Index

Note: Page numbers followed by t refer to tables; b, boxes; f, figures.

A Adrenal medullary imaging, 342–344

Abdomen clinical applications, 342–344
inflammation/infection imaging, 407 neuroblastoma, 342–344
mycotic abdominal aneurysm pheochromocytoma, 342, 343f
18F-FDG PET/CT, 415f MIBG, 342–344
shunt evaluation, 267–270, 268f Adverse reactions, 14–15
99mTc HMPAO leukocytes and, 406 Aerosols
Abscess DTPA, 540
hepatic, 18F-FDG PET/CT, 413f radiolabeled, ventilation imaging, 198–200
liver, 242 Agreement states, 423, 423f
ACE inhibitor. See Angiotensin-converting enzyme AIDS. See Acquired immunodeficiency syndrome
inhibitor Airway disease, lung scan and, 219
Acetazolamide (Diamox), 78–79, 534, 563t Akinesia, 131–132, 187
cisternogram and, 535 ALARA (as low as reasonable achievable) policy,
Acquired immunodeficiency syndrome (AIDS) 423–424, 435
dementia complex, radionuclide brain imaging of, Alpha-particle emission, 1
89–90 Alpharadine. See Radium-223 chloride
gallium imaging, 408–409 Aluminum ion, 17
neoplasm imaging, 201TI, 348 Alzheimer’s disease (AD), 446, 446f, 505
ACR. See American College of Radiology radionuclide brain imaging, 85–88, 87f–89f
Active arthritis, radiolabeled leukocytes, 405 Ambient exposure rate, survey of, 427
Acute cholecystitis, 495–496, 495f, 516 Ambient temperature, PET/CT, 61–62
hepatobiliary imaging, 252–255, 253f, 255b American College of Radiology (ACR), 55
Acute transplant rejection, 339 Amine precursor uptake and decarboxylation (APUD),
Acute tubular necrosis (ATN), 321, 324f–325f, 338, 351–352
473–474, 473f, 511 Anatomic (cortical) imaging, renal, 321, 322f
AD. See Alzheimer’s disease Anatomy
Adenocard. See Adenosine bronchopulmonary, 195, 196f
Adenomas cardiovascular system, 131–132
ectopic mediastinal parathyroid, 479, 479f, 513 respiratory system, 195–197, 196f
hepatic cell, 242 skeletal system, 271
parathyroid, 488–489, 488f, 514–515 Aneurysm, mycotic abdominal, 415f
toxic thyroid, 492–493, 492f, 515 Angiography, perfusion defects on, 211–212, 221b.
Adenopathy, HIV-reactive, 416f See also specific angiography techniques
Adenosine (Adenocard), 563t Angiotensin-converting enzyme (ACE) inhibitor
LBBB and, 168–169 renography, 328–336
pharmacologic stress imaging, 158–159, 539 abnormalities, 334
99mTc-MAG3, 334
patient preparation for, 159
protocol for, 159 scintigraphy, 330–331
ADHD. See Attention-deficit hyperactivity disorder abnormalities, 334
Adolescents. See also Children one-stage protocol for, 333
baseline activity multiple for examination of, 532t protocols for, 332
baseline activity multiplier for examination of, 531t single-day protocol for, 333
class for examination of, 531t two-stage protocol for, 333
minimum activity for examination of, 531t AOR. See Axis of rotation
skeletal system, 273–274, 275f Aorta
Adrenal glands, 315 dissection, PET/CT in, 175
18F-FDG distribution in, 372
imaging, 341–344
pearls and pitfalls, 343b–344b APD. See Avalanche photodiodes
pearls and pitfalls, 343b–344b APUD. See Amine precursor uptake and decarboxylation
pediatric examination, 530t Arrhythmia filtering, 184–185
physiology, 315 Arthritis
radiopharmaceuticals, 315–316 active, radiolabeled leukocytes, 405
glomerular filtration agents, 315–316 aseptic, bone scans, 301–302
renal cortical agents, 316 septic
tubular secretion agents, 316 bone scan, 296–300
18F-FDG PET/CT, 417f
tumor imaging, 353

577
 578 Index

Artifacts Benign non-neoplastic disease (Continued)

attenuation, 62–63, 63f Paget’s disease, bone scans, 300–301, 305f–306f
myocardial perfusion imaging, 145–147, 147f spontaneous osteonecrosis of knee, bone scan, 304
PET/CT, 66, 66f Benign osseous neoplasms, 281–285, 282b
cardiac creep, myocardial perfusion imaging, 148 Beta-particle emission, nuclear stability, 1–2, 2f
crystal, cracked, 63, 64f Bethanechol (Urecholine), 563t
metabolic, 62–63, 63f Bexxar. See Tositumomab
misregistration, 67, 67f BGO. See Bismuth germinate
motion, myocardial perfusion imaging, 148 Bicisate (99mTc-ECD), 74
myocardial perfusion imaging, 145–148, 147f, cerebral blood flow scan, 533–534
162t SPECT, brain imaging, 534
PMT, 63, 64f Bilateral renal artery stenosis, 499–500, 499f, 517
radionuclides examination, 65, 65f Bile duct obstruction, 258–259, 259f
ring, 59–60 Bile leak, 260–261, 262f, 458–459, 458f, 508–509
scaling, myocardial perfusion imaging, 148–149 Biliary atresia, hepatobiliary imaging, 261, 263f
SUV, 66–67, 66f Biliary obstruction, hepatobiliary imaging and, 258–260
technical, 62–69 Biologic half-life, 5
areas of decreased activity, 62–64, 63f Bismuth germinate (BGO), 48
areas of increased activity, 64–69, 65f Bladder cancers, 18F-FDG PET/CT neoplasm
myocardial perfusion imaging, 148 imaging, 391
As low as reasonably achievable. See ALARA policy Blank scan, PET/CT, 62
Ascites Blood flow
hepatic cirrhosis with, 241, 241f coronary, 134, 134f
malignant, bone scans and, 285–286, 290f lung, 196
Aseptic arthritis, bone scans, 301–302 Blood flow scan
Aspergillosis, 489f, 515 cerebral, 533–534
Asthma, lung scan, 226–228, 228f renal, 548
Asymmetric window, 34, 34f Blood pool imaging, 559t–562t
ATN. See Acute tubular necrosis Blood-brain barrier, 71
Atomic number, 1 Bombardment, 3
Atoms, 1 radionuclide production, 3–4
Attention-deficit hyperactivity disorder (ADHD), 90 Bone
Attenuation artifacts, 62–63, 63f cancer, malignant, 389–390
myocardial perfusion imaging, 145–147, 147f cysts, 281–285
PET/CT, 66, 66f disease, metabolic, 302–303
Attenuation correction lymphoma involvement of, 383, 384f
myocardial perfusion imaging and, 147–148, 148f metastases
PET, 50–51, 53, 54f 18F-FDG PET/CT neoplasm imaging, 394

SPECT, 41 prostate cancer and detecting, 280

AU. See Authorized user radiation therapy defect, 280, 281f
Authorized medical physicist, 422 pain, 277–278
Authorized nuclear pharmacist, 422 tumors
Authorized personnel, 422 18F-FDG PET/CT neoplasm imaging, 394, 394f

Authorized user (AU), 421–422, 422b malignant, 280–281

safety issues, 421 Bone imaging
pearls and pitfalls, 440b–441b PET/CT, pediatric examination, 530t
Automatic peaking, 34 SPECT, 547
Autopsy, emergency, 576 99mTc diphosphonates, 519t–520t

Avalanche photodiodes (APD), 33 Bone marrow imaging, 305

Avascular necrosis, bone scan, 303–304, 309f 18F-FDG distribution in, 373–374, 374f

Axis of rotation (AOR), 39 Bone marrow scan, 547–548

quality control, 61
B falsely elevated, 307–308
Back projection, 41–42
filtered, 41–42
PET, 53
Backscatter peak, 33
Baseline activity
multiple, pediatric/adolescent examination, 532t
multiplier, pediatric/adolescent examination, 531t
Becquerels, curies to, 521t, 523t
Behavioral dysfunction, radionuclide brain imaging, 90
Benign non-neoplastic disease
aseptic arthritis, bone scans, 301–302
avascular necrosis, bone scan, 303–304, 309f
bone scans, 300–305, 309f
hypertrophic pulmonary osteoarthropathy, bone scans,
301, 308f
metabolic bone disease, bone scans, 302–303
Bone mineral measurements, 305–309
controversy, 308–309
Bone scans, 449, 449f, 506
breast cancer and, 285–286, 286f
clinical applications, 275–305
aseptic arthritis, 301–302
avascular necrosis, 303–304, 309f
benign non-neoplastic disease, 300–305
benign osseous neoplasms and, 281–285, 282b
cellulitis, 296–300, 301f
CRPS, 305, 310f–311f
diskitis, 300, 304f
hypertrophic pulmonary osteoarthropathy, 301,
308f
malignant bone tumors and, 280–281
metabolic bone disease, 302–303
metastatic disease, 276–280, 278f–279f
osteomyelitis, 296–300, 302f

Bone scans (Continued)
Paget’s disease, 300–301, 305f–306f
radiation therapy, 304–305
septic arthritis, 296–300, 303f
soft-tissue uptake and, 272b, 285–288
spontaneous osteonecrosis of knee, 304
trauma, 272b, 288–296, 294f
dermatomyositis and, 285–286, 290f
extraosseous activity, 285–288, 286b
false-negative rate, 276–277
hepatic activity and, 286b, 288
heterotopic calcification, 286–287, 292f
hyperparathyroidism, 286–287, 291f
liver metastases and, 285–286, 287f
malignant ascites and, 285–286, 290f
malignant pleural effusion and, 285–286, 289f–290f
metastatic disease, cold lesion on, 272b, 280
muscle trauma, 286–287, 291f
myositis ossificans, 286–287, 292f
neuroblastoma and, 285–286, 289f
osteosarcoma metastasis and, 285–286, 288f
ovarian carcinoma and, 285–286, 287f
pediatric examination, 530t
PET/CT, 557
radiation therapy defect, 280, 281f
radiopharmaceuticals, 272, 280b, 286b
renal activity and, 288, 293f, 293b
splenic infarction, 286–287, 291f
superscan, 279–280, 279f
99mTc, 546–547
tumors on, 449, 449f, 506
Brain
lymphoma, 453–454, 453f, 507
neoplasms, imaging, 348
tumors
PET/CT, 80
radionuclide brain imaging and, 79–80, 81f–83f
Brain death, 459–460, 459f, 509
imaging, 533–534
radionuclide brain imaging and, 75–77, 78f
Brain imaging
18F-FDG distribution and, 365
pediatric examination, 530t
PET, with 18F-FDG, 556
PET metabolic, 71
planar, 71–72
radionuclide
AD and, 85–88, 87f–89f
behavioral dysfunction and, 90
brain death and, 75–77, 78f
brain tumors and, 79–80, 81f–83f
cerebellar diaschisis and, 80
cerebral infarction, 77–78, 79f
cerebrovascular disease and, 77–79, 78f
clinical applications, 75–90
CNS, 71–90
dementia and, 84–90, 86t, 87f–89f
epilepsy and, 80–84, 84f–85f
head trauma and, 90
neuropsychiatric disorders and, 90
PET image interpretation, 75, 77f
planar brain imaging, 71–72
SPECT, normal, 74, 76f
SPECT image interpretation, 74–75
substance abuse and, 90
TIAs and, 78–79, 80f
SPECT, 534
Brain perfusion imaging
PET, 72–75
SPECT, 71–75
Index 579
Brain scan
findings, case set, 450–451, 450f, 507
SPECT, normal, 74, 76f
Breakthrough, 6
Breast
BSGI, 554–555
18F-FDG distribution in, 372, 372f
lesions, preoperative localization, 353
Breast cancer
bone scans and, 285–286, 286f
18F-FDG PET/CT neoplasm imaging, 383–384
neoplasm imaging, Cardiolite, 349–351
Breastfeeding, 566
dose limits, 425
radioiodine during, 120, 125
radionuclides and, 12–13
radiopharmaceuticals and, 100, 566t–567t
Breast-specific gamma imaging (BSGI), 349–351
Bronchiectasis, lung scan, 226–228
Bronchitis
chronic, 223
lung scan, 226–228
Bronchopulmonary anatomy, 195, 196f
Brown fat, 18F-FDG distribution in, 368–369, 371f
Bruce multistage treadmill, exercise protocol, 538–539
Bruce treadmill, modified, 538–539
BSGI. See Breast-specific gamma imaging
Budd-Chiari syndrome (hepatic vein thrombosis), 243
C
CAD. See Coronary artery disease
Cadmium zinc telluride (CZT), 40, 137, 351
Calcification
heterotopic, bone scan, 286–287, 292f
metastatic, 302–303, 496–497, 496f, 516–517
Calibration, 426–427. See also Dose calibrators
COR, 60–61
image plane, PET/CT, 62
Camera-based clearances, renal function
quantitation, 321
Cancer
bladder, 18F-FDG PET/CT neoplasm imaging, 391
bone, 18F-FDG PET/CT neoplasm imaging, 389–390
breast
bone scans and, 285–286, 286f
18F-FDG PET/CT neoplasm imaging, 383–384
neoplasm imaging, Cardiolite, 349–351
colorectal, 18F-FDG PET/CT neoplasm imaging,
387–388, 387f
esophageal, 18F-FDG PET/CT neoplasm imaging,
384–386, 385f
gastric, 18F-FDG PET/CT neoplasm imaging, 386–387,
386f
gynecologic, 18F-FDG PET/CT neoplasm imaging, 391
head and neck, 18F-FDG PET/CT neoplasm imaging,
377–378, 377f
hepatocellular, 18F-FDG PET/CT neoplasm imaging,
388–389
lung, 448–449, 448f, 506
18F-FDG PET/CT neoplasm imaging, 378–381, 379f
pancreatic, 18F-FDG PET/CT neoplasm imaging,
389, 389f
prostate
bone metastases detected from, 280
18F-FDG PET/CT neoplasm imaging, 391–392
renal, 18F-FDG PET/CT neoplasm imaging, 391
sigmoid, 387–388, 387f
solid, staging of, 362t–363t, 376
squamous cell lung, 480–482, 480f, 513
testicular, 18F-FDG PET/CT neoplasm imaging, 391–392
 580 Index

