain period of time before the examination, it is necessary to reduce the intake of food (mineral waters, sea fish and sea food) and medications with higher iodine contents. This applies also to examinations with the application of iodinated contrast agents (CT).

Whole-body skeletal scintigraphy, 3-phase scintigraphy of a part of the skeleton, local skeletal scintigraphy, SPECT of a part of the skeleton

Examination principle and procedure

Imaging of the distribution of an osteotropic radiopharmaceutical in the skeleton. An osteotropic radiopharmaceutical is inbuilt into the bone metabolism. Its uptake is more intensive at sites with higher metabolic activity - osteogenesis, and less intensive in osteolytic foci. The skeletal scintigraphy detects a metabolically active bone process several months earlier than a conventional X-ray examination. This examination is of high sensitivity but relatively low specificity, unless the methods for more detailed evaluation of a pathological lesion are used, such as the evaluation of stages I and II and the SPECT methods. In our Centre, the standard practice for all patients is to carry out the 3-phase scintigraphy of a selected part of the skeleton and the whole-body recording. The (99mTc-MDP) radiopharmaceutical is administered intravenously and then a 15-minute recording is made of stages I and II at which we evaluate the perfusion of a pathological focus. When this part of the examination is terminated, the patient waits for the radiopharmaceutical to inbuilt into their skeleton. Patients may eat and they are recommended to drink more and empty their urinary bladder before recording stage III of the examination. The examination is carried out 2-4 hours after the application and the patient is lying on their back. For each patient, a targeted recording is made of the area with a pathological lesion or clinical problems and also for each patient a whole-body skeletal scintigraphy is made to exclude pathological changes in other parts of the skeleton. Additional images are often required.

 

Radiopharmaceutical

  • 99mTc-MDP - methylene diphosphonate

 

Method of application – intravenous injection.

 

Examination duration – approximately 60 minutes.

 

Indications

  • osteomyelitis
  • avascular necrosis
  • traumatic bone changes, occult fractures
  • vertebrogenic algic syndrome
  • postoperative check-ups of endoprostheses
  • extent and type of joint structure damage in  rheumatic and arthritic diseases
  • metabolic bone diseases, m. Paget
  • Tortured Child Syndrome – evidence of multiple bone fractures in various healing stages
  • differential diagnostics of unclear X-ray, CT, MRI findings
  • differential diagnostics of pain in bones
  • oncological indications

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • no special requirements, patients can eat, drink, take their medications
    • shortly before the examination, a patient must urinate to empty their urinary bladder 
    • patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding, especially X-ray, CT, or MRI findings and photo documentation

 Skeletal scintigraphy modifications

 

a/ Whole-body skeletal scintigraphy

Whole-body imaging of bone and joint structures in anterior and posterior projections using a computer-controlled continuous movement of the examination bed or gamma camera detectors. An advantage of skeletal gammagraphy is that with a single administration of a radiopharmaceutical the whole skeleton is visualised in a single examination. The gammagraphy will visualise a metabolically active bone process several months earlier than in an X-ray examination which is particularly important for early detection of bone metastases.


b/ Targeted local skeletal scintigraphy is the targeted planar imaging of a certain part of the skeleton, focused on a more detailed imaging of a pathological lesion.

 

c/ SPECT (Single Photon Emission Computer Tomography) of a part of the skeleton

is a tomography imaging of a certain part of the skeleton with the possibility of reconstruction in three planes – transversal, sagittal, and frontal.

 

d/ 3-phase scintigraphy of a part of the skeleton

Evaluation of the distribution of a radiopharmaceutical in the examined area in three phases: Blood Flow Phase I (angiography, 0-120 sec after the application), Blood Pool Phase II (3-10 minutes after the application), and Late Bone Phase III (2-4 hours after the injection). It facilitates the evaluation of perfusion of a pathological focus, helping thus in the differential diagnostics of some pathological processes in bones and joints.

Whole-body skeletal scintigraphy, 3-phase scintigraphy of a part of the skeleton, local skeletal scintigraphy, SPECT of a part of the skeleton

Examination principle and procedure

Imaging of the distribution of osteotropic radiopharmaceutical in the skeleton. An osteotropic radiopharmaceutical is increasingly accumulated in sites with higher bone metabolism and less accumulated in osteolytic foci. This examination is of high sensitivity but low specificity. In some cases, it is not possible to identify by scintigraphy the etiology of bone metabolic changes; also, osteomyelitis and a fracture or metastasis and a degenerative focus in spine may be visualised. In the case of unclear focal findings, we supplement also the targeted SPECT recording which significantly increases the sensitivity and specificity of the examination and in many cases it facilitates the differential diagnostics to distinguish between the degenerative foci and metastases. However, the scintigraphy visualises a metabolically active bone process several months earlier than in an X-ray examination, which is important mainly in the early detection of bone mts. The (99mTc-MDP) radiopharmaceutical is administered i.v. Almost all examinations are carried out as the 3-phase scintigraphy of a particular area of interest. First two phases are scanned immediately after the application of the radiopharmaceutical and last for maximum 15 minutes. They serve for the evaluation of the perfusion of the pathological process. The third bone phase is scanned 2-5 hours after the application. The examination is carried out in a lying position on the back, in some supplementary recordings also in a lying position on a side.  

 

Radiopharmaceutical

99mTc-MDP - methylene diphosphonate

 

Method of application

  • intravenous

 

Examination duration

  • First phases are examined immediately after the application (the examination lasts for about 15 minutes) and the bone phase is examined after a break, approximately 2-5 hours after the application, the recording lasts for about 45 minutes.

