1. Nuclear Medicine

2. General concept Radiopharmaceutics mCi, MBq (1mCi = 37MBq) Planar image and SPECT image Clinical presentation

3. Neurology imaging 99m Tc-HMPAO : cross to BBB and fix in the brain proportionally to perfusion 18 FDG : glucose metabolism 99m Tc-TRODAT : dopamine transporter 111 In-DTPA, 99m Tc-DTPA : CSF dynamics, V-P shunt patency study

4. Brain Perfusion Scan CVD : as early as 2 hours after the onset of symptoms, evaluate prognosis, Seizure : localize the seizure focus Brain tumor : an ancillary role Dementia : early detect Neuro-psychiatric

7. Radionuclide Cisternography NPH : communicating hydrocephalus, a delay in CSF absorption over the convexity CSF leakage

8. 1 h 2 h4 h 6 h 24 h 48 h

9. Endocrine imaging Thyroid scan : 99m TcO 4 -, 123 I, 131 I, 201 Tl Parathyroid scan : 99m TcO 4 - / 201 Tl subtraction, 99m Tc-MIBI Adrenal cortex scan : NP-59 Adrenal medulla scan : 131 I-MIBG

10. Thyroid scintigraphy Thyroid nodule Congenital hypothyroidism Thyroid cancer follow up 131 I treatment

13. I 131

15. Parathyroid scintigraphy Detection and localization of parathyroid adenoma

17. Adrenal medulla scintigraphy 131 I-MIBG : via the norepinephrine reuptake mechanism into catecholamine storage vesicles of adrenergic nerve ending. Confirm lesion discovered by CT and localize extraadrenal pheochromocytoma, Neuroblastoma, paraganglioma

19. Cardiovascular imaging Perfusion agents : 99m Tc-MIBI, 201 Tl Viability agents : 18 FDG, 201 Tl Multi-gated cardiac function (MUGA): 99m Tc-RBCs Infarct agents : 99m Tc-pyrophosphate Angio-venography : 99m Tc-RBCs

20. 201 Tl

21. Myocardial perfusion scintigraphy Pharmacologic stress test : Dipyridamole, Adenosine Homogeneous, heterogeneous Reversible redistribution Fixed defect Reverse redistribution

28. MUGA (radionuclide ventriculography ) For evaluation of ventricular size, RVEF, LVEF, regional wall motion

30. Angio-venography Lower extremities edema Detection and route out DVT, venous insufficiency, inflammation process, varicose vein,

31. Subcutaneous radionuclide Venography

33. Gastrointestinal imaging Liver-spleen scintigraphy : 99m Tc-sulfur colloid Cholescintigraphy : 99m Tc-DISIDA GI bleeding : 99m Tc-RBC Ectopic gastric mucosal scan : 99m TcO 4 - Gastric empty time

34. Liver-spleen scan 99m Tc-sulfur colloid : Liver (Kupffer ’ s cell)85%, Spleen 10%, Bone marrow 5% Detect the space-occupying lesion and evaluate its reticuloendothelial function, D.D. FNH from the other lesion splenic infarct, accessory spleen. 99m Tc-RBC scan for hemangioma

37. Cholescintigraphy biliary obstruction, D.D. of biliary atresia and neonatal hepatitis, bile leakage Normal : liver (5 mins), intrahepatic biles ducts (10-15 mins), common bile, gall bladder and duodenum duct (15-30 mins), small intestine (>30 mins)

39. 24 h 6 h 1 h 4 h 30 m 15 m5 m 2 h

40. 24h 7h2h4h 1h30m15m5m

42. Skeletal imaging 99m Tc-MDP (bone hydroxyapatite crystal) Regional blood flow, tissue extraction, osteoblastic activity Metastases, osteomyelitis, AVN, stress fx, occult bone trauma, joint prosthesis … sensitivity high, specificity moderate

43. Three phase bone scan

50. Oncologic imaging 67 Ga, 201 Tl, 99m Tc-MIBI, 18 FDG

51. 67 Ga scan Bind to transferrin and accumulate in a wide variety of malignant neoplasms and their metastases Inflammatory image Detection and staging of Hodgkin ’ s disease, non-Hodgkin ’ s lymphoma, melanoma, lung cancer, hepatoma, leukemia, gastric cancer, esophageal cancer …

52. 67 Ga scan

55. Renal imaging Glomerular agents : 99m Tc-DTPA Tubular agents : 99m Tc-MAG3 Cortical agents : 99m Tc-DMSA Diuretic renography Captopril renography

56. Renal scan ( 99m Tc-DTPA) Baseline : GFR, quantitative renal function Lasix : ddx of non-obstructive dilatation & mechanical obstruction, Capoten : renovascular hypertension

59. Renal scan ( 99m Tc-DMSA) Children APN, renal scarring, renal infarct, renal trauma, horseshoe kidney, ectopic kidney, renal cyst, renal abscess, renal tumor.

61. Pulmonary imaging Perfusion image : 99m Tc-MAA (10~90um) Ventilation image : 133 Xe, 99m Tc-DTPA aerosol PIOPED interpretation criteria V/Q mismatch

62. Pulmonary imaging pulmonary embolism, F/U pulmonary embolism after anti- coagulant therapy, perfusion change secondary to lung tumor, pre-operative evaluation for pneumonectomy, post-operative F/U …

63. ANT LEFTLPO POSTRPORIGHT

66. Salivary gland scintigraphy 99m TcO 4 - Symmetric gland accumulation, drainage, increased or decreased function. Salivary gland function, dry mouth, Sjogren ’ s syndrome, parotid tumor, NPC post radiation therapy …

68. Lymphoscintigraphy 99m Tc-sulfur colloid Lymphatic obstruction Detect sentinel lymph node (melanoma, breast cancer … )

70. Testicular/scrotal scintigraphy 99m-TcO 4 - D/D testicular torsion from epididymitis, hydrocele, hematocele, abscess...

71. Gastric empty scintigraphy 99mTc-sulfur colloid in eggs (solid meal) Half-empty time (solid meal,60 土 30min; liquid meal, 30 土 15min) Gastric outlet obstruction or function obstruction, DM gastroparesis, s/p vagotomy, gastrinoma … Follow up and evaluation of the effectiveness of treatment.