Principles of Nuclear Medicine: Self-Assessment and Board Review

839 Pages·2018·4.825 MB·English

by  Majid Assadi, Hojjat Ahmadzadehfar, Hans-Jürgen Biersack

Principles of Nuclear
Medicine
Self-Assessment and Board
Review
Majid Assadi
Hojjat Ahmadzadehfar
Hans-Jürgen Biersack
123
Principles of Nuclear Medicine
Majid Assadi • Hojjat Ahmadzadehfar
Hans-Jürgen Biersack
Principles of Nuclear
Medicine
Self-Assessment and Board Review
Majid Assadi Hojjat Ahmadzadehfar
Department of Nuclear Medicine Department of Nuclear Medicine
Bushehr University of Medical Sciences University Hospital Bonn
Bushehr Bonn
Iran Germany
Hans-Jürgen Biersack
Department of Nuclear Medicine
Univerity Hospital Bonn
Bonn, Nordrhein-Westfalen
Germany
ISBN 978-3-319-91700-9 ISBN 978-3-319-91701-6 (eBook)
https://doi.org/10.1007/978-3-319-91701-6
Library of Congress Control Number: 2018955704
© Springer International Publishing AG, part of Springer Nature 2018
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Preface
Principles of Nuclear Medicine: Self-Assessment and Board Review features more
than 4000 review questions along with answers through the 9 chapters and 133
subsections.
This guidebook has almost everything required for preparation for the national
and international nuclear medicine exams. It serves as both a study guide and an
in-depth review. This study tool is intended to be used in a simple method to help
readers by providing questions to evaluate their understanding of the material. It can
stand alone if the reader has already been exposed to the more comprehensive mate-
rial at some time in the past and is simply looking for a quick review.
Readers find in the book three main purposes. One is to allow the reader to evalu-
ate their current level of nuclear medicine understanding and assessing possible
weak points for further study. Second, it includes subsections to the textbooks,
should the reader wish to pursue a more in-depth study of specific topics. Finally,
practice exams help to familiarize the reader with the process of taking multiple-
choice examinations.
Moreover, it has made every effort to include questions from the entire spectrum
of nuclear medicine fields from basic to clinical fields. Some questions require pro-
found knowledge in basic and clinical nuclear medicine, which are both critical for
the accomplishment of the diagnostic and therapeutic missions.
This book will be useful to scientists and physicians associated with nuclear
medicine fields, e.g., radiologists, oncologists, medical physics, radiopharmacists,
and radiobiologists, and also they may find this to be a valuable resource. Nuclear
medicine is core knowledge in several fields; therefore they may benefit from basic
education in many aspects of nuclear medicine.
Bushehr, Iran Majid Assadi
Bonn, Germany Hojjat Ahmadzadehfar
Bonn, Germany Hans J. Biersack
v
Contents
1 Nuclear Medicine in Tumor Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Radiopharmaceuticals for Cancer Imaging:
Nature, Mechanisms of Localization, and Molecular Targets . . . . . 1
1.2 Radionuclide Imaging of Hepatic Tumors . . . . . . . . . . . . . . . . . . . . 8
1.3 PET in Lymphoma and Malignant Melanoma . . . . . . . . . . . . . . . . . 17
1.4 Parathyroid Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
1.5 Adrenocortical Scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
1.6 Gallium Scintigraphy in Tumor Diagnosis and Management . . . . . 39
1.7 Thallium-201 Chloride: A Tumor-Imaging Agent . . . . . . . . . . . . . . 50
1.8 MIBG in the Diagnosis of Neuroendocrine Tumors . . . . . . . . . . . . 54
1.9 Peptide-Receptor Scintigraphy in Oncology . . . . . . . . . . . . . . . . . . 59
1.10 Diagnostic Role of Radiolabeled Antibodies in Cancer . . . . . . . . . 65
1.11 Cancer Cell Biology: The Basics of Nuclear Oncology Imaging . . 72
1.12 Differential Thyroid Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
1.13 Medullary Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
1.14 Breast Scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
1.15 Pediatric Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
1.16 Functional Analysis of Cancer Therapy Effects on Other Organs . . 108
1.17 Use of Intraoperative Probes in Surgical Oncology . . . . . . . . . . . . . 112
1.18 Lymphatic Mapping and Sentinel Node Biopsy . . . . . . . . . . . . . . . 114
1.19 PET Imaging of Head and Neck Cancer . . . . . . . . . . . . . . . . . . . . . 120
1.20 External Beam Radiotherapy Treatment Planning with PET . . . . . 124
1.21 PET in Aerodigestive Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
1.22 PET in Gynecological Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
1.23 PET Imaging in Pediatric Oncology . . . . . . . . . . . . . . . . . . . . . . . . 154
1.24 PET in Genitourinary Tumors: Prostate, Bladder, Testicular,
and Renal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
1.25 Future Clinical Applications of PET: Amino Acid
and Nucleoside Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
1.26 PET Imaging of Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
1.27 Current and Future Directions in PET Technology . . . . . . . . . . . . . 170
vii
viii Contents
1.28 PET-MRI in Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
1.29 Molecular Imaging and Precision Medicine . . . . . . . . . . . . . . . . . . 175