 

Indications in oncology

Detection of bone metastases in tumours that metastasize into bones - staging (most frequently carcinoma of breast, lungs, prostate, kidneys, urinary bladder, thyroid, large intestine, gynaecological tumours)

 

  • differential diagnostics of pain in bones with a known oncological disease
  • monitoring of the therapy of a tumorous disease
  • diagnostics and monitoring  of primary bone tumours and monitoring thereof
  • differential diagnostics of X-ray, CT, MRI findings

 

Contraindications

Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations 


Indicating a gammagraphy examination should not be purposeless. Even though the examination is associated only with a small radiation burden, the indication must be based on potential diagnostic and health benefits for a patient.

 

Preparation of patients

  • no special requirements, patients may eat and drink and take medicines
  • shortly before the examination, a patient must urinate to empty their urinary bladder  

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding

Dynamic oesophageal scintigraphy and detection of gastroesophageal reflux

Examination principle and procedure

Following the oral administration of food labelled with the radiopharmaceutical  99mTc-MAA (99mTc- macroaggregated albumin), 99mTc-nanocoll (99mTc-colloid), we evaluate a motility disorder, potential retention, and the presence of gastroesophageal reflux.

 

Examination duration

30-60 minutes.

 

Radiopharmaceutical

  • 99mTc-NANOCOLL –colloid labelled with technetium-99m
  • 99mTc-MAA - 99mTc-macroaggregated albumin

 

Method of application

A patient lies on the examination bed, a detector is targeted on the entire oesophageal and gastric area. Prior to the detection, the patient tries to swallow the amount of food same as the amount to be administered together with a radioactively labelled indicator. Before the labelled food is swallowed, a fast dynamic recording is commenced (0.5 sec/image) using the gamma camera and then the patient swallows the active food. The measurements are focused on the rate and smoothness of swallowing, potential motility disorders, and retention. In the examination of gastroesophageal reflux, the stomach is filled up and then the oesophageal area is scanned with a dynamic recording lasting for 30 minutes (10 sec/image). During this process, we apply the Valsalva manoeuvre or induce coughing to increase the intra-abdominal pressure and induce thus the gastroesophageal reflux.

 

Indications

  • Evidence of swallowing disorders in various pathological conditions
  • Quantitative evaluation of the rate of food passage through the oesophagus
  • Evidence of gastroesophageal reflux

 

Contraindications

  • Pregnancy, lactation (relative) – see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

This examination is carried out on an empty stomach (8 hours without any intake of food); a patient must not smoke prior to the examination. In the examination aimed at the identification of a diagnosis, a patient must discontinue the intake of all medications affecting the oesophageal kinetics; when the therapy effect is assessed, the therapy must be maintained.

 

Radiation burden

Low – activity of the administered radiopharmaceutical is relatively low.

 

Required clinical information

It is necessary to state a clinical question regarding the purpose of examination and the expected answer to be confirmed by the examination. State whether you are interested in the evaluation of swallowing of liquid food (juice) or standardised solid food (sandwich). Examination results and therapy received by the patient.

Note

In the detection of gastroesophageal reflux, scintigraphy is the second-choice method after the pH metrics. We indicate it in the case of a positive clinical finding and a negative result of pH metrics.

Dynamic renal scintigraphy with the captopril test

Examination principle and procedure

In a hemodynamically significant renal artery stenosis, there is a significant reduction of blood flow to the renal area behind the stenosis as well as the reduction of glomerular filtration. A decrease in the perfusion pressure in the juxtaglomerular apparatus of a kidney leads to increased release of renin and to the activation of the renin–angiotensin system. Activation of the renin–angiotensin system leads to the vasoconstriction of efferent arteriole and thus to maintaining the glomerular filtration pressure. Administration of ACEI blocks the conversion of angiotensin I into angiotensin II (activation of the renin–angiotensin system) with a subsequent vasodilation of efferent arteriole. This results in the reduction of postcapillary resistance and subsequent acute and reversible reduction of the glomerular filtration pressure and thus the decrease in the glomerular filtration (GF) in the kidney with a significant renal artery stenosis. Reduction of the production of the primary ultrafiltrate in glomeruli subsequently leads to slower tubular transport of tubular pharmaceuticals. These changes in the kidney function can be detected by scintigraphy. Administration of captopril in the dynamic renal scintigraphy with a present hemodynamically significant renal artery stenosis leads to the temporary “deterioration” of a renography curve and other parameters of the affected kidney. The examination is standardly carried out in form of a repeated dynamic renal scintigraphy. One radionuclide study is carried out in basal conditions without administering captopril, the so-called basal study; the second one is carried out after the administration of angiotensin-converting enzyme (ACEI) inhibitor - captopril, the so-called captopril study. In patients whose hypertension is not caused by renal artery stenosis there is no change in the kidney function in the captopril study, as compared to the basal study. In patients with a hemodynamically significant renal artery stenosis, the renal function of the affected kidney is deteriorated in the captopril study. The principle of the examination is thus the comparison of the parameters measured in the dynamic renal scintigraphy carried out after the administration of ACEI (captopril study) and of parameters obtained in basal conditions (basal study). The examination is carried out as a two-day protocol. The captopril study is carried out as the first one. If the finding in the captopril study is normal, the probability that the patient has renovascular hypertension is low and the basal study is not required. In the case of a pathological finding, the examination is repeated within 7 days without administering captopril. The examination is carried out 60 minutes after the oral administration of captopril; the examination lasts for 30 minutes. During the entire examination, a patient’s blood pressure and heart rate are monitored; in at-risk patients, the i.v. access is introduced.  

 

Radiopharmaceutical

  • 99mTc-DTPA - diethylenetriaminepentaacetic acid
  • 99mTc-MAG3 - mercaptoacetyltriglycine

 

Method of application –intravenous injection.