Cancer (Continued) Cathode ray tube (CRT)

thyroid gamma scintillation camera, 28–29
18F-FDG PET/CT neoplasm imaging, 378 image manipulation, 34
scan, 536–537 CCK. See Cholecystokinin
thyroid, non-iodine avid, 114–116, 115f–117f Cellulitis
Capoten. See Captopril bone scan, 296–300, 301f
Captopril (Capoten), 328–336, 563t osteomyelitis differentiated from, 297–299
ACE inhibitor renography, 334–336 Center of rotation (COR)
ACE inhibitor scintigraphy, 332–334 calibration, 60–61
renogram, for renovascular hypertension diagnosis, quality control, 55
550–551 Central nervous system (CNS), 71
Carbon-11, 13 CSF imaging, 90–96
characteristics, 519t–520t imaging
Carcinogenesis, radiation, 565 CSF, 90–96
Carcinoid, pulmonary, 352, 354f radionuclide brain, 71–90
Carcinoma lymphoma and involvement in, 383
ovarian, bone scans and, 285–286, 287f pearls and pitfalls, 95b–96b
thyroid, 111–114, 112f radionuclide brain imaging, 71–90
therapy for, 118b–119b, 121 Cerebellar diaschisis, radionuclide brain imaging, 80
transitional cell, 477, 477f, 512 Cerebral blood flow scan, 533–534
Cardiac creep artifacts, myocardial perfusion imaging, 148 Cerebral cisternography, 559t–562t
Cardiac cycle, 132 Cerebral infarction, 77–78, 79f
Cardiac death, 162 Cerebrospinal fluid (CSF)
Cardiac function, radionuclide imaging, 175–193 imaging, 90–96
computer methods, 176–178 clinical application of, 91–96
E-RNA, 183–193 communicating hydrocephalus and, 91–92, 92f
first-pass studies, 178–183 CSF leaks and, 92–93, 93f
gated planar imaging technique, 184–186, 184f–186f noncommunicating hydrocephalus and, 92
GSPECT, 154, 186–188, 186f normal examination and, 91, 91f
clinical applications of, 188–193 radiopharmaceuticals for, 90–91
image interpretation, 182–183 shunt patency and, 93–96, 94f–95f
intracardiac shunts and, 182–183 technique for, 90–91
radiopharmaceuticals, 180, 183–184 leaks, 92–93, 93f
right ventricular function, 182 rhinorrhea, 486, 486f, 514
technique, 180–182, 181f Cerebrovascular disease, 77–79, 78f
Cardiac imaging Cesium-137
18F-FDG protocol for, 173 characteristics, 519t–520t
PET, 169–175 Chemisorption, 272
with 18F-FDG, 555–556 Chemotaxis, 397–399
myocardial perfusion, 170, 172 Chemotherapy
myocardial viability, 172–173 18F-FDG and, 376

N-13 ammonia protocol for, 171–172 cardiotoxicity, GSPECT and, 189–193

radiopharmaceuticals for, 170–172 metastatic disease, skeletal system, 280
Rb-82 CI protocol for, 170–171, 171f Chest pain, evaluation of acute, 167
viability image interpretation for, 173–175 CHF. See Congestive heart failure
Cardiac output, 131 Children
Cardiac rest/stress imaging, PET, 556–557 administered activity for various examinations and, 530t
Cardiac valvular disease, GSPECT and, 190–193 adrenal gland examination, 530t
Cardiolite. See Technetium 99m sestamibi baseline activity
Cardiomyopathy, 161–162 multiple, 532t
dilated, 468–469, 468f, 511 multiplier, 531t
GSPECT and, 189–190, 190f bone imaging, 530t
Cardiotoxicity, chemotherapeutic, 189–193 bone scans, 530t
Cardiovascular abnormalities, lung scan, 232–233, brain imaging, 530t
233f–234f class for examination of, 531t
Cardiovascular system, 131 cystography, 530t
anatomy, 131–132 radionuclide, 551
cardiac function, radionuclide imaging, 175–193 dosage, 529
cardiac imaging, PET, 169–175 European, 529
E-RNA, pearls and pitfalls, 138b gastric emptying, 530t
imaging gastroesophageal reflux, 264
myocardial perfusion SPECT, 132–169 gastrointestinal liquid emptying, 530t
radionuclide, 131 hepatobiliary imaging, 530t
myocardial perfusion imaging, SPECT, 132–169 hydronephrosis in, 328
myocardial perfusion studies, pearls and pitfalls, 138b hyperthyroidism, 119
pearls and pitfalls, 138b lung scan, 530t
physiology, 131–132 Meckel’s diverticulum, 530t
Caregivers, dose limits and, 425 minimum activity for examination of, 531t
Carrier-free isotopes, 4 radiation safety, 125
Catheter, infected central, 415f radionuclide cystogram in, 551
 Index 581

Children (Continued) Collimator (Continued)

renal scan, 530t Meckel’s diverticulum scan, 543
skeletal system, 273–274, 275f multihole, 30
tumor imaging, 530t myocardial perfusion imaging, SPECT, 538
PET/CT, 530t parallel hole, 30–31, 32f
Cholecystitis parathyroid scan, 537
acute, 495–496, 495f, 516 patient-to-detector face distances, effect of, 31, 32f
hepatobiliary imaging, 252–255, 253f, 255b peritoneal shunt patency, 546
chronic, hepatobiliary imaging, 255–258, 257f–258f PET/CT tumor imaging with 18F-FDG, 555
intrahepatic, 485–486, 485f, 514 pinhole, 30
pericholecystic hepatic activity sign, 253 pulmonary perfusion scan, 540
Cholecystokinin (CCK), 253–254, 563t pulmonary ventilation scan
Cholescintigraphy, 261 DTPA aerosol, 540
Chondroblastomas, 281–285, 284f, 498–499, 498f, 517 133Xe, 539

Chromatography radionuclide cystogram in children, 551

radiochemical purity and, 17–18 renal blood flow scan, 548
thin-layer, 17–18 renal scan
Chromium-51 cortical imaging, 548
characteristics, 519t–520t glomerular filtration, 549
Chronic cholecystitis, hepatobiliary imaging, 255–258, tubular function, 549
257f–258f resolution, 35
Chronic myocardial ischemia, 175 rest gated equilibrium ventriculography, 537
Chronic obstructive pulmonary disease (COPD), 198–199, salivary gland imaging, 546
455–456, 455f, 507–508 septal length and, 30–31, 31f
lung scan and, 219, 223–226, 224f–226f somatostatin receptor scan with 111In pentetreotide,
Chronic transplant rejection, 339–340 553
Cimetidine (Tagamet), 249, 563t source-to-camera distances, effect of, 31, 31f
Circumflex coronary artery, 132, 133f SPECT
Cisternography, 534–535 brain imaging, 534
cerebral, 559t–562t liver imaging, 542
collimator, 535 myocardial perfusion imaging, 538
dosimetry, 535 spleen imaging, 542
nuclear imaging, sample techniques, 534–535 spleen imaging, SPECT, 542
radiopharmaceuticals, 534 spleen scan, 541
Citrate, 67Ga, 397 99mTc-pertechnetate, thyroid scan, 535

imaging, 559t–562t thyroid scan

CNS. See Central nervous system cancer, 536
Cobalt-57, 519t–520t 123I, 536

Cobalt-60, 519t–520t 99mTc-pertechnetate, 535

Coincidence time window, 43–44 Colloid scans, 239–240

Cold lesions, on bone scans, 280, 280b distribution, 240
Colitis, ulcerative, 414f 99mTc, 240t

Collateral coronary vessels, myocardial perfusion imaging gastroesophageal reflux, 264

and, 163 Colon cancer metastases, 479–480, 479f, 513
Collimator, 29–31, 30f Colorectal cancer, 18F-FDG PET/CT neoplasm imaging,
bone imaging, SPECT, 547 387–388, 387f
bone marrow scan, 548 Communicating hydrocephalus, CSF imaging and, 91–92,
bone scans, 99mTc, 547 92f
captopril renogram for diagnosis of renovascular Complex regional pain syndrome (CRPS), 305, 310f–311f.
hypertension, 551 See also Pain
cerebral blood flow scan, 533–534 Compton interaction, 44
cisternogram and, 535 Computed tomography (CT), 38. See also CT pulmonary
diuretic renography, 550 angiography; PET/CT; Single-photon emission
esophageal transit, 544 computed tomography; SPECT/CT
evaluation, 61 emission, 38–39
gallium scan for, 552 misregistration of, 67
gamma camera, 29–31, 30f parameters, 53–54
gamma scintillation camera, 29–31, 30f scanner, 62
gastric emptying, 545 Computer methods
gastroesophageal reflux, 544 cardiac function radionuclide imaging, 176–178
gastrointestinal bleeding scan, 543 qualitative data display, cardiac function radionuclide
hepatobiliary scan, 542 imaging and, 176
high-sensitivity, 31 quantitative data display
123I, thyroid scan, 536 cardiac function radionuclide imaging and,
isotope energy and, 30–31 176–178
leukocyte scan, 554 ejection fraction image and, 177
liver imaging, SPECT, 542 functional images and, 177
liver scan, 541 paradox image and, 178, 179f
low-energy, 31 phase and amplitude analysis, 178, 179f–181f
lymphoscintigraphy, 553 stroke volume images and, 177, 178f
 582 Index

Congenital organification defect, imaging, 105, 106f Decay tables (Continued)