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
2 Nuclear Medicine in Tumor Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 177
2.1 Principles of Radionuclide Therapy . . . . . . . . . . . . . . . . . . . . . . . . . 177
2.2 Dosimetric and Radiobiological Considerations . . . . . . . . . . . . . . . 178
2.3 Dosimetric and Radiobiological Considerations:
Patient-Specific Dosimetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
2.4 Benign Thyroid Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
2.5 Radionuclide Therapy of the Thyroid: Treatment of Thyroid
Malignancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
2.6 Phosphorus-32 Therapy in Myeloproliferative Disease . . . . . . . . . . 213
2.7 Palliation of Bone Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
2.8 Therapeutic Use of Radiolabeled Antibodies:
Hematopoietic Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
2.9 Therapeutic Use of Radiolabeled Antibodies:
Hematopoietic Tumors (Solid Tumors) . . . . . . . . . . . . . . . . . . . . . . 228
2.10 MIBG Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
2.11 Receptor-Targeted Radiopeptide Therapy . . . . . . . . . . . . . . . . . . . . 232
2.12 Use of Labeled Lipiodol in the Treatment of Hepatic Tumors . . . . 235
2.13 Alternative Approaches to Targeting Therapy . . . . . . . . . . . . . . . . . 237
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
3 Nuclear Medicine in Bone and Joint Disorders . . . . . . . . . . . . . . . . . . 239
3.1 Bone Scintigraphy: Procedure and Interpretation . . . . . . . . . . . . . . 239
3.2 Evaluation of Primary Bone Tumors . . . . . . . . . . . . . . . . . . . . . . . . 260
3.3 Evaluation of Malignancy: Metastatic Bone Disease . . . . . . . . . . . 276
3.4 Assessment of Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
3.5 Radionuclide Assessment of a Painful Joint Prosthesis . . . . . . . . . . 302
3.6 Vascular Manifestations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
3.7 Bone Scintigraphy in Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
3.8 Bone Scintigraphy in Sports Medicine . . . . . . . . . . . . . . . . . . . . . . 326
3.9 Growth and Metabolic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
3.10 Arthritis: Current Status of Scintigraphy and Future Trends . . . . . . 343
3.11 Radiation Synovectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
4 Nuclear Medicine in Gastrointestinal Function . . . . . . . . . . . . . . . . . . 349
4.1 Salivary Gland Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
4.2 Esophageal Function (Transport and Motility) . . . . . . . . . . . . . . . . 355
4.3 Gastric Motility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
4.4 Intestine: Evaluation of Absorption . . . . . . . . . . . . . . . . . . . . . . . . . 366
4.5 Studies on Small Bowel and Colonic Transit. . . . . . . . . . . . . . . . . . 372
4.6 Hepatobiliary Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
4.7 Scintigraphic Measurement of Hepatic Function . . . . . . . . . . . . . . 380
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Contents ix
5 Nuclear Medicine in Acute Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
5.1 Nuclear Cardiology and Cardiac Transplantation . . . . . . . . . . . . . . 383
5.2 Cardiovascular Conditions: Venous Thrombosis . . . . . . . . . . . . . . . 384
5.3 Pulmonary Embolism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
5.4 Non-embolic Disease of the Lungs . . . . . . . . . . . . . . . . . . . . . . . . . 406
5.5 Gastrointestinal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
5.6 Cholescintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
5.7 Neonatal Hyperbilirubinemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
5.8 Nuclear Medicine in the Acute Care of Neurological Patients . . . . 432
5.9 Radiolabeled Agents for the Localization of Infection
and Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
5.10 Undiagnosed Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
5.11 Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
5.12 Nuclear Imaging in Cardiovascular Infection
and Cardiac Transplant Rejection . . . . . . . . . . . . . . . . . . . . . . . . . . 451
5.13 The Immunocompromised Patient . . . . . . . . . . . . . . . . . . . . . . . . . . 452
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
6 Nuclear Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
6.1 Radiopharmaceuticals for the Study of the Heart . . . . . . . . . . . . . . 457
6.2 Radionuclide Ventriculography and the Assessment
of Impaired Ventricular Function . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
6.3 Infarct Avid Imaging and Myocardial Perfusion Scintigraphy
Techniques Using Single-Photon Radiotracers . . . . . . . . . . . . . . . . 478
6.4 Positron Emission Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489
6.5 Cardiac Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492
6.6 Detection of Coronary Artery Disease . . . . . . . . . . . . . . . . . . . . . . . 499
6.7 Prognosis of Patients with Known or Suspected Coronary
Artery Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 510
6.8 Assessment After Myocardial Revascularization. . . . . . . . . . . . . . . 517
6.9 Assessment of Myocardial Viability in Dysfunctional