 

Examination duration

  • approximately 90 minutes together with the administration of captopril

 

Indications

  • differential diagnostics of secondary hypertension in suspected renovascular hypertension to assess the presence of a hemodynamically severe renal artery stenosis

 

Clinical indications

  • malign or accelerated hypertension
  • sudden development or sudden deterioration of hypertension
  • hypertension resistant to the standard therapy
  • onset of hypertension before the age of 30 years or after the age of 55 years
  • deterioration of renal functions during the therapy with ACE inhibitors or angiotensin II receptor blockers
  • unexplainable sudden deterioration of renal functions
  • a small kidney finding, unilaterally
  • repeated congestive heart failure in older patients with hypertension in a bilateral renal artery stenosis as a result of inadequately increased activity of the renin–angiotensin system and aldosterone secretion

abdominal murmurs with the diagnostic importance mainly in young people with dysplasia of renal arteries

Dynamic renal scintigraphy

Examination principle and procedure

It is a functional and morphological examination of kidneys, it facilitates an informative assessment of the size, shape and location of kidneys, perfusion of kidneys, assessment of discharge parameters, the software calculates the separated kidney function (proportion of left and right kidneys in the total function), and the value of total GF. The examinations is focused on the monitoring of a dynamic recording of kinetics and distribution of the radiopharmaceutical in renal parenchyma, its intrarenal transport, excretion into the pyelocaliceal system, and its discharge into ureters and urinary bladder. It is carried out in a lying position on abdomen or in a sitting position, while the detector is in the posterior projection, the examination starts immediately after the i.v. application of a radiopharmaceutical ( 99mTc-DTPA, 99mTc-MAG3) and lasts for 30-40 minutes. A more detailed evaluation of morphology, kidney shape anomalies, dystopia, and structural abnormalities (pyelonephritic scars, susp. tumours, differential diagnostics of columna Bertini), as well as more accurate determination of a separated kidney function are carried out using the static scintigraphy with 99mTc-DMSA.

 

Radiopharmaceutical

  • 99mTc-DTPA - diethylenetriaminepentaacetic acid
  • 99mTc-MAG3 -mercaptoacetyltriglycine

 

Method of application – intravenous injection.

 

Examination duration -30-40 minutes

 

Indications

  • suspected damage to renal parenchyma or discharge disorder
  • in the differential diagnostics of obstructive and nonobstructive hydronephrosis (furosemide stress test)
  • assessment and monitoring of renal function

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • After a meal, well hydrated – 500 -1,000 ml of liquids 30-60 minutes prior to the examination

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding, especially an X-ray of kidneys, i.v.  urography, or CT, biochemical results.

Dynamic scintigraphy of a transplanted kidney

Examination principle and procedure

The same as in the dynamic renal scintigraphy, the difference is in the detector’s position which is set to a frontal projection with regard to the location of the transplanted kidney. The first examination should be carried out 1-3 days after the transplantation and serves as the reference examination. The examination protocol includes also the angioscintigraphy of the transplanted kidney.

 

Radiopharmaceutical

  • 99mTc-DTPA - diethylenetriaminepentaacetic acid
  • 99mTc-MAG3 - mercaptoacetyltriglycine

 

Method of application – intravenous injection.

 

Examination duration - approximately 25-35 minutes

 

Indications

  • diagnostics of post-transplantation complications: acute tubular necrosis, acute and chronic rejection, renal artery thrombosis, urinoma, hematoma, lymphocele
  • damage to the transplanted kidney by the immunosuppressive therapy
  • control of the therapeutic effect

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

after having a meal, well hydrated

 

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding, especially a surgery finding, if the transplantation was carried out just prior to the examination, a USG finding, and laboratory results.

Cholescintigraphy – dynamic hepatobiliary scintigraphy

Examination principle and procedure

After the i.v. administration of a hepatobiliary radiopharmaceutical, we monitor its uptake by hepatocytes, excretion into bile ducts, and passage into duodenum. The examination is started immediately after the i.v. application of the radiopharmaceutical (99mTc-EHIDA/ HIBIDA, 99mTc-HIDA ) in a lying position on the back and it lasts for 60 minutes; further imaging is carried out as required, every hour. To stimulate the gall bladder emptying, fat food is given to a patient during the examination (egg, cheese, chocolate, or milk to newborns and infants). A relative contraindication for the examination is high bilirubin level.

 

Radiopharmaceutical

  • 99mTc-HIBIDA -mebrofenin - trimethyl iminodiacetic acid
  • 99mTc-HIDA

 

Method of application –intravenous injection.

 

Examination duration – 60-90 min

 

Indications

  • congenital abnormalities of bile ducts
  • acute cholecystitis
  • differential diagnostics of cholestasis (differential diagnostics of neonatal jaundice)
  • functional and organic disorders of gall bladder and bile ducts motility
  • dyskinesis of the sphincter of Oddi
  • bile escape detection
  • confirmation of focal nodular hyperplasia of liver

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations
  • Relatively - high bilirubin level.

 

Preparation of patients and required clinical information

A patient should come on an empty stomach, bring some chocolate, cheese, or hard-boiled eggs, or milk for newborns and small children.  

On the examination date it is not allowed to take anticholinergics, choleretics, and opium preparations.

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding, especially the values of bilirubin and liver enzymes.

Lymphoscintigraphy of extremities

Examination principle and procedure

Radioactive colloid is applied into the interstitial tissue in distal parts of lower and upper extremities, from where the colloid particles are transported via the lymph ducts to the tributary lymph nodes. This facilitates the imaging of the lymph system in a corresponding tributary area. The examination is carried out 20-30 minutes after the application of the radioactive colloid and consists of two phases -> phase 1 – in rest, and phase 2 – after the load.

 

Radiopharmaceutical

  • 99mTc-nanocoll

 

Method of application –intradermal, usually 4 incisions into the area between fingers 1-2 and 4-5.