Congestive heart failure (CHF) 89Sr, 528t

GSPECT and, 190 99mTc, 525t

lung scan and, 232–233 Dedicated cardiac SPECT, 40

Console controls, 34, 34f myocardial perfusion imaging with, 137
Contamination Deep venous imaging, thrombus detection, 233–235
environmental, 359 Deep venous testing, lung scan and, 219
limits, surface, 576 Defects
test, 433 congenital organification, imaging, 105, 106f
Contour mapping, 228–229, 230f liver, 239
Conversion table, radioactivity, 521t, 523t LV inferior wall, 463–465, 463f, 510
COPD. See Chronic obstructive pulmonary disease myocardial perfusion reverse, 149–150, 151f
COR. See Center of rotation myocardium, 148
Coronary arteries, 132 nonreversible, 149, 151f
circumflex, 132, 133f reversible, 149, 150f
LAD, 132, 133f nonreversible, 149, 151f
Coronary artery disease (CAD), 132–133 nonsegmental, 206
coronary stenosis and, 162–163 pars, 295, 299f
diagnosis, 160–162 perfusion, 201, 206, 206b
GSPECT functional data and, 161–162 angiography, 211–212, 221b
SPECT imaging data for, 160–161 image analysis and, 211–212
GSPECT and, 188 lobar, 219, 220f
multivessel, 502–504, 502f, 518 mismatch, 206–207
myocardial perfusion imaging and, 160–167 nonsegmental, 206
prognosis/risk stratification reverse, 149–150, 151f
GSPECT functional data and, 162 segmental, 206, 207f–211f, 213t
SPECT imaging data for, 162, 189t triple match, 206–207
Coronary blood flow, 134, 134f whole-lung, 219, 220f
Coronary reserve, 134 radiation therapy, 280, 281f
Coronary stenosis, 162–163 reversible, 149, 150f
GSPECT functional data and, 163 segmental
SPECT imaging data and, 162–163 perfusion, 206–207, 207f–211f, 212t
Cortical imaging, renal scan, 548–549 PIOPED concept of, 206
Count rate, 36 Dementia
CRPS. See Complex regional pain syndrome AIDS and, radionuclide brain imaging of, 89–90
CRT. See Cathode ray tube multi-infarct, radionuclide brain imaging, 88
Crystal radionuclide brain imaging, 84–90, 86t, 87f–89f
artifacts, cracked, 63, 64f Dementia with Lewy body (DLB), 89
cracked, 469–470, 469f, 511 Dermatomyositis, bone scans and, 285–286, 290f
detector devices, 31–32 Detector
crystal characteristics and, 31–32 geometry, PET, 49–50, 49f
photon, 32 head alignment, quality control, 61
CSF. See Cerebrospinal fluid DEXA. See Dual energy x-ray absorptiometry
CT. See Computed tomography Diabetic foot infection, radiolabeled leukocytes and, 404
CT pulmonary angiography (CTPA), 203–204 Diamox. See Acetazolamide
lung scan, 219, 221f–222f, 221b Diaschisis, cerebellar, 80
Curies, becquerels to, 521t, 523t Diastolic function, GSPECT quantitative data, 187–188
CXR interpretive criteria. See Radiographic interpretive Diethylenetriaminepentaacetic acid (DTPA), 12, 315–316
criteria aerosol, 540
Cyclosporin nephrotoxicity, 340 cerebral blood flow scan, 533
Cyclotron isotope, production of, 4 pulmonary ventilation scan, 540
Cystic duct sign, 253, 255f purity, testing for, 18
Cystography 99mTc, 198

pediatric examination, 530t ventilation imaging, 203, 204f

radionuclide, 338 Diffuse disorders, liver-spleen imaging, 237, 241
pediatric, 551 Diffuse lung disease, lung scan and, 218–219, 218f
CZT. See Cadmium zinc telluride Diffuse renal disease, 321
Diffuse toxic goiter, imaging, 109, 111f
D Diffuse vasculitis, 484–485, 484f, 514
Data display Diisopropyl IDA, 249–250
qualitative, 176 Dilution studies, unsealed byproduct material, 427
quantitative, 176–178 Dimercaptosuccinic acid (DMSA), 316
Dead time, 36 Diphosphonates, skeletal system, 271
electronic, 25 Dipyridamole (Persantine), 15, 563t
Decay tables LBBB and, 168–169
flourine-18, 527t pharmacologic stress imaging, 158–159, 539
67Ga, 527t image interpretation and, 159
123I, 527t patient preparation for, 158
131I, 528t protocol for, 159
111In, 527t Diskitis, 300, 304f
 Index 583

Diuretic renography, 550 Dosimetry (Continued)

curves, 326, 326f pulmonary perfusion scan, 540
data interpretation, 326, 327f pulmonary ventilation scan
furosemide, 326 DTPA aerosol, 540
uropathy, obstructive, 324–328 133Xe, 540

significant obstruction, 328, 329f radionuclide cystogram in children, 551

DLB. See Dementia with Lewy body renal blood flow scan, 548
DMSA. See Dimercaptosuccinic acid renal scan
Dobutamine (Dobutrex), 563t cortical imaging, 549
pharmacologic stress imaging, 158, 160 glomerular filtration, 549
protocol for, 160 tubular function, 549
Dobutrex. See Dobutamine requirements, 466–467, 466f, 510
Dosages/dose rest gated equilibrium ventriculography, 539
ALARA and, 435 somatostatin receptor scan with 111In pentetreotide, 553
determining, 426 SPECT
effective, 424–425, 435, 436t brain imaging, 534
pediatric, 529 liver imaging, 542
European, 529 myocardial perfusion imaging, 538
radiation, 434t spleen imaging, 542
radionuclide therapy patient hospital release and, spleen imaging, SPECT, 542
570t–571t spleen scan, 541
radiopharmaceuticals, pediatric, 529 99mTc-pertechnetate, thyroid scan, 535

recording, 426 thyroid cancer scan, 536

Dose calibrators, 26–27, 27f, 426 thyroid gland uptake, 100–101
maximum activity, 27 thyroid scan
radiopharmaceutical, 27 123I, 536

Dose limits, 424–425, 424b 99mTc-pertechnetate, 535

breastfeeding, 425 Doxorubicin, 189

caregivers and, 425 DPA. See Dual-photon absorptiometry
embryo/fetus, 425 DTPA. See Diethylenetriaminepentaacetic acid
family and, 425 Dual energy x-ray absorptiometry (DEXA), 306–309,
occupational, 425 312f
public, 425 DPA compared with, 307
Dose medical event, 429–430 Dual-photon absorptiometry (DPA), 307
Dosimetry Dynamic flow imaging, cerebral blood flow scan,
bone imaging, SPECT, 547 533–534
bone marrow scan, 548 Dyskinesia, 131–132, 187
bone scan Dysplasia, fibrous, 281–285, 285f, 487–488, 487f, 514
PET/CT, 557
99mTc, 547 E
brain imaging ECG. See Electrocardiogram
PET FDG, 555 Ectopic mediastinal parathyroid adenomas, 479, 479f,
SPECT, 534 513
breast imaging with gamma camera, breast-specific, Ectopic thyroid tissue, imaging, 104–105, 105f–106f
554 EDTMP. See Ethylene diaminetetra methylene
captopril renogram for diagnosis of renovascular phosphonic
hypertension, 551 EDV. See End-diastolic volume
cardiac rest/stress imaging, PET, 557 Effective dose, 424–425, 435, 436t
cerebral blood flow scan, 533–534 Effective half-life, 5
cisternogram and, 535 Effective renal plasma flow (ERPF), 316
diuretic renography, 550 Ejection fraction, 131
esophageal transit, 544 Ejection fraction images, 177
gallium scan for, 552 Electrocardiogram (ECG), 132–133
gastric emptying, 545 Electronic dead time, sodium iodide well counters and, 25
gastroesophageal reflux, 544 Electrons, 1
gastrointestinal bleeding scan, 544 capture, 2
hepatobiliary scan, 542 gamma emission and, 2
123I, thyroid scan, 536 internal conversion, gamma-ray emissions and, 2–3
leukocyte scan, 555 Emboli
liver imaging, SPECT, 542 fat, 233, 234f
liver scan, 541 pulmonary, 204–205, 205f
lymphoscintigraphy, 553 acute, imaging, 212
Meckel’s diverticulum scan, 543 lung scan clinical applications and, 203–223
myocardial perfusion imaging, SPECT, 538 lung scan follow-up, 221–223
parathyroid scan, 537 Embolism
PET, cardiac rest/stress imaging, 557 PIOPED
PET FDG brain imaging, 555 image interpretation and, 212–213
PET/CT segmental defects and, 206
bone scan, 557 PISAPED, 216
tumor imaging with 18F-FDG, 555 pulmonary, 203–223, 471–472, 471f, 511
 584 Index

Embryo Fat
dose limits, 425 brown
radiopharmaceuticals dose and, 565t–566t 18F-FDG distribution in, 368–369, 371f

Emergency procedures emboli, 233, 234f

autopsy, of patients who have had therapeutic amounts Fatty infiltration, of liver, 240–241
radionuclide, 576 FDG. See Fluorodeoxyglucose
for patients who have had therapeutic amounts Fetus
radionuclide, 576 dose limits, 425
radioactive material spills, 504, 504f, 518, 575, 576t radiation and, 565
major, 575, 576t radiopharmaceuticals dose and, 565t–566t
minor, 575, 576t Fever of unknown origin (FUO)
Emission CT, 38–39 18F-FDG PET/CT, 416–417

Emphysema, 223 imaging

Enalaprilat (Vasotec), 328–332, 563t gallium, 407
ACE inhibitor scintigraphy, 332–333 radiolabeled leukocytes, 401
Enchondromas, 281–285, 283f 18F-FDG. See Fluorine-18 fluorodeoxyglucose

End-diastolic volume (EDV), 131 Fibrous dysplasia, 281–285, 285f, 487–488, 487f, 514
Energy resolution, 34–36 Field of view (FOV), 47–48
FWHM and, 35–36 Field uniformity, 36
Energy window assessment
asymmetric, 34, 34f energy window centering and, 59, 60f
field uniformity assessment and centering, 59, 60f flood-field image, 58–59, 58f
Environmental contamination, intravascular PMT, 58–59, 59f
microsphere, 359 quality control, 57–60, 58f
Epilepsy technetium mixing and, 58–59, 59f
extratemporal lobe, 84 correction, quality control, 59–60
radionuclide brain imaging, 80–84, 84f–85f Filtered back projection, 41–42
temporal lobe, 500, 500f, 517 PET, 53
Equilibrium radionuclide angiography (E-RNA), 175, Filtering
183–193 arrhythmia, 184–185
pearls and pitfalls, 138b image, 42
E-RNA. See Equilibrium radionuclide angiography frequency, 42
ERPF. See Effective renal plasma flow tomographic image production, 42
Esophageal cancer, 18F-FDG PET/CT neoplasm imaging, First-pass radionuclide angiography (FP-RNA), 175,
384–386, 385f 178–180. See also Radionuclides
Esophageal transit, 262–264, 544 Fission, 3
scintigraphy, 262–263 isotopes, 4
time, 264 radionuclide production, 3–4
Ethylene diaminetetra methylene phosphonic (EDTMP), 311 Fissure sign, 217
European pediatric dose, pediatric, 529 Flare phenomenon, 279
Ewing’s sarcoma, 281, 282f Flood-field image
Exametazime (99mTc-HMPAO), 74 field uniformity assessment, 58–59, 58f
Excretion technetium mixing and, 58–59, 59f
fluorine-18, 13 Fluorine-18
67Ga, 11 bone scan PET/CT, 557
123I, 9 characteristics, 519t–520t
131I, 9 decay table, 527t
renography, 319 excretion, 13
half-time, 319 for imaging, 12–13
studies, unsealed byproduct material, 427 Fluorine-18 fluorodeoxyglucose (18F-FDG), 397, 462–463,
99mTc, 7–8, 11f 462f, 509
Exercise protocol, Bruce multistage/modified Bruce administered activity, 364
treadmill, 538–539 cardiac imaging protocol with, 173
Exercise SPECT, 138–139, 139f. See also Single-photon chemotherapy treatments and, 376
emission computed tomography distribution
Exercise stress protocol, myocardial perfusion imaging, aorta, 372
157–160 bone marrow, 373–374, 374f
exercise protocol and, 157–158 brain, 365
patient preparation for, 157 breast, 372, 372f
Exposure, radiation brown fat, 368–369, 371f
ambient, 427 gastrointestinal tract, 372–373, 373f
radiopharmaceuticals and, 434, 434t general, 364–374, 364f
External beam teletherapy, 309–311 genitourinary tract, 373, 373f
Extraosseous activity, bone scan, 285–288, 286b heart, 370
Extratemporal lobe epilepsy, 84 lungs, 372
lymph nodes, 373–374
F muscle, 368–369, 370f
18FNaF. See 18F sodium fluoride PET/CT, 364–374, 364f, 365t–368t
18Fsodium fluoride (18F NaF), 272–273 salivary gland, 365–368
Family, dose limits and, 425 spleen, 373–374
 Index 585

