The Pathophysiologic Basis of Nuclear Medicine PDF
Preview The Pathophysiologic Basis of Nuclear Medicine
AbdelhamidH.Elgazzar(Ed.)ThePathophysiologicBasisofNuclearMedicine SecondEdition Abdelhamid H. Elgazzar (Ed.) The Pathophysiologic Basis of Nuclear Medicine Second Edition With325Figuresin676Partsand87Tables AbdelhamidH.Elgazzar,MD,FCAP Diplomate,AmericanBoardofPathology Diplomate,AmericanBoardofNuclearMedicine ProfessorandChairman DepartmentofNuclearMedicine FacultyofMedicineKuwaitUniversityHealthSciencesCenter POBox24923,13110Safat,Kuwait ISBN3-540-23992-8 Springer-VerlagBerlinHeidelbergNewYork LibraryofCongressControlNumber:2006931132 Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations, recitation,broadcasting,reproductiononmicrofilmorinanyotherway,andstorageindata banks.Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisions oftheGermanCopyrightLawofSeptember9,1965,initscurrentversion,andpermissionfor usemustalwaysbeobtainedfromSpringer-Verlag.Violationsareliableforprosecutionunder theGermanCopyrightLaw. SpringerisapartofSpringerScience+BusinessMedia http://www.springer.com ˇ Springer-VerlagBerlinHeidelberg2006 PrintedinGermany Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformationaboutthe applicationofoperativetechniquesandmedicationscontainedinthisbook.Ineveryindividual casetheusermustchecksuchinformationbyconsultingtherelevantliterature. Editor:Dr.UteHeilmann DeskEditor:WilmaMcHugh Copy-editing:WSEditorialLtd,Shrewsbury,UK ProductionEditor:JoachimW.Schmidt Coverdesign:eStudioCalamar,Spain Typesetting:FotoSatzPfeiferGmbH,D-82166Gräfelfing Printedonacid-freepaper–24/3150–543210 To Heba, Moda and Kareem Preface to the First Edition Thereisagreatdifferencebetweenthesuperficialreadingofafilmandtheproper interpretationofaclinicalscintigraphicimagebyanimagingspecialist.Fullyutiliz- ingtheclinicalimage,theimagingspecialistevaluatesboththeanatomicalandthe physiologicalstructureofthehumanbody.Firstthespecialistmustappreciatethe patient’sclinicalproblem.Workingfromthisclinicalcontext,hethenapplieshisun- derstanding of the pathophysiological basis of disease and his knowledge of how suchpathologymaytranslateintovariousimagingpatterns.Thisawarenessofthe impactofpathophysiologyonimagingstudiesiscriticaltotheproperpracticeof nuclearmedicine. Nuclear medicine is a unique and growing medical specialty that contributes mostsignificantlytoourunderstandingofthefunctionalchangeswhichaccompany disease. In this way, nuclear medicine helps to advance scientific understanding. Boththediagnosticandthetherapeuticaspectsofnuclearmedicinerelyfortheiref- ficacyonthephysiologicalchangesproducedbydisease.Clearly,adetailedunder- standingofbothnormalandmorbidpathophysiologyisprerequisitetoasuccessful careerinthisgrowingfieldofmedicine. Todaynuclearmedicineisoneofthemedicalspecialtieswithgreatopportunities forinnovationandcreativethinking.Wearefortunatetobepracticingnuclearmedi- cineatatimeofrapidscientificprogressandsignificantgrowthinourcontributions topatientcareandwell-being.Theresourcesdevotedtonuclearmedicine,however, willbemostprofitablyusedwhenbothresearchersandpracticingphysicianshave takenthetimetounderstandthepathophysiologicalbasisofscintigraphyandradio- nuclidetherapy. Asapracticingnuclearmedicinephysicianandteacher,Iknowthatbeginning students and physicians in both radiology and nuclear medicine have in the past lackedaconcisetextbookwhichfocusesonthepathophysiologicalbasisofnuclear medicine.Ifeelthatthecontributingauthorstothisbookhavecollectivelyfulfilled