 

Examination duration -approximately 60 minutes

 

Indications

  • differential diagnostics of extremity swellings
  • lymph flux disorders
  • evidence of lymph tissue involution
  • evidence of lymphogenous metastases

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

  • No preparation of patients is required.  Shortly before the examination it is necessary to release, well in advance, any potential bandage and to balance the temperature of an extremity with the ambient temperature (in the case of significantly cold or hot weather). It is recommended not to carry out the examination immediately after a patient comes to the clinic.  

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding.

Lymphoscintigraphy of sentinel lymph nodes with subsequent peroperative detection by the gamma probe

Examination principle and procedure

A sentinel lymph node is the first lymph node in the lymphatic drainage basin which receives the lymphatic drainage directly from a tumour. The purpose of the lymphoscintigraphy of sentinel lymph nodes is to identify their number and locations together with their drainage basin and demonstrate thus lymphatic drainage basins that are potential sites of lymphogenous metastases. Then the surgical biopsy of scintigraphy-detected sentinel nodes is carried out, as well as the histology examination thereof. The subsequent procedure is based on the assumption that if a sentinel lymph node does not contain any metastatic cells, other LNs in the same drainage basin do not contain them either. Subsequent lymphadenectomy with potential preoperative and postoperative complications is not required in patients with a negative histology finding in sentinel lymph nodes. The examination is used mainly for the detection of sentinel LNs in a malign melanoma and breast carcinoma. It can also be applied in cervical carcinoma, carcinoma of large intestine, and other tumour diseases. Radioactive colloid is applied intracutaneously (4-6 incisions) into the area around a scar after the extirpation of lesion - in a malign melanoma, or periareolar incisions - in a breast tumour, from where the colloid particles are transported via lymphatic ducts into tributary lymph nodes. The scanning is commenced immediately after the application with a dynamic recording for the purpose of lymphatic drainage imaging. A patient’s position is chosen depending on the tumour location. 2-4 hours after the application of the radiocolloid, late static recordings are made in various projections. Locations of sentinel lymph nodes are labelled on the patient’s skin in two projections in a surgical position, i.e. in the patient’s position during the planned surgery. That is why it is important to cooperate with a surgeon. The surgery is usually carried out on the following day, using the peroperative gamma probe which will mark in vivo the focus of higher radiopharmaceutical cumulation on the basis of the measured impulses and an acoustic signal, corresponding to a sentinel lymph node. By measuring the impulses of the extirpated LN ex vivo and by measuring the size of the extirpation site, the surgeon will verify a correct choice of a scintigraphy-detected sentinel LN. It is also necessary to carry out a thorough peroperative revision to exclude suspected metastatic LNs.

 

Radiopharmaceutical

  • 99mTc-nanocoll
  • 99mTc-Sentiscint

 

Method of application – intradermal, periareolar

 

Examination duration – approximately 2 –3 hours

 

Indications

  • detection and demarcation of sentinel lymph nodes and subsequent peroperative detection thereof using a gamma probe and surgical dissection

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

This examination does not require any special preparation; patients can eat, drink, and take medicines. Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding.

MIBG scintigraphy of endocrine and neuroendocrine tumours

Radionuclide diagnostics of pheochromocytoma/ paraganglioma/ neuroblastoma

 

Examination principle and procedure

 

Radiopharmaceutical

  • 123I-MIBG, as a noradrenalin analogue, is accumulated in catecholamine secretion granules of neuroendocrine tissues.  The radiopharmaceutical is very slowly applied i.v. The examination is carried out in a lying position on the back. The scanning is carried out 4 hours and 24 hours after the application, in indicated cases also 48 hours after the application.

 

Radiopharmaceutical  

  • 123I-MIBG - meta- iodobenzylguanidine

 

Method of application – slowly intravenously, best through the inserted cannula.

 

Examination duration - approximately 60 - 90 minutes within 1-2 days.

 

Indications

  • hyperplasia of adrenal medulla
  • pheochromocytoma/ paraganglioma, malign pheochromocytoma
  • neuroblastoma
  • other – carcinoid, medullar thyroid carcinoma, gastrinoma, insulinoma, glucagonoma, vipoma

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • blockage of thyroid by chlorigene 2 days prior to the application of a radiopharmaceutical, on the day of application, and 3 days after the application
  • discontinuation of the therapy with sympathomimetics, tricyclic antidepressants, reserpine, labetol, calcium channel blockers, cocaine derivatives

 patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding

Indirect radionuclide cystography

Examination principle and procedure

It is carried out in connection with the dynamic renal scintigraphy after an increased supply of liquids with the aim to physiologically fill up the urinary bladder. In this examination, the urinary bladder is not catheterised. A dynamic recording of the urination process is made while monitoring the regurgitation of active urine from the urinary bladder to ureters or to the pelvis. Passive or active reflux may be detected. The examination is carried out in a sitting position on a chamber pot, while maintaining the patient’s intimacy. The recording is carried out shortly before the urination process starts and terminates after the urination is completed. As the patient’s cooperation is required during the urination scanning, examinations in children are limited by a child’s age and cooperation degree.

 

Radiopharmaceutical

  • 99mTc-DTPA - diethylenetriaminepentaacetic acid
  • 99mTc-MAG3 - mercaptoacetyltriglycine

 

Method of application – intravenous injection.

 

Examination duration - together with a dynamic scintigraphy approximately 60 - 90 minutes

 

Indications

  • diagnostics of vesicoureteral, vesico-renal reflux

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • this examination is carried out in connection with the dynamic renal scintigraphy after an increased intake of liquids with the aim to fill up the urinary bladder physiologically
  • increased intake of liquids

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding

Perfusion scintigraphy of joints and soft tissues

Examination principle and procedure

This examination serves for the detection of focal processes in soft tissues (muscles, joints) and for the determination of their metabolic activity. Radioactive pertechnetate (99mTc O4- ) is increasingly accumulated at locations with increased hyperaemia and with increased metabolic activity. The (99mTcO4 -) radiopharmaceutical is applied i.v., the examination begins immediately after the application and lasts for approximately 60 minutes; a patient’s position is chosen depending on the location of the examined pathological focus or area.