Fluorine-18 fluorodeoxyglucose (Continued) Function imaging

thymus, 368, 370f renal, 317–318, 318f, 322–324
thyroid, 365–368, 369f uropathy, obstructive, 322–328
tonsils, 365–368 Functional images, 177
vocal cord, 365, 369f FUO. See Fever of unknown origin
imaging, 12–13 Furosemide (Lasix), 563t
PET, 74, 75t, 559t–562t diuretic renography, 326
brain imaging, 556 FWHM. See Full width at half maximum
cardiac imaging, 555–556
PET/CT G
distribution of, 364–374, 364f, 365t–368t 67Ga. See Gallium-67
FUO, 416–417 68Ga. See Gallium-68
inflammation/infection imaging, 409–417, 411f–416f Gadolinium oxyorthosilicate (GSO), 48
osteomyelitis, 412–416, 416f Gadolinium-153, 519t–520t
patient preparation for, 361–364 Gallbladder, 255–256
PET/CT, neoplasm imaging with, 361 Gallium-67 (67Ga)
bone metastases, 394 in bowels, 11–12
breast cancer, 383–384 characteristics, 519t–520t
colorectal cancer, 387–388, 387f citrate, 397
esophageal cancer, 384–386, 385f imaging, 559t–562t
gastric cancer, 386–387, 386f decay table, 527t
gastrointestinal stromal tumors, 387 excretion, 11
gynecologic cancers, 391 imaging, 9–12
head and neck cancer, 377–378, 377f abdominal inflammation/infection, 407
hepatocellular cancer, 388–389 clinical applications, 407–409
hepatoma, 388–389, 388f FUO, 407
lung cancer, 378–381, 379f immunocompromised patient, 407–409, 408f
lymphomas, 381–383, 382f infection, 406–409
malignant bone tumors, 389–390 inflammation, 406–409
malignant melanoma, 390–391, 391f localization mechanisms for inflammation/infection, 406
miscellaneous tumors, 392–394, 392f osteomyelitis, 409
occult tumor, 394–395 retroperitoneal inflammation/infection, 407
pancreatic cancer, 389, 389f sarcoidosis, 409, 410f
pearls and pitfalls of, 395b technique, 406–407
PET image quantitation, 374–375 thoracic inflammation/infection, 407
prostate and testicular cancers, 391–392 neoplasm imaging, 345–347, 347f
qualitative image interpretation, 374 clinical applications of, 346–347
renal and bladder cancers, 391 hepatoma, 347, 350f
solitary pulmonary nodule, 378–381, 380t Hodgkin’s disease, 346–347, 349f
thyroid cancer, 378 lymphoma, 346–347, 348f
tumors of unknown primary origin, 394–395 scan, 551–552
whole-body, 375–395 Gallium-68 (68Ga)
radiation treatments and, 376 characteristics, 519t–520t
uptake, 376 radionuclide generator system, 5
factors influencing, 381 Gamma camera
Fluorodeoxyglucose (FDG) breast-specific, breast imaging with, 554–555
adrenal gland imaging, 341–342 collimators, 29–31, 30f
PET, 80 quality control, 55–59
brain imaging with, 555 skeletal imaging with, 273
Focal lesions SPECT, 39–40
miscellaneous, liver-spleen imaging of, 242–243 Gamma emission
spleen scan and, 244 electron capture and, 2
Focal nodular hyperplasia, 242, 243f Gamma scintillation camera, 28f
Food and Drug Administration (FDA), 15 collimator, 29–31, 30f
FOV. See Field of view console controls, 34, 34f
FP-RNA. See First-pass radionuclide angiography count rate, 36
Fractures. See also Trauma CRT, 28–29
bone scan, 288–296, 294f, 294t, 295t crystal detector devices, 31–32
rib, bone scan, 291–292, 295f dead time, 36
stress, 294, 297f–298f field uniformity, 36
fatigue, 297f–298f frame manipulation, 37–38
insufficiency, 294, 298f image acquisition, 36–37
metatarsal, 461–462, 461f, 509 image display and, 37
Frame image processing, 37
manipulation, 37–38 instrumentation, 28–38
mode, 36, 176 operator interaction, 38
Frequency filtering, 42 PACs, 28–29
Frontotemporal dementia (FTD), 88–89. See also performance parameters, 28–29, 29t
Dementia PHA, 28–29, 33–34
Full width at half maximum (FWHM), 35–36, 35f photon detector devices, 31–32
 586 Index

Gamma scintillation camera (Continued) Gated SPECT (Continued)

photon transducers, 32–33 CHF and, 190
PMT, 28–29 myocardial infarction, 188
quality control, 28–38 noncoronary disease, 138b, 188–189
resolution, 34–36 coronary stenosis and, 163
spatial filters, 37, 38f image interpretation, 186–188
temporal filters and, 37 LVEF, 155
Gamma-ray emissions myocardial infarction and, 165, 188
delay, 3 myocardial perfusion imaging, 132–133, 154–157
internal conversion electrons and, 2–3 data display for, 156, 156f–157f
Gastric cancer, 18F-FDG PET/CT neoplasm imaging, interpretation of, 156, 156f–157f
386–387, 386f technique for, 154–155, 155f
Gastric emptying, 264–267, 545 myocardial viability determination and, 166–167, 166f
causes of abnormal, 267, 267b noncardiac surgery, preoperative risk assessment and, 167
delayed, 266f, 267 qualitative data, 176, 187
infant, 267 quantitative data, 187
normal, 266f, 267 diastolic function, 187–188
pearls and pitfalls, 268b systolic function, 187
pediatric examination, 530t for radionuclide imaging
radiopharmaceuticals for, 266 cardiac function, 175, 186–193, 186f
solid meal, 266t, 267 typical post-stress, 154–155
studies, 559t–562t Geiger-Mueller (GM) counter, 23, 24f
uses of, 267 Generation tables, 99mTc, 526t
Gastroesophageal function Generator systems
esophageal transit, 262–264 99Mo-99mTc, 5–6, 6f

gastric emptying, 264–267 dry, 5

gastroesophageal reflux, 264 purity, 16–17
studies, 261–267 wet, 5
Gastroesophageal reflux, 264, 544–545 radionuclide, 5–7
limits, 264, 265f buildup and decay in, 6, 6f
pediatric, 264 elution column inside, 17
Gastrointestinal bleeding, 477–478, 477f, 512 elution times, 6
common causes of, 247 99Mo-99mTc, 5–6, 6f

detecting, 247 photon-emitting, 6–7

lower, 247–248, 248f purity of, 16–17
scan, 543–544 Genitourinary system, 315
small-bowel, 247–248, 247f 18F-FDG distribution in, 373, 373f

studies, 245–248 pearls and pitfalls, 343b–344b

interpretation of, 247–248, 248b physiology, 315
pearls and pitfalls, 268b radionuclide renal evaluation, 316–321
99mTc, 245–246 radiopharmaceuticals, 315–316
Gastrointestinal liquid emptying, pediatric examination, glomerular filtration agents, 315–316
530t renal cortical agents, 316
Gastrointestinal stromal tumors, 18F-FDG PET/CT tubular secretion agents, 316
neoplasm imaging, 387 Geometric efficiency, 24
Gastrointestinal tract, 237 Gestalt image interpretation, 216
abdominal shunt evaluation, 267–270, 268f Glioma, low-grade temporal, 467–468, 467f, 510
18F-FDG distribution in, 372–373, 373f Global hypokinesia, 468–469, 468f, 511
gastroesophageal function studies, 261–267 Glomerular filtration
gastrointestinal bleeding studies, 245–248 agents
hepatic blood pool imaging, 243, 244f adrenal glands, 315–316
hepatobiliary imaging, 249–261 genitourinary system, 315–316
liver-spleen imaging, 237–243 renal scan, 549
Meckel’s diverticulum imaging, 248–249 Glove phenomenon, 275
pearls and pitfalls, 268b Glucagon, 15, 563t
radiolabeled leukocytes, 401, 402f Glucose transporters, 12
splenic imaging, 243–245 GM counter. See Geiger-Mueller counter
Gated planar imaging technique, radionuclide imaging, Goiter, multinodular, 457, 457f, 508
184–186, 184f–186f Gold-198, 20
Gated SPECT (GSPECT), 131. See also Single-photon Graft infection, vascular, 405, 405f
emission computed tomography Granuloma, inactive, 413f
accuracy, 155 Grave’s disease, 463, 463f, 509–510
CAD imaging, 109, 111f
diagnosis and, 161–162 Gravity sedimentation, 399
prognosis/risk stratification, 162 GSO. See Gadolinium oxyorthosilicate
clinical applications, 157, 188–193 GSPECT. See Gated SPECT
CAD, 188 Guidelines for the Clinical Evaluation of
cardiac valvular disease and, 190–193 Radiopharmaceutical Drugs (FDA), 15
cardiomyopathy and, 189–190, 190f Gynecologic cancers, 18F-FDG PET/CT neoplasm imaging,
chemotherapeutic cardiotoxicity, 189–193 391
 Index 587

H Hodgkin’s disease, neoplasm imaging, 346–347, 349f

Half-life, 4–5 Hodgkin’s lymphoma, staging, 376. See also Lymphoma
biologic, 5 Hospitalized radionuclide therapy patients
effective, 5 activities and release of, 570t–571t
physical, 4–5 dose rate and release of, 570t–571t
effective compared with, 5 hospital personnel and, 569
HAMA. See Human antimouse antibody instructions to patients, 572t
Hashimoto’s thyroiditis, 109–111 maintenance records, 572t
Hazard levels, radioactive material, 430–431 NRC and, 569
Head and neck cancer, 18F-FDG PET/CT neoplasm radiation safety and, 569
imaging, 377–378, 377f release criteria, 572t
Head trauma, radionuclide brain imaging, 90 RSO and, 569
Heart, 18F-FDG distribution in, 370 Human antimouse antibody (HAMA), 14
Hemangioma, hepatic cavernous, 466, 466f, 510 Human immunodeficiency virus (HIV), 416f. See also
Hepatic abscess, 18F-FDG PET/CT, 413f Acquired immunodeficiency syndrome
Hepatic activity, bone scans and, 286, 288, 295t Hybridoma, 13
Hepatic blood pool imaging, 243, 244f Hydrocephalus
pearls and pitfalls, 268b communicating, 91–92, 92f
Hepatic cavernous hemangioma, 466, 466f, 510 noncommunicating, 92
Hepatic cell adenomas, 242 Hydronephrosis, 477, 477f, 512
Hepatic cirrhosis, 447, 447f, 506 nonobstructive, 325–326
with ascites, 241, 241f pediatric, renal radionuclide evaluation of, 328
liver-spleen imaging, 240–241 Hyperacute transplant rejection, 339
Hepatic vein thrombosis. See Budd-Chiari syndrome Hyperparathyroidism, 125, 496–497, 496f, 516–517
Hepatitis, neonatal, 452, 452f, 507 bone scans, 286–287, 291f
hepatobiliary imaging, 261, 263f Hyperplasia, focal nodular, 242, 243f
Hepatobiliary imaging, 249–261, 452, 452f, 485–486, Hypertension
485f, 507, 514 pulmonary, lung scan, 223
biliary atresia, 261, 263f renovascular, 330–331, 334, 335f
biliary obstruction and, 258–260 captopril renogram for diagnosing, 550–551
cholecystitis Hypertensive myocardial hypertrophy, 169, 169f
acute, 245b, 252–255, 253f Hyperthyroidism
chronic, 255–258, 257f–258f dose calculations for, 119–120
clinical setting, 252–261 pediatric, 119
acute cholecystitis, 252–255, 253f, 253b primary, 131I therapy of, 117–120, 118b–119b
delayed gallbladder visualization and, 255–256 radioiodine therapy of, 117–120, 118b–119b
IDA, 559t–562t toxic nodular goiter-related, 120
in jaundiced patients, 251–252 Hypertrophic pulmonary osteoarthropathy, 452–453,
neonatal hepatitis, 261, 263f 452f, 507
normal scan, 252 bone scans, 301, 308f
pearls and pitfalls, 268b Hypokinesia, 131–132, 187
pediatric examination, 530t global, 468–469, 468f, 511
pharmacologic adjuncts, 253–254
morphine, 254–255, 256f I
123I.See Iodine-123
sincalide, 254
131I.See Iodine-131
postsurgical, 260–261
post-traumatic, 260–261 Ibritumomab tiuxetan (Zevalin)
radiopharmaceuticals, 249–250 radiation safety, 357
scintigraphy, 260, 261f–262f radioimmunotherapy, 356
90Y, radioimmunotherapy, 356–357, 357f
technique, 250–252, 251f–252f
Hepatobiliary scan, 542–543 ICANL. See Intersocietal Commission on the Accreditation
Hepatocellular cancer, 18F-FDG PET/CT neoplasm of Nuclear Medicine Laboratories
imaging, 388–389 IDA. See 99mTc-iminodiacetic acid
Hepatocyte function, 259, 260f Image acquisition
Hepatoma, 242, 242f, 451–452, 451f, 507 gamma scintillation camera, 36–37
18F-FDG PET/CT neoplasm imaging, 388–389, 388f PET, 52–53
intravascular microspheres, 358–360 filtered back projection and, 53
neoplasm imaging, 67Ga, 347, 350f quality control, 36–37
Heterotopic calcification, bone scan, 286–287, 292f SPECT and time of, 41
Hexamethylpropyleneamine oxime (HMPAO), 397 three-dimensional, 52–53
cerebral blood flow scan, 533 disadvantages of, 53
SPECT, brain imaging, 534 Image analysis
Hibernating myocardium, 173–174, 173f–174f lung scan, 207–212
High probability, 213, 214f–215f perfusion defects and, 211–212, 212t
Hip prostheses assessment, 295, 300f Image display
osteomyelitis and, 295–296, 300f gamma scintillation camera, 37
Histiocytosis, 18F-FDG PET/CT neoplasm imaging, instrumentation, 37
393 quality control, 37
HIV. See Human immunodeficiency virus SPECT, myocardial perfusion, 142, 144f
HMPAO. See Hexamethylpropyleneamine oxime tomographic image production, 42
 588 Index