thisneed.Inaddition,Ihopethatthisbookwillserveasapracticalreferencefor practicing radiologists and nuclear medicine physicians. Given the rapid pace of researchinthefieldofnuclearmedicine,keepinguptodateafterthecompletionof formaltrainingisachallengeforallofus. Along with the contributing authors, I hope that this book will help to spread medicalknowledgeandenhancepatientcarewithinthefieldofnuclearmedicine. AbdelhamidH.Elgazzar,MD,FCAP Forward to the First Edition Diagnostic imaging studies may be interpreted in one of two ways. The initial approach is that of the „imager“, dealing solely with pattern recognition. In this respect,theexperiencedobserverwillsurelyoutperformtheyoungerphysicianwho possessesamorelimitedfundofsuchknowledgeinhisorhermemorybank.The othermeansofinterpretingimagesdrawsbasicpathophysiologyandclinicalknowl- edgeofadiseaseentityintotheinterpretiveprocess.Functionalnuclearmedicine imagingstudiesareexquisitelysensitivebutnotoriouslynon-specific.Forthisrea- son, nuclear medicine is most often used as a screening tool or as a monitor of changesinfunctionwhentherapeuticinterventionsareperformed. Thenon-specificityofradionuclideimagingstudiesmakesitparticularlyimpor- tantthatnuclearmedicinephysicianshaveabroad,in-depthunderstandingofthe basicpathophysiologyofthediseaseprocesseswhichtheyarebeingaskedtostudy. ItisinthisareathatDr.AbdelhamidH.Elgazzarandhismanycolleagueshaveex- celled.Inthefollowing22chapters,theyprovideuswithalucid,systemicpresenta- tionofthepathophysiologyassociatedwithvariousdiseaseprocessesandhowthis knowledgeimpactsonscintigraphicinterpretations.Inadditiontotheclinicalpre- sentations,chaptersdealingwithcellstructureandfunction,radiopharmaceutical localization,biologiceffectsofionizingradiationandradionuclidetherapyprovide veryusefulinformation.Theformatemployedbythisgiftedinternationalpanelof authorsprovidesuswithanextraordinarytextwhichdiffersfromsomeoftheother finepublicationsinourfield.Itremainstruetotheveryessenceoffunctionalimag- ingwhichcharacterizesthefieldofnuclearmedicineanddistinguishesitfromthe moremorphologicallybasedradiologicimagingprocedures. Bothresidentsandactivepractitionersofnuclearmedicinewillprofitfromthe enormousamountofclinicallyrelevantinformationprovidedherein.Thisvolume will surely enhance our role as well-rounded nuclear medicine physicians, as op- posedtobeingmorelimited„imagers“.Itisonlyinthismannerthatwecanfulfillour obligationastrue consultants andplay apivotalrole inassistingpatientmanage- mentdecisions. WearemostindebtedtoDr.Elgazzarandhisco-authorsforenhancingourdiag- nosticskillswiththisextraordinarytextbook. LeonardM.Freeman,MD Preface to the Second Edition Thefieldofnuclearmedicineiscontinuingtogrowrapidly,incorporatingadvances in molecular biology, pathophysiology and molecular imaging. In an effort to ac- commodatethesechangesandbeinlinewiththefuturedirectionofnuclearmedi- cine,wehaveupdatedthefirsteditionofThePathophysiologicBasisofNuclearMedi- cine,buildingonitsstrengthsandmakingmodificationstoremedyanyweakareas. Toreflectnewdevelopmentsintheareaofmolecularimaging,aseparatechapter onthebasisofpositronemissiontomographyhasbeenincluded,moreinformation abouttherapyusingradionuclideshasbeenadded,andthechaptersonthecell,ra- diopharmaceuticaluptake,inflammation,bone,respiratorysystemandneurology havebeenexpanded.Furthermore,theclinicalaspectsoftheroleofmolecularimag- inginnuclearimagingareemphasized,sinceanimagingspecialistmustappreciate thepatient’sclinicalproblemforafullutilizationofnuclearimages.Forinstance,the