 

Radiopharmaceutical

  • 99mTcO4

 - pertechnetate (sodium pertechnetate)

 

Method of application – intravenous injection.

 

Examination duration - approximately 60 minutes

 

Indications

  • differential diagnostics of pathological foci in soft tissues

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • no special requirements

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding

Perfusion lung scintigraphy (SPECT)

Examination principle and procedure

A radiopharmaceutical in form of 99mTc - labelled macroaggregated albumin is absorbed, after the i.v. administration, in capillaries of well perfused pulmonary areas, while it cannot get into non-perfused areas. Those are visualised on the lung scintigraphy as areas with radioactivity outage. The perfusion defect has often a shape corresponding to the segmental or lobar lung segmentation.

 

It is the imaging of the distribution of pulmonary capillary perfusion and the detection of defects in blood flow through a pulmonary vascular bed. Approximately 0.1% of pulmonary capillaries are microembolised. In a short period of time, macroaggregated albumin is enzymatically degraded in lungs into smaller fragments; they pass through pulmonary capillaries and are caught by the monocyte-macrophage system.

 

This examination is most frequently indicated in suspected pulmonary embolism. However, a perfusion defect may be caused by other reasons. Specificity of this examination is increased by the concurrently carried out ventilation lung scintigraphy: a perfusion defect without a ventilation disorder is typical for pulmonary embolism; a perfusion defect with a concurrent ventilation disorder does not prove pulmonary embolism. A negative finding from the perfusion lung scintigraphy excludes pulmonary embolism.

 

The examination is carried out in a lying position on the back or in a standing position and begins few minutes after the i.v. application (in a lying position) of a radiopharmaceutical (99mTc-macroaggregated albumin) and lasts for 30-40 minutes. In our Centre, the examination of pulmonary perfusion is carried by the perfusion and ventilation lung scintigraphy and subsequently by the SPECT tomography method which significantly increases the sensitivity and specificity of the examination.

 

Ideally, the perfusion lung scintigraphy should be carried out as soon as possible after the occurrence of clinical symptoms (within 5 -7 days).

 

Radiopharmaceutical

  • 99mTc -macroaggregated human serum albumin

 

Method of application – intravenously

 

Examination duration

In the combined ventilation-perfusion lung scintigraphy, the examination begins with the perfusion lung scintigraphy, lasting 15-20 minutes, and follows with the ventilation scintigraphy; a patient may be required to stay in our Centre for several hours.

 

Indications

  • diagnostics of pulmonary embolism and monitoring of the therapy effect (re-perfusion assessment),
  • differential diagnostics of dyspnoe,
  • preoperative assessment of the pulmonary perfusion extent.

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations
  • right-left shunt
  • severe pulmonary hypertension
  • Patients with severe breathlessness who are not able to lay in a horizontal position during the  examinations and patients otherwise not cooperating.

 

Preparation of patients

  • No special requirements, patients can eat, drink, and take their medications.
  • Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding.

 

Note

In comparison with the HRCT of lungs, this examination imposes a lower radiation burden for a patient, it is recommended in women in reproductive age, younger patients, patients with renal diseases and in the case of a negative x-ray.

Radionuclide phlebography

Examination principle and procedure

After the intravenous administration of the 99mTc-MAA radiopharmaceutical (99mTc-macroaggregated albumin) into a peripheral vein of the examined extremities, we monitor the radioindicator flow through the venous system. 99mTc-MAA is then captured in pre-capillaries of lungs and the potential presence of pulmonary embolism is assessed. See the Perfusion Lung Scintigraphy. In examinations of lower extremities, it is applied into leg dorsum veins, while the constrictive bandage is applied under the knees and above the ankle. A recording is made of the flow of the first half of the radiopharmaceutical amount through the veins up to the level of the inferior vena cava. Then the constrictive bandage is released and the second half of the radiopharmaceutical volume is applied, using the same method as with the first recording.

 

In the examination of upper extremities, it is applied into hand dorsum veins. A recording is made of the radiopharmaceutical flow through the veins up to the level of the superior vena cava. Then the recording of the perfusion lung scintigraphy is made.

 

Examination duration

30-60 minutes (depending on the number of examined extremities), symmetric imaging of both lower and upper extremities is recommended.

 

Radiopharmaceutical

99mTc-MAA – macroaggregated albumin labelled with technetium-99m. The maximum recommended activity is divided into a required number of injections and a sufficient volume is supplemented (>2 ml) to maintain the imaging quality.

 

Method of application

Intravenous injection into peripheral veins of extremities. The best method is to use butterfly cannulas and symmetrical, synchronised administration by two employees.

 

Indications

  • Examination of the patency of the deep venous system of lower extremities (with a limited explanatory power for the shin area and a significant explanatory power in the iliofemoral area.
  • Examination of the functional status of the venous system of lower extremities and the inferior vena cava.
  • Examination of the functional status of the venous system of upper extremities, brachial area, and the superior vena cava.
  • Superior vena cava syndrome.

 

Contraindications

  • Pregnancy, lactation (relative) – see the General Contraindications for Nuclear Medicine Examinations

 

 

Preparation of patients

  • Not necessary. It is advisable to warm the extremity (in warm water) to dilate the peripheral venous system.

 

Radiation burden

In the perfusion lung scintigraphy examination the radiation burden is not increased, as the same activity is used in both examinations. In general, it is comparable to a conventional X-ray examination, significantly lower than the CT, and significantly lower than the DSA examination.