Image filtering Imaging (Continued)

frequency, 42 retroperitoneal inflammation/infection, 407
ramp, 42 sarcoidosis, 409, 410f
tomographic image production, 42 technique, 406–407
Image interpretation thoracic inflammation/infection, 407
18F-FDG PET/CT neoplasm, 374 gamma scintillation camera
Gestalt, 216 spatial filters, 37
GSPECT, 186–188 temporal filters, 37
lung scan, 211–212 hepatic blood pool, 243, 244f
airway disease and, 219 pearls and pitfalls, 268b
ancillary signs and, 217 hepatobiliary, 249–261
clinical information incorporated into, 216–217 acute cholecystitis, 252–255, 253f, 253t
criteria for, 212–216 biliary atresia, 261, 263f
diffuse lung disease and, 218–219, 218f biliary obstruction and, 258–260
Gestalt, 216 chronic cholecystitis, 255–258, 257f–258f
optimizing, 216–217 clinical setting, 252–261
perfusion defects and, 219, 220f neonatal hepatitis, 261, 263f
PIOPED and, 212–213 normal scan, 252
PISAPED and, 216 pearls and pitfalls, 268b
pleural effusions and, 217–218 pharmacologic adjuncts, 253–254
special situations and, 217–219 postsurgical, 260–261
triple matches location and, 219 post-traumatic, 260–261
Image plane calibration, PET/CT, 62 radiopharmaceuticals, 249–250
Image processing scintigraphy, 260, 261f–262f
gamma scintillation camera, 37 technique, 250–252, 251f–252f
PET, 52–53 123I, 8–9

Image production, tomographic 131I, 8–9

image display, 42 111In, 12

image filtering, 42 infection, 397

image reconstruction, 41–42 18F-FDG PET/CT, 409–417, 411f–416f

instrumentation, 41–42 gallium, 406–409

quality control, 41–42 pearls and pitfalls of, 418b
Image quantitation, PET, 374–375 radiolabeled leukocytes, 397–406
Image reconstruction radiopharmaceuticals, 397, 398t
iterative algorithms, 42 99mTc HMPAO leukocytes, 405–406

tomographic, 41–42 inflammation, 397

Imaging. See also specific imaging techniques 18F-FDG PET/CT, 409–417, 411f–416f

adrenal gland, 341–344 future agents for, 417–419

adrenal medullary, 342–344 gallium, 406–409
clinical applications, 342–344 pearls and pitfalls of, 418b
bone marrow, 305 radiolabeled leukocytes, 397–406
cardiac, PET, 169–175 99mTc HMPAO leukocytes, 405–406

cardiovascular system, radionuclide, 131 interictal, 84, 85f

CNS, 71–96 liver-spleen, 237–243
congenital organification defect, 105, 106f pearls and pitfalls, 268b
CRT, manipulation of, 34 Meckel’s diverticulum, 248–249
CSF, 90–96 pearls and pitfalls, 268b
clinical application of, 91–96 pharmacologic interventions and, 249
communicating hydrocephalus and, 91–92, 92f 99mTc pertechnetate, 249, 250f

CSF leaks and, 92–93, 93f
noncommunicating hydrocephalus and, 92
normal examination and, 91, 91f
radiopharmaceuticals for, 90–91
shunt patency and, 93–96, 94f–95f
technique for, 90–91
diffuse toxic goiter, 109, 111f
ectopic thyroid tissue, 104–105, 105f–106f
equipment, properties of typical, 28–29, 29t
18F-FDG for, 12–13
fluorine-18 for, 12–13
67Ga, 9–12
abdominal inflammation/infection, 407
clinical applications, 407–409
FUO, 407
immunocompromised patient, 407–409, 408f
infection, 406–409
inflammation, 406–409
localization mechanisms for inflammation/infection,
406
osteomyelitis, 409
monoclonal antibodies for, 13–15, 356
tumors and, 14
myocardial perfusion
abnormal scan visual analysis and, 149–153
abnormal scans and, 149–154
artifacts and, 145–148, 147f, 162t
attenuation artifacts and, 145–147, 147f
CAD and, 160–167
Cardiolite for, 136, 137f
chest pain evaluation and, 167
clinical applications of, 160–169
collateral coronary vessels and, 163
coronary stenosis and, 162–163
dedicated cardiac SPECT for, 137
dual isotope, 140–141, 140f
exercise stress protocol, 157–160
exercise 99mTc SPECT, 139–140, 140f
exercise thallium SPECT, 138–139, 139f
GSPECT, 154–157
GSPECT data display, 156, 156f–157f
GSPECT interpretation and, 156, 156f–157f
 Index 589

Imaging (Continued) Imaging (Continued)

GSPECT technique, 154–155, 155f
hypertensive myocardial hypertrophy and, 169, 169f
image alignment and, 145
image interpretation approach and, 144–145
image interpretation for, 144–154
LBBB and, 168–169
lung activity and, 150–152, 152f
myocardial activity and, 149
three-dimensional, PET, 48, 48f
thyroid gland, 99–116
clinical applications of, 104–114
clinical protocol for, 104
congenital organification defect, 105, 106f
diffuse toxic goiter and, 109, 111f
ectopic thyroid tissue and, 104–105, 105f–106f
123I, 104

myocardial infarction risk stratification and, multinodular, 109, 110f

164–165 non-iodine avid thyroid cancers, 114–116, 115f–117f
myocardial revascularization and, 163–164, 164f normal, 104
myocardial viability determination and, 165–167 post-radioiodine therapy, 113–114, 115f
Myoview for, 136–137 99mTc, 104

noncardiac surgery, preoperative risk assessment and, technique for, 104

167 thyroid carcinoma and, 111–114, 112f
noncoronary disease states and, 167–169 thyroid nodules, 105–109
normal appearance and variants in, 148–149 post-thyroidectomy, 112–113, 113f
patient absorbed dose considerations and, 141, 146t thyroiditis and, 109–111
PET, 170, 172 thyroid nodules, 105–109
pharmacologic stress, 158 post-thyroidectomy, 112–113, 113f
principle of, 133–134 thyroiditis, 109–111
protocols for, 137–141, 141t 201TI for, 12

quantitative analysis of, 153–154 tumor, monoclonal antibodies for, 14

radiopharmaceuticals for, 134–137 two-dimensional, PET, 47–48, 47f
radiopharmaceuticals for, new, 137 unsealed byproduct material, studies, 427–428
right ventricular activity and, 152, 153f ventilation, 204–205
SPECT, 132–169, 142f–143f diagnostic principle, 204–205
SPECT, false-positive scan, 161 DTPA, 203, 204f
splanchnic activity and, 152–153, 153f 133Xe for, 9
99mTc labeled radiopharmaceuticals for, 135–136 Imaging agents. See also specific agents
201TI for, 135 radiopharmaceutical, perfusion, 197, 198f
transient ischemic dilation and, 152, 153f ventilation, 198–200
valvular lesions and, 167–168 radioactive gas, 199–200
myocardial perfusion, SPECT, 132–169, 142f–143f radiolabeled aerosol, 198–200
false-positive scan, 161 technique for, 200
image display and, 142–144, 144f–145f Immunocompromised patients
myocardial viability, PET, 172–173 gallium imaging, 407–409, 408f
neoplasm, conventional, 345 radiolabeled leukocytes, 402–403
neuroreceptor, 90 113mIn. See Indium 113m

parathyroid gland, Cardiolite for, 126–128, 126f IND. See Investigational new drug
parathyroid glands, 125–130 Indium 111 (111In)
perfusion characteristics, 519t–520t
diagnostic principle, 204–205 decay table, 527t
renal, 317, 317f for imaging, 12
positron emitters for, 12–13 leukocyte imaging, labeling, 559t–562t
pulmonary emboli, acute, 212, 212t leukocytes, 397, 400–401, 402f
radioiodine, 112–113, 113f oxine leukocytes, 399–405
post-, 113–114, 115f pentetreotide, 351–353
post-radioiodine therapy, 113–114, 115f somatostatin receptor scan, 552–554
radionuclide, 7–15, 8t–9t Indium 113m (113mIn), 12
adverse reactions of, 14–15 radionuclide generator system, 5
cardiac function, 175–193 Infants, gastric emptying, 267. See also Children
cardiovascular system, 131 Infarct
characteristics of, 519t–520t large anterior-apical, 448, 448f, 506
radiopharmaceuticals for, 7–15, 10t lateral left ventricular, 454–455, 454f, 507
adverse reactions of, 14–15 multi-infarct dementia, 88
localization mechanisms and, 7, 11t small inferior, 454–455, 454f, 507
renal Infarction
anatomic (cortical), 321, 322f cerebral, 77–78, 79f
functional, 317–318 inferior wall myocardial wall, 497–498, 497f, 517
renal function, 317–318, 318f myocardial
renal transplant evaluation, pearls and pitfalls, acute, 167
343b–344b GSPECT and, 188
resolution, 36 risk stratification after, 164–165
salivary glands, 128–130 splenic, bone scans, 286–287, 291f
splenic, 243–245, 559t–562t Infection
abnormal, 244–245 catheter, central, 415f
normal, 243–244, 245f diabetic foot, radiolabeled leukocytes and, 404
99mTc for, 7–8 gallium scan for, 551–552
 590 Index

Infection (Continued) Instrumentation (Continued)

imaging, 397 temporal filters and, 37
18F-FDG PET/CT, 409–417, 411f–416f tomographic image production, 41–42
gallium, 406–409 Interictal imaging, 84, 85f
pearls and pitfalls of, 418b Intermediate probability, 217–218
radiolabeled leukocytes, 397–406 Internal conversion, 2
radiopharmaceuticals, 397, 398t electrons, gamma-ray emissions and, 2–3
99mTc HMPAO leukocytes, 405–406 International system (SI) units, 521t, 523t
musculoskeletal system, radiolabeled leukocytes, 403f Intersocietal Commission on the Accreditation of Nuclear
neuropathic joint, radiolabeled leukocytes and, Medicine Laboratories (ICANL), 55
404–405 Intracardiac shunts, 182–183
post-traumatic, radiolabeled leukocytes and, 404 left-to-right, 182
prosthetic joint, radiolabeled leukocytes and, 404 right-to-left, 182
vascular graft, radiolabeled leukocytes, 405, 405f Intrahepatic cholecystitis, 485–486, 485f, 514
Inferior wall defect, LV, 463–465, 463f, 510 Intraoperative localization, neoplasm imaging and,
Infiltrative disorders, liver-spleen imaging, 241 353–355
Inflammation Intravascular microspheres
imaging, 397 environmental contamination and, 359
18F-FDG PET/CT, 409–417, 411f–416f hepatoma, 358–360
future agents for, 417–419 liver metastases, 358–360
gallium, 406–409 90Y, 358–360, 359f

pearls and pitfalls of, 418b Intravenous push method, 529

radiolabeled leukocytes, 397–406 Investigational new drug (IND), 15
99mTc HMPAO leukocytes, 405–406 Iodine
Inflammatory disease, lung scan, 229–232, 231f escape peak, 33
Information density, 34 non-iodine avid thyroid cancers, 115f
Inherent resolution, 35 uptake, thyroid
Inherent spatial resolution, 34 factors affecting, 101–102, 102t, 103b
Injection techniques, 529 test, 101
intravenous push method, 529 Iodine-123 (123I)
Ollendorf tourniquet method, 529 absorption and excretion of, 9
Instrumentation, 23 characteristics, 519t–520t
collimator, 29–31, 30f decay table, 527t
console controls, 34, 34f for imaging, 8–9
count rate, 36 production, 8–9
crystal detector devices, 31–32 thyroid gland imaging, 104
dead time, 36 thyroid gland uptake, 99–101, 100f
dose calibrator, 26–27, 27f thyroid scan, 535–536
field uniformity, 36 Iodine-131 (131I), 20
frame manipulation, 37–38 absorption and excretion of, 9
gamma scintillation camera, 28–38, 28f characteristics, 519t–520t
GM counter, 23, 24f decay table, 528t
image acquisition, 36–37 hyperthyroidism therapy, primary, 117–120,
image display and, 37 118b–119b
image processing, 37 for imaging, 8–9
ionization chamber, 23, 24f radiation safety aspects, 124–125, 125f
operator interaction, 38 release of individuals after administering, 437
pearls and pitfalls, 68b spill, 504, 504f, 518
PET, 43–53 therapy
PHA, 33–34 nursing instructions, 574
photon detector devices, 31–32 requirements for, 573
photon transducers, 32–33 special considerations for, 573
quality control, 55–62 thyroid disease therapy, 116–125
AOR, 61 functioning metastases and, 123–124
collimator evaluation, 61 patient preparation for, 120–121
COR determination and correction, 60–61 postsurgical ablation and, 121–123
detector head alignment, 61 principle of, 116–117
field uniformity assessment and, 57–59, 58f radiation safety aspects and, 124–125, 125f
field uniformity assessment and correction, 59–60 thyroid gland uptake, 99–101
gamma camera, 55–59 Ionization chamber, 23, 24f
linearity testing and, 55–57 dose calibrator, 26–27
spatial resolution and, 55–57 Ischemia
SPECT, 59–61 myocardial
system performance, 61 chronic, 175
resolution and, 34–36 LV anteroseptal, 483–484, 483f, 513
single probe counting systems, 25–26, 26f reversible, 490–491, 490f, 515
sodium iodide well counter, 23–25, 25f Ischium
spatial filters and, 37, 38f osteomyelitis of, 18F-FDG PET/CT, 416f
SPECT, 38–42, 39f 131I-sodium iodide, 429