Myocardium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520
6.10 Myocardial Infarction: Assessment of Thrombosis . . . . . . . . . . . . . 527
6.11 Congenital Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528
6.12 Single-Photon Imaging of Myocardial Metabolism:
Role of Iodine-123 Fatty Acids and Fluorine-18 Deoxyglucose . . . 531
6.13 Clinical Applications of Positron Emission Tomography
in Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532
6.14 Myocardial Innervation: Imaging and Quantification . . . . . . . . . . . 533
6.15 Nuclear Medicine Techniques in the Assessment
of Human Thrombosis and Atheroma . . . . . . . . . . . . . . . . . . . . . . . 536
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
x Contents
7 Nuclear Medicine in Neurological and Psychiatric Diagnosis . . . . . . 539
7.1 Blood–Brain Barrier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
7.2 Lipophilic Tracers: The Amines . . . . . . . . . . . . . . . . . . . . . . . . . . . 541
7.3 Lipophilic Tracers for the Study of Regional
Cerebral Blood Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
7.4 Ligands for Neuroreceptor Imaging by Positron
or Single-Photon Emission Computed Tomography . . . . . . . . . . . . 547
7.5 PET Tracers for Brain Scanning . . . . . . . . . . . . . . . . . . . . . . . . . . . 549
7.6 Neuroactivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
7.7 Image Analysis Through Brain SPECT and PET . . . . . . . . . . . . . . 552
7.8 SPECT Brain Imaging in Cerebrovascular Disease . . . . . . . . . . . . . 554
7.9 Nuclear Medicine in the Management of Patients
with Epilepsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562
7.10 Nuclear Medicine and the Management of Patients
with Parkinsonian Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 568
7.11 Anxiety Disorders and Effective Disorders . . . . . . . . . . . . . . . . . . . 573
7.12 Addictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
7.13 Management of Patients with Schizophrenia . . . . . . . . . . . . . . . . . . 580
7.14 PET and SPECT Imaging in Evaluating Alzheimer’s Disease
and Related Dementias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582
7.15 Nuclear Medicine and Drug Studies on the Brain . . . . . . . . . . . . . . 588
7.16 Cerebrospinal Fluid Physiology, Clearance Flow Studies,
and Cerebrospinal Fluid Shunt Studies . . . . . . . . . . . . . . . . . . . . . . 589
7.17 Clinical PET-MRI in Neuropsychiatric Disorders . . . . . . . . . . . . . . 596
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598
8 Nuclear Medicine in Renal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . 599
8.1 Overview of Renal Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . 599
8.2 Radiopharmaceuticals: Their Intrarenal Handling
and Localization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600
8.3 Dynamic and Static Renal Imaging . . . . . . . . . . . . . . . . . . . . . . . . . 608
8.4 Quantitative Evaluation of Clearance . . . . . . . . . . . . . . . . . . . . . . . 614
8.5 Measurement and Interpretation of Renal Transit Times . . . . . . . . . 619
8.6 Role of PET in Renal Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . 620
8.7 Renal Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
8.8 Pediatric Nephro-urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 624
8.9 Nuclear Medicine in the Clinical Diagnosis and Treatment
of Obstructive Uropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 639
8.10 Vascular Disorders, with Emphasis on Hypertension . . . . . . . . . . . 648
8.11 Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 659
8.12 Renal Space-Occupying Lesions and Trauma . . . . . . . . . . . . . . . . . 661
8.13 Renal Transplant Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 662
8.14 Genital Tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 675
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683
Contents xi
9 Basic Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685
9.1 Cell Biology Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685
9.2 Radionuclide Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686
9.3 Fundamentals of Radiochemistry . . . . . . . . . . . . . . . . . . . . . . . . . . 690
9.4 Radiopharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695
9.5 Basic Physics and the Detection and Counting
of Radiation in Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . 704
9.6 Nuclear Medicine Imaging Instrumentation . . . . . . . . . . . . . . . . . . 733
9.7 Nuclear Medicine Computers: Basic Principle . . . . . . . . . . . . . . . . 749
9.8 Nuclear Medicine Computers: Applications . . . . . . . . . . . . . . . . . . 752
9.9 Single-Photon Emission Computed Tomography . . . . . . . . . . . . . . 755
9.10 Positron Emission Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . 760
9.11 Molecular Imaging Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . 767
9.12 Radiation Protection and Dosimetry in Clinical Practice . . . . . . . . 769
9.13 Clinical Decision-Making: An Introductory Quantitative
Approach to Diagnostic Investigations . . . . . . . . . . . . . . . . . . . . . . 793
9.14 Decision Analysis Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . . 798
Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 799
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 801