 

Required clinical information

A request for the acute indicated perfusion lung scintigraphy should contain the request to examine a suspected section of the affected part of the venous system and the results of the USG (Doppler) of the vascular system of extremities, or the result of other imaging methods. The D-dimmer serum value and other results related to phlebothrombosis and PE.

 

Note

In the case of large swelling of lower extremities, the examination is often impossible to carry out. The examination is bound to the perfusion lung scintigraphy.

Scintigraphy of dopamine transporters in brain - DaTScan 123I-(SPECT)

Examination principle and procedure

The activity of presynaptic dopamine transporters (DaT) in striatum can be evaluated using the 123I-labelled ioflupane - FP-CIT (DaTSCANTM) which is accumulated in striatum. The measurements are focused on the intensity and symmetry of the radiopharmaceutical uptake in nc. caudatus and putamen. The main indication is the differentiation of the Parkinson’s disease and diseases in the Parkinson-plus syndrome group which have a pathological finding, using the 123I-ioflupanee (DaTSCAN), from other forms of Parkinsonian syndromes and essential tremor. The examination also helps in the differentiation of dementia with Lewy bodies, in which the density of dopamine transporters is lower, from the Alzheimer’s disease, in which the finding from this examination is normal.

 

Radiopharmaceutical

  • 123I-ioflupane -FP-CIT (DaTSCANTM)

 

Method of application – intravenous injection.

 

Examination duration

The recording as such lasts for 45-60 minutes. Since the administration of a radiopharmaceutical, usually at about 09:00, a patient waits for the examination for 4 hours.

 

Indications

  • differential diagnostics of the Parkinson’s disease and the Parkinson-plus syndrome from other Parkinsonian syndromes and essential tremor.

 

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations
  • Inadequate patient’s cooperation, in mental problems. A patient must be able to remain lying without moving their head for the entire duration of the examination. If required, the head is fixed and the patient is sedated.

 

Preparation of patients and required clinical information

Patients do not have to come on an empty stomach – adequate intake of food and liquids. It is required to thoroughly adjust the therapy with antiparkinsonics:

 

L-DOPA and its derivatives – NOT NECESSARY to discontinue.

 

Following medications must be discontinued - at least for 48 hours: tricyclic antidepressants, selegiline, Zoloft, Kokain, Adipex, Ritalin, Benzotropin, buproprion.

 

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding.

Scintigraphy of tumours with 67Ga-citrate

Examination principle and procedure

67Ga-citrate is increasingly accumulated in tissues with higher cell proliferation and is able to visualise viable tumorous tissue and a focus of active inflammation. The examination is indicated in the determination of the extent of a tumorous disease, to detect metastases, monitor the therapy success, and detect relapse of a tumorous or an inflammatory disease. It is carried out 24, 48, 72, and sometimes also 96 hours after the application of the radiopharmaceutical.

 

Radiopharmaceutical

  • 67Ga-citrate - gallium citrate
  • Method of application - i.v.

 

Examination duration - approximately 90-120 minutes within 3-4 days.

 

Indications

  • malign lymphoma
  • malign melanoma
  • pulmonary carcinoma
  • bone sarcoma
  • sarcoidosis
  • differential diagnostics of cryptogenic carcinoma and inflammation

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • in the examination of abdominal area - laxatives for emptying the large intestine

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding

Scintigraphy of salivary glands (sialoscintigraphy)

Examination principle and procedure

Functional and morphological examination of salivary glands based on their ability to uptake 99mTcO4- from the blood circulation; the radiopharmaceutical uptake corresponds to the activity of sodium/iodide symporters. It is carried out as a dynamic recording and static recordings are supplemented, if required. The (99mTcO4-) radiopharmaceutical is applied i.v., the examination is carried out in a lying position on the back, it begins immediately after the application, it lasts for 40 minutes, in the second half of the  examination a saliva stimulant is administered (lemon juice). The measurements are focused on the intensity and symmetry of the radiopharmaceutical cumulation in salivary glands and on the rate and intensity of a reaction to the saliva stimulant.

 

Radiopharmaceutical

  • 99mTcO4 - pertechnetate (sodium pertechnetate)

 

Method of application – intravenous injection.

 

Examination duration - approximately 40-60 min

 

Indications

  • Sjögren’s syndrome
  • diagnostics of the functional status and drainage of salivary glands
  • inflammations, sialolithiasis
  • tumours, abscesses, cysts
  • lymphatic infiltration

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • patients should bring a lemon
  • patients must come with an empty stomach (8 hours), prior to the examination they must drink  a larger amount of pure water; 1 hour before the examination it is not allowed to drink sweet, salty, and sour drinks, chew (not even a chewing gum) and brush one’s teeth

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding.

Thyroid scintigraphy

Examination principle and procedure

Radioactive pertechnetate (99mTcO4-) is absorbed in the thyroidal tissue and the rate of its accumulation approximately 30 minutes after the application  is directly proportional to the functional status of the  thyroidal tissue and the to the activity of  sodium/iodide symporters. It is a functional and morphological imaging of thyroidal tissue. The assessment is focused on the shapes, locations, and sizes of thyroid lobes. The detection is focused on foci with lower accumulation of the radiopharmaceutical – cold nodules (cysts, tumours) or foci with increased accumulation of the radiopharmaceutical – hot nodules (hyperfunctional tissue - autonomous adenoma) or the ectopic thyroid  tissue is diagnosed. The (99mTcO4-) radiopharmaceutical is applied i.v., the examination is carried out 30-40 minutes after the application, in a lying position on the back, in the frontal projection, using a pinhole collimator.

 

Radiopharmaceutical

  • 99mTcO4 - pertechnetate (sodium pertechnetate)

 

Method of application – intravenous injection.