SPECT/CT, 42–43 Isomeric transition, 2

 Index 591

Isotopes Leukocytes (Continued)

carrier-free, 4 99mTc HMPAO, 405–406

collimators and energy of, 30–31 abdomen/pelvis and, 406

cyclotron, production of, 4 clinical applications of, 406
fission, 4 labeling, 405
metastable, 3 normal distribution of, 406
notation technique for, 405–406
basic, 1–3 thorax and, 406
nuclear decay and, 1–3 LeVeen shunts, 267, 268f
nuclear stability and, 1–3 Lexidronam (Quadramet), 311
nuclear decay of, 1 Lexiscan. See Regadenoson
nuclear stability of, 1 License types, 424
Isovolumic relaxation, 132 “Master Materials,” 424
Iterative algorithms, 42 Linearity testing, quality control, 55–57
Lingual thyroid, 500–501, 500f, 517
J Lisinopril, 331–332
Jaundiced patients, hepatobiliary imaging in, List mode, 36, 176
251–252 Liver
abscess, 242
K defects, 239
Knee, spontaneous osteonecrosis of, 304 fatty infiltration of, 240–241
81mKr. See Krypton-81m 18F-FDG distribution in, 373

Krypton-81m (81mKr) imaging, 559t–562t

characteristics, 519t–520t
radionuclide generator system, 5
ventilation imaging, 200
L bone scans and, 285–286, 287f
Labeling
leukocyte imaging, 559t–562t
radioactive material, 431, 431f
radiochemical, 17–19
radiolabeled leukocytes and principle of, 399
radiopharmaceutical, 63–64
red blood cell, techniques, 557–558
99mTc HMPAO leukocytes, 405
of vials/syringes, 427
LAD coronary artery. See Left anterior descending
coronary artery
Lambda sign, 409
Large anterior-apical infarct, 448, 448f, 506
Lasix. See Furosemide
LBBB. See Left bundle-branch block
Lead x-ray peak, 33–34
Left anterior descending (LAD) coronary artery,
132, 133f
Left bundle-branch block (LBBB), 168–169, 168f
Left ventricle (LV), 131
inferior wall defect, 463–465, 463f, 510
myocardial ischemia, 483–484, 483f, 513
during systole, 131–132
Left ventricle ejection fraction (LVEF), 145
GSPECT, 155
neoplasms, primary, liver-spleen imaging, 242
sign, reappearing, 260–261
SPECT imaging, 541–542
Liver metastases
intravascular microspheres, 358–360
Liver scan, 541
abnormal, 239–243, 240t, 267b
normal, 238–239, 238f–239f
sign, 258–259
Liver-spleen imaging, 237–243
diffuse disorders, 241
focal lesions, miscellaneous, 242–243
abscess, 242
Budd-Chiari syndrome, 243
hepatic cirrhosis, 240–241
infiltrative disorders, 241
liver neoplasms, primary, 242
focal nodular hyperplasia, 242, 243f
hepatic cell adenomas, 242
hepatoma, 242
liver scan
abnormal, 239–243, 240t, 267b
normal, 238–239, 238f–239f
metastatic disease, 242
pearls and pitfalls, 268b
planar imaging, 237–238
radiopharmaceuticals, 237
SPECT, 237–238
99mTc, 237, 267b

Lesions Localization studies, unsealed byproduct material,

cold, on bone scans, 280, 280b 427–428
focal LOS. See Lutetium oxyorthosilicate
liver-spleen imaging of, 242–243 Low probability, 217–218
spleen scan and, 244 very, 213–214
lytic, 276–277 Luminal. See Phenobarbital
valvular, 167–168 Lung cancer, 448–449, 448f, 506
Leukocytes 18F-FDG PET/CT neoplasm imaging, 378–381, 379f

imaging, labeled, 559t–562t metastatic, 380, 381f

Indium-labeled, 400–401, 402f squamous cell, 480–482, 480f, 513
oxine, 111In, 399–405 Lung perfusion imaging, 494–495, 494f, 516,
radiolabeled, 397–406 559t–562t
clinical applications, 400–405 Lung scan
labeling principle, 399 asthma, 226–228, 228f
normal scan, 399–400, 400f bronchiectasis, 226–228
technique, 399 bronchitis, 226–228
scan, 554–555 cardiovascular abnormalities, 232–233, 233f–234f
 592 Index

Lung scan (Continued) Malignant bone cancer, 18F-FDG PET/CT neoplasm

CHF, 232–233 imaging, 389–390
clinical applications, 203–233 Malignant bone tumors, 280–281
diagnostic principle and, 204–205 Malignant melanoma, 18F-FDG PET/CT neoplasm
COPD, 223–226, 224f–226f imaging, 390–391, 391f
CTPA, 219, 221f–222f Malignant pleural effusions, 289f–290f
deep venous testing and, 219 MALT. See Mucosa-associated lymphoid tissue
image analysis, 207–212 “Master Materials” license, 424
image interpretation, 211–212 Matrix size
airway disease and, 219 gamma scintillation camera, image acquisition and, 36–37
ancillary signs and, 217 SPECT, 41
clinical information incorporated into, 216–217 MBI. See Molecular breast imaging
criteria for, 212–216 MDP. See Methylene diphosphonate
diffuse lung disease and, 218–219, 218f Mebrofenin, 249–250
Gestalt, 216 Meckel’s diverticulum, 501–502, 501f, 518
modified PIOPED II criteria, 213 imaging, 248–249, 559t–562t
optimizing, 216–217 pearls and pitfalls, 268b
perfusion defects and, 219, 220f pharmacologic interventions and, 249
PIOPED and, 212–213 99mTc pertechnetate, 249, 250f

PISAPED and, 216 pediatric examination, 530t

pleural effusions and, 217–218 scan, 543
special situations and, 217–219 Medial tibial stress syndrome. See Shin splints
triple matches location and, 219 Medical events
inflammatory disease, 229–232, 231f dose, 429–430
mucous plugs, 226, 227f safety issues, 429–430
neoplasms, 228–229, 229f–230f Melanoma, malignant, 390–391, 391f
non-embolic diseases, 223–233 Memory, gamma scintillation camera, 36–37
COPD, 223–226, 224f–226f Mercaptoacetyltriglycine (mertiatide, MAG3), 316.
normal, 200–203 See also 99mTc-MAG3
perfusion, 200–201, 201f clearance, 321
ventilation, 201–203, 202f Mertiatide. See Mercaptoacetyltriglycine
pediatric examination, 530t Metabolic artifacts, 62–63, 63f
pleural effusions, 217–218 Metabolic bone disease, bone scans, 302–303
loculated, 233 Metabolic brain imaging, PET, 71
pulmonary emboli follow-up, 221–223 Metaiodobenzylguanidine (MIBG), 342–344
pulmonary hypertension, 223 Metastable isotopes, 3
V/Q, 203–204 Metastases
Lungs bone, 18F-FDG PET/CT neoplasm imaging, 394
blood flow, 196 colon cancer, 479–480, 479f, 513
18F-FDG distribution in, 372 functioning, thyroid disease and, 123–124
myocardial perfusion imaging and activity of, 150–152, liver
152f bone scans and, 285–286, 287f
radiolabeled leukocytes, 401 intravascular microspheres, 358–360
Lutetium oxyorthosilicate (LSO), 48 lytic sternal, 491–492, 491f, 515
LV. See Left ventricle osteosarcoma, bone scans and, 285–286, 288f
LVEF. See Left ventricle ejection fraction painful osseous, palliative therapy, 309–314
Lymph nodes, 18F-FDG distribution in, 373–374 skeletal, diffuse, 456, 456f, 508
Lymphoma, 456–457, 456f, 474–475, 474f, 508, 511 Metastatic calcification, 302–303, 496–497, 496f, 516–517
bone involvement and, 383, 384f Metastatic disease
brain, 453–454, 453f, 507 bone, prostate cancer and detecting, 280
case set, 445–446, 445f, 505 bone scan and, 276–280, 278f
CNS involvement and, 383 cold lesion on, 280, 280b
18F-FDG PET/CT neoplasm imaging, 381–383, 382f interpretation of, 278–279
neoplasm imaging, 67Ga, 346–347, 348f superscan, 279–280, 279f
progressive, 382–383, 383f liver-spleen imaging, 242
radioimmunotherapy, 356–358 skeletal, chemotherapy, 280
Lymphoscintigraphy, 553–554 sternal, bone scan, 278–279, 279f
neoplasm imaging, 353–355, 355f Metastatic lung cancer, 380, 381f
Lytic lesion, 276–277 Metastron. See Strontium-89 chloride
Lytic sternal metastasis, 491–492, 491f, 515 Metatarsal, stress fractures, 461–462, 461f, 509
Methimazole, 117–119
M Methylene diphosphonate (MDP), 272–273
M. avium-intracellulare, 408 MIBG. See Metaiodobenzylguanidine
Macroaggregated albumin (MAA), 197 Microspheres
MAG3. See Mercaptoacetyltriglycine intravascular
Magnetic resonance cholangiopancreatography (MRCP), environmental contamination and, 359
258 hepatoma, 358–360
Magnetic resonance imaging (MRI), 54–55 liver metastases, 358–360
system designs, 54–55 90Y, 358–360, 359f

Malignant ascites, 285–286, 290f 90Y, 359f

 Index 593

Milk scan, 264 Myocardial perfusion (Continued)

Misadministration, 429
Misregistration artifacts, 67, 67f
99Mo. See Molybdenum-99
99Mo-99mTc generator systems, 5–6, 6f
dry, 5
purity, 16–17
wet, 5
Modified PIOPED II criteria
lung scan, 213
perfusion, 213–216
high probability, 213, 214f–215f
nondiagnostic, 215–216
normal, 215
PE-absent, 215–216
PE-present, 215–216
very low probability, 213–214
ventilation, 213–215
high probability, 213, 214f–215f
very low probability, 213–214
Molecular breast imaging (MBI), 349–351
Molybdenum, 4
concentration, permissible, 434
Molybdenum-99 (99Mo)
characteristics, 519t–520t
99mTc generator yield and, 526t
Monoclonal antibodies
imaging, 13–15, 356
tumors and, 14
labeled, neoplasm imaging and, 355–356
problems with clinical application of, 14
production, 13, 14f
radiolabeled, 397
Morphine, 563t
hepatobiliary imaging, 254–255, 256f
Motion artifacts, myocardial perfusion imaging, 148
MRCP. See Magnetic resonance cholangiopancreatography
MRI. See Magnetic resonance imaging
Mucosa-associated lymphoid tissue (MALT), 381–382.
See also Lymphoma
Mucous plugs, lung scan, 226, 227f
Multi-infarct dementia, radionuclide brain imaging, 88
Multinodular goiter, 457, 457f, 508
Multiple myeloma, 18F-FDG PET/CT neoplasm imaging,
392–393, 392f
Multivessel CAD, 502–504, 502f, 518
Muscle
18F-FDG distribution in, 368–369, 370f
trauma, bone scans and, 286–287, 291f
Musculoskeletal system. See also Skeletal system
infections, radiolabeled leukocytes, 403, 403f
reverse, defect, 149–150, 151f
studies, pearls and pitfalls, 138b
Myocardial perfusion imaging, 559t–562t
abnormal scans, 149–154
visual analysis, 149–153
artifacts and, 145–148, 147f, 162t
CAD and, 160–167
Cardiolite for, 136, 137f
chest pain evaluation and, 167
clinical applications of, 160–169
collateral coronary vessels and, 163
coronary stenosis and, 162–163
dedicated cardiac SPECT for, 137
dual isotope, 140–141, 140f
exercise stress protocol, 157–160
exercise 99mTc SPECT, 139–140, 140f
exercise thallium SPECT, 138–139, 139f
GSPECT, 154–157
data display, 156, 156f–157f
interpretation and, 156, 156f–157f
technique for, 154–155, 155f
hypertensive myocardial hypertrophy and, 169, 169f
image alignment and, 145
image interpretation, 144–154
approach to, 144–145
LBBB and, 168–169
lung activity and, 150–152
myocardial activity and, 149
myocardial infarction risk stratification and, 164–165
myocardial revascularization and, 163–164, 164f
myocardial viability determination and, 165–167
Myoview for, 136–137
noncardiac surgery, preoperative risk assessment and,
167
noncoronary disease states and, 167–169
normal appearance and variants in, 148–149
patient absorbed dose considerations and, 141, 146t
PET, 170, 172
pharmacologic stress, 158
principle of, 133–134
protocols for, 137–141, 141t
quantitative analysis of, 153–154
radiopharmaceuticals for, 134–137
new, 137
right ventricular activity and, 152, 153f
SPECT, 132–169, 142f–143f, 538
false-positive scan, 161
image display and, 142–144, 144f–145f
splanchnic activity and, 152–153, 153f
99mTc labeled radiopharmaceuticals for, 135–136