differencebetweenasuperficialfilmreadingandtheproperinterpretationofaclini- calscintigraphicimagebyaholisticapproachhasbeenhighlighted.Workingfrom this clinical context, the specialist can then apply his or her understanding of the pathophysiologic basis of disease and the knowledge of how such pathology may translateintovariousimagingpatterns.Awarenessoftheimpactofpathophysiology onimagingstudiesiscriticaltotheproperpracticeofnuclearmedicine.Theaddi- tionalinformationaboutclinicalandimagingcorrelationwillmakethistextanim- portantcompaniontothosewhoarebeingtrainedinnuclearmedicinetechnology andclinicalnuclearmedicine. Appreciation is extendedto reviewers of the first editionin several journals as wellasmembersofthenuclearmedicinecommunityfromaroundtheworldfortheir helpfulandmotivatingfeedback,bothpublishedandprivate.Itismysincerehope thatthisbookwillhelpmedicalprofessionalstofurtherunderstandwhatnuclear medicinetechnologycanofferinthediagnosisandtreatmentofdisease.Adeeper understandingofthescientificandclinicalbasisofnewdirectionsinmedicalimag- ingwillcertainlyleadtofurthermodificationsandnewinnovations.Ialsohopethat thisrevisedtextwillhelptoadvanceknowledgeinthefieldofnuclearmedicineand improvecurrentlyavailablediagnosticandtherapeutictoolsinthetreatmentofpa- tientswithvariousdiseases. AbdelhamidH.Elgazzar,MD,FCAP X Acknowledgements ItiswithmydeepestappreciationthatIthankallwhosesinceresupportmadethis edition a reality. To Dr. A.I. Behbehani, Fatma Al-Rasheedi, Jehan Al-Shammari, Dr.JarahAliAl-Tabeekh,AhmedM.Mohammed,MagdiKhalil,HebaEssam,Dr.K. Narayana, Dr. Abdelmonem Omar, Dr. Hussein Abdel-Dayem, James D’Almeida, Veronica Cody, Ayman Taha and to a great pathologist and artist, my very good friendDr.SaifAbdel-Aziz,whopassedawaybeforethiseditionappears,toallIam verygrateful. Contents 1 TheCell:Structure,Function,andMolecularBiology ShankarVallabhajosula,SehamMustafa ......................... 1 2 PathophysiologyandMechanismsofRadiopharmaceuticalLocalization ShankarVallabhajosula,AzuOwunwanne ....................... 29 3 Basisof18F-FDGPositronEmissionTomographyImaging SehamMustafa,AbbasAlavi,AbdelhamidH.Elgazzar ............ 50 4 Inflammation AbdelhamidH.Elgazzar,MagdaElmonayeri ..................... 67 5 NuclearHematology KshitishC.Das .................................................. 90 6 MusculoskeletalSystem AbdelhamidH.Elgazzar,DiaShehab ........................... 132 7 ThyroidGland SalilD.Sarkar ................................................. 209 8 ParathyroidGland AbdelhamidH.Elgazzar ....................................... 222 9 AdrenalGland SleimanNaddaf,AbdelhamidH.Elgazzar ....................... 238 10 BasisofRenalScintigraphy SalilD.Sarkar,PravinC.Singhal............................... 249 11 BasisofTumorImaging1:PrinciplesofTumorPathologyandBiology EzzeldinM.Ibrahim,JaudahA.Al-Maghrabi .................... 264 12 BasisofTumorImaging2:ScintigraphicandPathophysiologicCorrelation SumanJana,HusseinM.Abdel-Dayem ............................ 278 13 RespiratorySystem AbdelhamidH.Elgazzar,MoussaKhadada ...................... 305 14 BasisofCardiacImaging1:MyocardialContractilityandAssessment ofCardiacFunction SherifI.Heiba,MohammadZubaid .............................. 330 15 BasisofCardiacImaging2:MyocardialPerfusion,Metabolism,Infarction, andReceptorImaginginCoronaryArteryDiseaseandCongestiveHeart Failure JosefMachac................................................... 352 16 DigestiveSystem1:GastrointestinalTract FuadHassan,EmanAl-Enizi,AbdelhamidH.Elgazzar ........... 395
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