 

Examination duration - approximately 15-20 min, the examination is carried out 30-40 min after the application

 

Indications

  • solitary thyroid nodule, multinodular goiter (prior to the surgery)
  • evidence of the functional autonomy of thyroid (autonomous adenoma)
  • diagnostics of retrosternal goiter
  • differential diagnostics of formations on the neck or intrathoracic formations
  • thyroiditis
  • lingual goiter
  • evidence of the presence of the functional thyroidal tissue to exclude or confirm congenital  hypothyreosis

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

  • discontinue a medication affecting the thyroidal function
  • iodine preparations must be discontinued 6-8 weeks prior to the examination
  • the examination may be carried out 6-8 weeks after the contrast radiodiagnostic examination
  • patients may eat, drink, and take medications

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding, especially USG of thyroid and values of T3, T4, TSH

Scintigraphy diagnostics of hepatic haemangioma (SPECT)

Examination principle and procedure

Examination for the purpose of hepatic haemangioma evidence. Hemangioma (angiodysplasia) is visualised as a focus of increased activity due to increased accumulation of labelled erythrocytes. Hemangioma is not visualised, if the supply vessel is thrombosed. The scintigraphy visualises the haemangioma sized at least approximately 10-15 mm. Once the blood sample is collected and after the patient’s erythrocytes are labelled with  99mTcO4- and reinjected, the scanning (or SPECT) of the liver area is commenced; the total duration of the examination is approximately 90 minutes.

 

Radiopharmaceutical

  • 99mTc -labelled native autologous erythrocytes

 

Method of application –intravenous injection.

 

Examination duration -approximately 90 minutes

 

Indications

  • differential diagnostics of focal lesions in liver (differential diagnostics of haemangioma and mts)

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

  • on an empty stomach
  • Chlorigene
  • patients may bring a snack and liquids

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding (USG, CT, MRI)

Scintigraphy diagnostics of tumours containing somatostatin receptors

Examination principle and procedure

The 111In-pentetreotide radiopharmaceutical  (OctreoScan), as the somatostatin analogue, is bound to somatostatin receptors that are expressed in the membrane of neuroendocrine tumours. The scanning is carried out 4 hours, 24 hours, and sometimes also 48 hours after the application, with the administration of 111In-pentetreotide (OctreoScan).

 

Radiopharmaceutical

  • 111In-pentetreotide (OctreoScan)

 

Method of application – intravenous with flushing with the physiological solution

 

Examination duration

  • 120 -180 minutes within 1-3 days.

 

Indications

  • neuroendocrine tumours - primary diagnostics to assess the appropriateness of the therapy using somatostatin analogues, detection of metastases or relapse, assessment of the therapy effect
  • carcinoid
  • other

 

Contraindications

  • Pregnancy, lactation (relative) –see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • in the examination with the OctreoScan - on the day of radiopharmaceutical administration, no preparation is required. After the administration of the radiopharmaceutical, it is necessary to drink a lot of liquids during the whole day, eat yogurts and sour dairy products and meals with high contents of fibres -cereals, müsli, whole-grain pastry, fruit

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding

Scintigraphy examination of blood losses in the GIT using labelled autologous erythrocytes (Meckel’s diverticulum)

Examination principle and procedure

Detection of locations and extent of bleeds, mainly in the lower GIT. Bleeds with the minimum intensity of 0.1-0.2 ml/min are detected as well as a focus of increased accumulation of labelled erythrocytes in abdomen; subsequent change in the focus position caused by intestinal motility proves the bleeding into GIT. The examination facilitates long-term, several hours lasting monitoring of the patient, it is appropriate also in intermittent bleeds. An additional recording can be carried out on the following day. Once the blood sample is collected and a patient’s erythrocytes are labelled, labelled autologous erythrocytes are applied i.v. The examination begins immediately after the application, it is carried out in a lying position on the back, and lasts for 60 minutes. In a negative finding in the initial dynamic recording, other static recordings are made approximately every hour or again on the next morning. If required, a SPECT recording is also carried out to identify a more accurate anatomic location of s bleeding source. The examination is only meaningful, if the patient is currently present with signs of gastrointestinal bleeding.

Radiopharmaceutical

  • 99mTc -labelled vital autologous erythrocytes

 

Method of application – intravenous injection.

 

Examination duration - approximately 60 minutes, recordings are made every hour or also the next morning, if required

 

Indications

  • evidence and identification of the bleeding site, mainly in the lower and central part of the digestive tract (polyps, diverticula, bleeding Meckel’s diverticulum)

 

Contraindications

  • Pregnancy, lactation (relative) – see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

Patients should arrive to the clinic with an empty stomach.

Chlorigene – administered to a patient in form of tablets in our clinic, in the morning prior to the examination.

Scintigraphy diagnostics of the Meckel’s diverticulum

 

Examination principle and procedure

The Meckel’s diverticulum is a rather frequent malformation present in approximately 2% of the population. The Meckel’s diverticulum contains in 20 % the functional ectopic gastric mucosa which absorbs the 99mTcO4 - radiopharmaceutical and can be thus visualised by the scintigraphy. Ectopic gastric mucosa in the Meckel’s diverticulum is visualised as soon as the radiopharmaceutical is absorbed in the gastric mucosa. The examination is carried out in a lying position on the back, immediately after the intravenous application of the (99mTcO4 -) radiopharmaceutical; the examination lasts for 60-90 minutes. If required, the SPECT recording is carried out as well to identify an exact anatomical location of the Meckel’s diverticulum.

 

Radiopharmaceutical

  • 99mTcO4-pertechnetate (sodium pertechnetate)

 

Method of application – intravenous injection.