pearls and pitfalls, 313b–314b 201TI for, 135

Mycobacterium avium intracellulare, 348, 381 transient ischemic dilation and, 152, 153f
Mycobacterium tuberculosis, 408 valvular lesions and, 167–168
Mycotic abdominal aneurysm, 18F-FDG PET/CT, Myocardial viability
415f determination, 165–167
Myeloma, multiple, 392–393, 392f GSPECT and determining, 166–167, 166f
Myocardial infarction PET, 172–173
acute, 167 SPECT and determining, 165–166
GSPECT and, 188 Myocardial wall infarction, 497–498, 497f, 517
risk stratification after, 164–165 Myocardium
GSPECT and, 165 activity, 149
SPECT and, 164–165 defects, 148
Myocardial ischemia hibernating, 165, 173–174, 173f–174f
chronic, 175 nonreversible defects, 149, 151f
LV anteroseptal, 483–484, 483f, 513 revascularization, evaluation of, 163–164, 164f
Myocardial perfusion, 131 GSPECT and, 164
abnormalities, 150 SPECT and, 163–164, 164f
PET, 170, 172 reversible defects, 149, 150f
interpreting, 172 stunned, 174–175, 174f
 594 Index

Myositis ossificans, bone scans, 286–287, 292f Nephritis, interstitial, 336, 337f. See also Pyelonephritis
Myoview. See Technetium 99m tetrofosmin Nephrotoxicity, cyclosporin, 340
Neuroblastoma, 342–344, 462, 462f, 509
N bone scans and, 285–286, 289f
N-13. See Nitrogen-13 18F-FDG PET/CT neoplasm imaging, 393

Nal. See Sodium iodide Neuropathic joint infection, radiolabeled leukocytes and,
Necrosis, avascular, 303–304, 309f 404–405
Neonatal hepatitis, 452, 452f, 507 Neuropeptide receptor imaging, neoplasm, 351–353
hepatobiliary imaging, 261, 263f somatostatin, 351–353, 353f
Neoplasm imaging Neuropsychiatric disorders, radionuclide brain imaging,
adrenal, 353 90
Cardiolite, 349–351, 350f Neuroreceptor imaging, 90
breast cancer, 349–351 Neutrino, 3
conventional, 345 Neutrons, 1
18F-FDG PET/CT, 361 Nitrogen-13 (N-13), 13
bone metastases, 394 ammonia
breast cancer, 383–384 PET with, cardiac rest/stress imaging, 556–557
colorectal cancer, 387–388, 387f protocol, 171–172
esophageal cancer, 384–386, 385f characteristics, 519t–520t
18F-FDG distribution and, 364–374, 364f, 365t–368t Nodules
gastric cancer, 386–387, 386f pulmonary, solitary, 378–381, 380t
gastrointestinal stromal tumors, 387 thyroid, 105–109, 106t, 107f
gynecologic cancers, 391 cold, 105–107, 106t, 107b, 107f, 475, 475f, 511–512
head and neck cancer, 377–378, 377f discordant, 108, 109f, 447–448, 447f, 506
hepatocellular cancer, 388–389 hot, 107–108, 108f
hepatoma, 388–389, 388f warm, 108–109
lung cancer, 378–381, 379f Noncardiac surgery, preoperative risk assessment, 167
lymphomas, 381–383, 382f GSPECT functional data and, 167
malignant bone tumors, 389–390 SPECT imaging data and, 167, 168f
malignant melanoma, 390–391, 391f Noncommunicating hydrocephalus, CSF imaging and, 92
miscellaneous tumors, 392–394, 392f Noncoronary disease, GSPECT and, 188–189
occult tumor, 394–395 Non-embolic diseases, lung scan, 223–233
pancreatic cancer, 389, 389f COPD, 223–226, 224f–226f
patient preparation for, 361–364 Non-Hodgkin’s lymphoma. See also Lymphoma
pearls and pitfalls of, 395b staging, 362t–363t, 376
PET image quantitation, 374–375 Non-iodine avid thyroid cancers, imaging, 114–116,
prostate and testicular cancers, 391–392 115f–117f
qualitative image interpretation, 374 Nonradioactive pharmaceuticals, 15, 563t
renal and bladder cancers, 391 Nonreversible defects, 149, 151f
solitary pulmonary nodule, 378–381, 380t Nonsegmental defects, perfusion, 206
thyroid cancer, 378 Non-small-cell carcinoma, 379–380
tumors of unknown primary origin, 394–395 PET/CT, 380
whole-body, 375–395 Normal pressure hydrocephalus (NPH), 476–477, 476f,
67Ga, 345–347, 347f 512. See also Hydrocephalus
clinical applications of, 346–347 Normalization scan, PET/CT, 62
hepatoma, 347, 350f NPH. See Normal pressure hydrocephalus
Hodgkin’s disease, 346–347, 349f NRC. See Nuclear Regulatory Commission
lymphoma, 346–347, 348f Nuclear decay
intraoperative localization, 353–355 alpha-particle emission and, 1
labeled monoclonal antibodies, 355–356 of isotopes, 1–3
lymphoscintigraphy, 353–355, 355f of positrons, 3, 4f
neuropeptide receptor, 351–353 of radionuclides, 1, 2f
somatostatin, 351–353, 353f of 99mTc, 3, 3f
pearls and pitfalls, 360b Nuclear imaging, sample techniques
PET/CT bone imaging, SPECT, 547
18F-FDG, 361 bone marrow scan, 547–548
indications for, 361 bone scans
procedure comparison for, 361, 362t–363t PET/CT, 557
radiopharmaceuticals, 345 99mTc, 546–547
201TI, 347–349 brain death, 533–534
AIDS and, 348 brain imaging
brain neoplasm, 348 PET, with 18F-FDG, 556
clinical applications of, 348–349 SPECT, 534
Neoplasms breast imaging with gamma camera, breast-specific,
benign osseous, bone scans and, 281–285 554–555
liver, primary, 242 captopril renogram for diagnosis of renovascular
lung scan, 228–229, 229f–230f hypertension, 550–551
skeletal system, 277–278 cardiac imaging
soft-tissue, 285–286 PET, with 18F-FDG, 555–556
Nephrectomy, 486–487, 486f, 514 rest/stress, 556–557
 Index 595

Nuclear imaging, sample techniques (Continued) Nuclear Regulatory Commission (Continued)

cerebral blood flow scan, 533–534 technical requirements, 426–427
cisternogram, 534–535 ambient exposure rate, survey of, 427
diuretic renography, 550 calibration, 426–427
esophageal transit, 544 dose calibrators, 426
exercise protocol, Bruce multistage/modified Bruce dose determination, 426
treadmill, 538–539 dose recording, 426
gallium scan, 551–552 labeling of vials/syringes, 427
gastric emptying, 545 reference sources, 426–427
gastroesophageal reflux, 544–545 survey instruments, 426
gastrointestinal bleeding scan, 543–544 transmission, 426–427
hepatobiliary scan, 542–543 Nuclear stability
leukocyte scan, 554–555 of beta-particle emission, 1–2, 2f
liver scan, 541 of isotopes, 1–3
lymphoscintigraphy, 553–554
Meckel’s diverticulum scan, 543 O
myocardial perfusion imaging, SPECT, 538 Occult tumors, 18F-FDG PET/CT neoplasm imaging,
parathyroid scan, 537 394–395
peritoneal shunt patency, 545–546 Occupational dose, 425
PET Octreotide. See Somatostatin
brain imaging with 18F-FDG, 556 Off-peak, camera head, 446–447, 446f, 505
cardiac imaging with 18F-FDG, 555–556 Ollendorf tourniquet method, 529
cardiac rest/stress imaging, 556–557 Operator interaction, gamma scintillation camera, 38
PET/CT Osseous metastases, painful, 309–314
bone scan, 557 palliative therapy, 309–314
tumor imaging with 18F-FDG, 555 radiation safety and, 311–312
pharmacologic stress imaging radiopharmaceuticals for, 311
adenosine, 539 Osteoarthropathy, hypertrophic pulmonary, 452–453,
dipyridamole, 539 452f, 507
pulmonary perfusion scan, 540–541 bone scans, 301, 308f
pulmonary ventilation scan Osteoblastoma, 281–285
DTPA aerosol, 540 Osteogenic sarcoma, 280, 281f
133Xe, 539–540 Osteoid osteoma, 281–285, 283f
radionuclide cystogram in children, 551 Osteomyelitis
red blood cell labeling techniques, 557–558 bone scan, 296–300, 302f
renal blood flow scan, 548 cellulitis differentiated from, 297–299
renal scan 18F-FDG PET/CT, 412–416, 416f

cortical imaging, 548–549 gallium imaging, 409

glomerular filtration, 549 hip prostheses assessment and, 295–296, 300f
tubular function, 549 of ischium, 18F-FDG PET/CT, 416f
rest gated equilibrium ventriculography, 537 radiolabeled leukocytes, 403–404, 404f
salivary gland imaging, 546 Osteonecrosis, spontaneous, 304
somatostatin receptor scan with 111In pentetreotide, Osteoporosis, bone mineral measurement and, 306
552–554 Osteosarcoma metastasis, bone scans and, 285–286,
SPECT imaging 288f
brain, 534 Ovarian carcinoma, bone scans and, 285–286, 287f
liver, 541–542 Overall spatial resolution, 35
spleen, 541–542 Oxidation, 18
spleen scan, 541 Oxygen-15, 13
thyroid scan characteristics, 519t–520t
cancer, 536–537
123I, 535–536 P
99mTc-pertechnetate, 535 PACs. See Picture achieving systems
Nuclear medicine, nonradioactive pharmaceuticals in, Paget’s disease, 281–285
563t bone scans, 300–301, 305f–306f
Nuclear Regulatory Commission (NRC), 423–424 polyostotic, 472–473, 472f, 511
agreement states, 423, 423f sarcomatous degeneration of, 300–301, 307f
ALARA policy, 423–424 PAH. See Para-aminohippurate
dose limits, 422b, 424–425 Pain
license types, 424 bone, 277–278
“Master Materials” license, 424 chest, evaluation of acute, 167
radionuclide requirements, 17 CRPS, 305, 310f–311f
radionuclide therapy patients, hospitalized and, 569 Painful osseous metastases, 309–314
radiopharmaceutical requirements, 15–16 palliative therapy
regulations, 423 radiation safety and, 311–312
CRF 35.100, 424 radiopharmaceuticals for, 311
CRF 35.200, 424 Palliative therapy, 309–314
CRF 35.300, 424 Pancreatic cancer, 18F-FDG PET/CT neoplasm imaging,
CRF 35.400, 424 389, 389f
CRF 35.500, 424 Panda sign, 409
 596 Index

Para-aminohippurate (PAH), 320–321 Perfusion imaging (Continued)