 

Examination duration - approximately 90-120 minutes

 

Indications

  • suspected presence of the bleeding Meckel’s diverticulum
  • differential diagnostics of the etiology of bleeding into the digestive tract or atypical pain in abdomen in suspected ectopic gastric mucosa

 

Contraindications

  • Pregnancy, lactation (relative) – see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

Patients should arrive with an empty stomach, as the escape of the digested stomach content which contains increased activity can have negative effects on the examination result (false positivity).

Determination of residual urine using radiopharmaceuticals

Examination principle and procedure

The purpose is to calculate the value of residual urine. The examination is carried out in connection with the dynamic renal scintigraphy. A recording is made above the urinary bladder area prior to and after the urination and the amount of discharged urine is measured. The measured values are used to calculate the residual urine.  

 

Radiopharmaceutical

  • 99mTc-DTPA - diethylenetriaminepentaacetic acid 
  • 99mTc-MAG3 - mercaptoacetyltriglycine

 

Method of application – intravenous injection.

 

Examination duration - in connection with the dynamic scintigraphy - total duration approximately 60-90 minutes

 

Indications

  • determination of residual urine

 

Contraindications

  • Pregnancy, lactation (relative) – see -> General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

The examination is carried out in connection with the dynamic renal scintigraphy, except for the increased intake of liquids it does not require any preparation of the patient.

Static renal scintigraphy (+ SPECT)

Examination principle and procedure

The radiopharmaceutical is cumulated and fixed for a certain period of time in cells of proximal tubules of kidneys, depending on their functional status, which facilitates the visualisation of the status of functional renal parenchyma, assessment of the location, shapes, and sizes of kidneys, calculation of the separated function, and detection of focal lesions. The (99mTc-DMSA) radiopharmaceutical is administered i.v.; the examination is carried out 2-4 hours after the application in a lying position on the back or on the stomach, or in a standing position; the examination lasts for approximately 15-20 minutes; the SPECT examination lasts for 30-45 minutes.

 

Radiopharmaceutical

99mTc-DMSA - dimercaptosuccinic acid

 

Method of application –intravenous injection.

 

Examination duration

  • approximately 20 minutes, the SPECT examination lasts for 30-45 minutes, the examination is carried out 2-4 hours after the application of the radiopharmaceutical.

 

Indications

  • confirmation of the renal function, agenesis
  • renal dystopia, ptosis, ren migrans
  • shape anomalies of kidneys, renal hypoplasia
  • pyelonephritis and reflux nephropathy (evidence of a scar – mainly in paediatric nephrology)
  • identification of the proportion of individual kidneys in the total function (separated function)
  • drawing kidneys on a patient’s skin prior to the planned radiotherapy
  • traumatic renal lesions
  • determination of functional residue of a corrugated kidney
  • differential diagnostics of focal processes in kidneys – differential diagnostics of tumours and columna Bertini

 

Contraindications

  • Pregnancy, lactation (relative) – see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

  • no special requirements, patients may eat, drink, and take medicines
  • insertion of an intravenous cannula in small children - necessary cooperation with a paediatrician

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding, especially USG of kidneys

Static scintigraphy of liver and spleen (SPECT)

Examination principle and procedure

After the application, the administered radiopharmaceutical is fast absorbed by Kupffer cells in liver, with regard to the presence of phagocytic reticuloendothelial cells in the spleen, the spleen is visualised as well. The distribution of the radiopharmaceutical in the parenchyma of liver and spleen is proportionate to the phagocytic ability of RES, reflecting the functionality of parenchyma. The examination begins with the projection in a lying position on the back and continues with lateral projections and a posterior projection. It may be supplemented with the SPECT method.

 

Radiopharmaceutical

  • 99mTc-Sn-colloid, Nanocoll

 

Method of application –intravenous injection.

 

Examination duration - approximately 45-60 minutes

 

Indications

  • focal diseases of liver – abscesses, cysts, tumours
  • diffusion diseases of liver, cirrhosis
  • focal nodular hyperplasia of liver
  • quantitative evaluation of the activity of MMS in liver and spleen and hepatic portal circulation
  • evidence of asplenia, accessory spleen and posttraumatic splenosis, evidence of functionality of spleen tissue after surgical re-implantation (or also as the selective spleen scintigraphy)

 

Contraindications

  • Pregnancy, lactation (relative) – see  General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients and required clinical information

  • no special requirements

Patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding (especially a USG finding or CT, MRI)

Ventilation lung scintigraphy

Examination principle and procedure

It is the imaging of the distribution of pulmonary alveolar ventilation and the detection of disorders of lung ventilation. The (81mKr) radiopharmaceutical is applied by inhalation in form of inert gas, using a mask; the examination is carried out during the inhalation, depending on the patient’s health condition, in a lying, sitting, or standing position.

 

Radiopharmaceutical

  • 81mKr -krypton

 

Method of application – inhalation. 


Patients inhale the inert gas, which is odourless, through the inhalation mask. The gas is released from a special generator.

 

Examination duration - approximately 10-15 minutes. In the combined ventilation-perfusion lung scintigraphy, the examination begins with the ventilation lung scintigraphy and continues with the subsequent perfusion lung scintigraphy or the SPECT method. Patients may be required to stay in our centre for several hours.

 

Indications

  • In suspected pulmonary embolism, to supplement the perfusion lung gammagraphy to increase its specificity. Perfusion defect without a ventilation disorder is typical for pulmonary embolism; a perfusion defect with a concurrent ventilation disorder does not prove pulmonary embolism.
  • Evidence of disorders of patency of peripheral airways and loss of airiness with the identification of its extent.

 

Contraindications

  • Pregnancy, lactation (relative) – see the General Contraindications for Nuclear Medicine Examinations

 

Preparation of patients

  • no special requirements, patients may eat, drink, and take medications

patients must bring their results and photo documentation of performed examinations that might contribute to the correct interpretation of a scintigraphy finding