Paradox image, 178, 179f abnormal scans, 149–154
Paraganglioma, 18F-FDG PET/CT neoplasm imaging, artifacts and, 145–148, 147f, 162t
393–394 CAD and, 160–167
Parathyroid adenoma, 126–128, 127f, 488–489, 488f, Cardiolite for, 136, 137f
514–515 chest pain evaluation and, 167
ectopic mediastinal, 479, 479f, 513 clinical applications of, 160–169
Parathyroid gland. See also Thyroid gland collateral coronary vessels and, 163
imaging, 125–130 coronary stenosis and, 162–163
Cardiolite for, 126–128, 126f dedicated cardiac SPECT for, 137
localization, 125–130 dual isotope, 140–141, 140f
pearls and pitfalls, 129b exercise stress protocol, 157–160
Parathyroid scan, 537 exercise 99mTc SPECT, 139–140, 140f
Parkinson’s disease (PD), 89 exercise thallium SPECT, 138–139, 139f
Pars defect, 295, 299f GSPECT, 154–157, 155f–157f
PCP. See Pneumocystis pneumonia hypertensive myocardial hypertrophy and, 169, 169f
PD. See Parkinson’s disease image alignment and, 145
Peak image interpretation, 144–154
backscatter, 33 LBBB and, 168–169
iodine escape, 33 lung activity and, 150–152
lead x-ray, 33–34 myocardial activity and, 149
renography, 320 myocardial infarction risk stratification and,
renography time to peak, 319 164–165
Peaking, automatic, 34 myocardial revascularization and, 163–164, 164f
Pelvis myocardial viability determination and, 165–167
inflammation/infection imaging, 407 Myoview for, 136–137
mycotic abdominal aneurysm, 18F-FDG PET/CT, 415f noncardiac surgery, preoperative risk assessment and,
99mTc HMPAO leukocytes and, 406 167
Pentagastrin (Peptavlon), 563t noncoronary disease states and, 167–169
Pentetreotide normal appearance and variants in, 148–149
111In, 351–353 patient absorbed dose considerations and, 141, 146t
somatostatin receptor scan, 552–554 PET, 170, 172
Peptavlon. See Pentagastrin pharmacologic stress, 158
Peptides, radiolabeled, 397 principle of, 133–134
Percutaneous transluminal coronary angioplasty (PTCA), protocols for, 137–141, 141t
163–164 quantitative analysis of, 153–154
Perfusion radiopharmaceuticals for, 134–137
brain imaging right ventricular activity and, 152, 153f
PET, 72–75 SPECT, 132–169, 142f–145f, 538
SPECT, 71–75 splanchnic activity and, 152–153, 153f
CXR interpretive criteria, 213, 213t 99mTc labeled radiopharmaceuticals for, 135–136

defects, 201, 206, 212t 201TI for, 135

angiography, 211–212, 216b transient ischemic dilation and, 152, 153f

image analysis and, 211–212 valvular lesions and, 167–168
lobar, 219, 220f radiopharmaceutical agents, 197, 198f
mismatch, 206–207 renal, 317, 317f
nonsegmental, 206 Pericholecystic hepatic activity sign, 253
reverse, 149–150, 151f Peritoneal shunt patency, 545–546
segmental, 206, 207f–211f, 213t Persantine. See Dipyridamole
triple match, 206–207 Pertechnetate
whole-lung, 219, 220f checking for presence of free, 18, 19f
lung, imaging, 559t–562t sodium, 7
lung scan, 200–201, 201f 99mTc, 18, 19f

modified PIOPED II criteria, 213–216 Meckel’s diverticulum imaging with, 249, 250f
high probability, 213, 214f–215f parathyroid gland imaging and, 126–128, 129b
nondiagnostic, 215–216 thyroid scan, 535
normal, 215 PET. See Positron emission tomography
PE-absent, 215–216 PET/CT
PE-present, 215–216 advantages, 53–54
very low probability, 213–214 in aortic dissection, 175
myocardial, 131 attenuation correction artifact, 66, 66f
abnormalities, 150 bone, pediatric examination, 530t
PET, 170, 172 bone scan, 557
reverse, defect, 149–150, 151f brain, pediatric examination, 530t
studies, pearls and pitfalls, 138b brain tumor, 80
pulmonary, 195–197 18F-FDG

scan, 205–207 distribution of, 364–374, 364f, 365t–368t

Perfusion imaging FUO, 416–417
diagnostic principle, 204–205 inflammation/infection imaging, 409–417, 411f–416f
myocardial, 559t–562t neoplasm imaging with, 361

PET/CT (Continued)
osteomyelitis, 412–416, 416f
patient preparation for, 361–364
18F-FDG, neoplasm imaging
bone metastases, 394
breast cancer, 383–384
colorectal cancer, 387–388, 387f
esophageal cancer, 384–386, 385f
gastric cancer, 386–387, 386f
gastrointestinal stromal tumors, 387
gynecologic cancers, 391
head and neck cancer, 377–378, 377f
hepatocellular cancer, 388–389
hepatoma, 388–389, 388f
lung cancer, 378–381, 379f
lymphomas, 381–383, 382f
malignant bone tumors, 389–390
malignant melanoma, 390–391, 391f
miscellaneous tumors, 392–394, 392f
occult tumor, 394–395
pancreatic cancer, 389, 389f
pearls and pitfalls of, 395b
PET image quantitation, 374–375
prostate and testicular cancers, 391–392
qualitative image interpretation, 374
renal and bladder cancers, 391
solitary pulmonary nodule, 378–381, 380t
thyroid cancer, 378
tumors of unknown primary origin, 394–395
whole-body, 375–395
misregistration artifact, 67, 67f
neoplasm imaging
18F-FDG, 361
indications for, 361
non-small-cell carcinoma, 380
protocol, 53
quality control, 61–62
ambient temperature and, 61–62
blank scan and, 62
CT scanner and, 62
image plane calibration, 62
normalization scan and, 62
scanners, 43f, 53, 364
skeletal, 272–273
tumor
with 18F-FDG, 555
pediatric examination, 530t
PET/MRI, 54–55
system designs, 54–55
PHA. See Pulse height analyzer
Pharmaceuticals, nonradioactive, 563t. See also
Radiopharmaceuticals
Pharmacologic stress imaging
adenosine, 158–159, 539
patient preparation for, 159
protocol for, 159
dipyridamole, 158–159, 539
image interpretation and, 159
patient preparation for, 158
protocol for, 159
dobutamine, 158, 160
protocol for, 160
myocardial perfusion imaging and, 158
regadenoson, 158–160
patient preparation for, 160
protocol for, 160
Pharmacopeia, U.S. (USP)
radiochemical purity acceptability limits and, 18
radionuclide requirements, 17
radiopharmaceutical requirements, 15–17
Index 597
Phase and amplitude analysis, 178, 179f–181f
Phenobarbital (Luminal), 563t
Pheochromocytoma, 342, 343f, 474, 474f, 511
18F-FDG PET/CT neoplasm imaging, 393–394,
393f
Phosphorus-32, 20
characteristics, 519t–520t
Photomultiplier tube (PMT), 23–24
artifact, 63, 64f
field uniformity assessment and, 58–59, 59f
gamma scintillation camera, 28–29
PET, 49, 49f
photon transducer, 32–33
scintillation events and, 33
single probe counting system, 25–26
Photon annihilation event, 43–44, 45f
Photon detector devices, 31–32
crystal, 32
solid state semiconductors, 32
Photon emission, PET image degradation and, 44, 46f
Photon scatter, PET image degradation and, 44, 46f
Photon transducers, 32–33
scintillation events and, 33
Pick’s disease. See Frontotemporal dementia
Picture achieving systems (PACs), 28–29
PIOPED. See Prospective Investigation of Pulmonary
Embolism Diagnosis
PISAPED. See Prospective Investigative Study of Acute
Pulmonary Embolism
Planar imaging
brain, 71–72
normal, 71–72, 72f–73f
technique, 71
liver-spleen, 237–238
Plasma sample-based clearances, renal function
quantitation, 321
Pleural disease, 200–201
Pleural effusions
loculated, lung scan and, 233
lung scan and, 217–218, 233
malignant, bone scans and, 285–286, 289f–290f
Plummer’s disease. See Toxic nodular goiter
PMT. See Photomultiplier tube
Pneumocystis carinii, 406
Pneumocystis pneumonia (PCP), 408, 408f. See also
Pneumonia
treatment, 408
Pneumonia, 229, 231f, 493–494, 493f, 515–516
Positron annihilation events, 44, 45f
Positron emission, 3
Positron emission tomography (PET), 38
attenuation correction, 50–51, 53, 54f
brain imaging
with 18F-FDG, 556
metabolic, 71
brain perfusion imaging, 72–75
radiopharmaceuticals, 72–74
cameras, overview of, 43–48
cardiac imaging, 169–175
with 18F-FDG, 555–556
N-13 ammonia protocol for, 171–172
radiopharmaceuticals for, 170–172
Rb-82 CI protocol for, 170–171, 171f
viability image interpretation for, 173–175, 173f
cardiac rest/stress imaging, 556–557
detector geometry, 49–50, 49f
events detected by, 44
FDG, 80
brain imaging with, 555
18F-FDG, 559t–562t
 598 Index

Positron emission tomography (Continued) Prostate cancers

image acquisition, 52–53 bone metastases detected from, 280
filtered back projection and, 53 18F-FDG PET/CT neoplasm imaging, 391–392

image interpretation, 75, 77f Prostate-specific antigen (PSA), 280

image processing, 52–53 Prosthetic joint
instrumentation, 43–53 infections, radiolabeled leukocytes and, 404
misregistration of, 67 loosening, 478–479, 478f, 512–513
myocardial perfusion, 170, 172 Protons, 1
interpreting, 172 PSA. See Prostate-specific antigen
myocardial viability, 172–173 PS-PMT. See Positron sensitive PMTs
photon annihilation event and, 43–44, 45f PTCA. See Percutaneous transluminal coronary
photon emission and image degradation, 44, 46f angioplasty
photon scatter and image degradation, 44, 46f Public dose, 425
PMT, 49, 49f Pulmonary arteries, 195–196
positron annihilation events, 44, 45f Pulmonary carcinoid, 352, 354f
quality control, 43–53 Pulmonary emboli, 204–205, 205f
radial blurring, 50, 50f acute, imaging, 212
radiation safety, 434–435, 435f lung scan clinical applications and, 203–223
radiation therapy, 376–377 lung scan follow-up, 221–223
radiopharmaceuticals, 14–15, 72–74 Pulmonary embolism, 203–223, 449–450, 449f, 471–472,
cardiac, 170–172 471f, 506, 511
18F-FDG, 74, 75t acute, signs and symptoms associated with, 216b,
quality control requirements, 17 216–217
resolution, 51–52 Pulmonary hypertension, lung scan, 223
scattered coincidences and, 46–47 Pulmonary nodules, solitary, 378–381, 380t
reducing, 47–48 Pulmonary perfusion, 195–197
scintillation detectors, 48–49 scan, 540–541
simultaneous separate events and image degradation, basic concepts of, 205–207
44–45, 47f Pulmonary ventilation scan
system sensitivity, 51–52 DTPA aerosol, 540
three-dimensional imaging, 48, 48f 133Xe, 539–540

two-dimensional imaging, 47–48, 47f Pulse height analyzer (PHA), 32–34

Positron emitters energy spectrum, 33, 33f
for imaging, 12–13 gamma scintillation camera, 28–29
radiopharmaceuticals and activity of, 27 signal intensity information, 34
Positron sensitive PMTs (PS-PMT), 33, 351. See also Pyelonephritis
Photomultiplier tube acute, 321, 323f, 336, 336f
Positron-emitting radionuclides, 4 18F-FDG PET/CT, 414f

Positrons, nuclear decay of, 3, 4f

Postsurgical ablation, thyroid disease, 121–123 Q
Post-traumatic infections, radiolabeled leukocytes and, Quadramet. See Lexidronam
404 Qualitative data, GSPECT, 176, 187
Pregnancy, 565 Quality control, 23
dose limits, 425 collimator, 29–31, 30f
radiation safety, 475–476, 475f, 512 console controls, 34, 34f
radioiodine during, 120, 125 count rate, 36
radionuclides and, 12–13 crystal detector devices, 31–32
radiopharmaceuticals during, 100 dead time, 36
Probability dose calibrator, 26–27, 27f
high, 213, 214f–215f field uniformity, 36
intermediate, 217–218 frame manipulation, 37–38
low, 217–218 gamma scintillation camera, 28–38, 28f
very, 213–214 GM counter, 23, 24f
Progressive lymphoma, 382–383, 383f image acquisition, 36–37
Propylthiouracil, 117–119 image display and, 37
Prospective Investigation of Pulmonary Embolism image processing, 37
Diagnosis (PIOPED) instrumentation, 55–62
categories, 213 AOR, 61
image interpretation and collimator evaluation, 61
lung scan, 212–213 COR determination and correction, 60–61
modified criteria for, 213 detector head alignment, 61
lung scan, 213 field uniformity assessment and, 57–59, 58f
perfusion, 213–216 field uniformity assessment and correction, 59–60
ventilation, 213–215, 214f–215f gamma camera, 55–59
segmental defects, 206 linearity testing and, 55–57
Prospective Investigative Study of Acute Pulmonary spatial resolution and, 55–57
Embolism (PISAPED), 216 SPECT, 59–61
nondiagnostic, 216 system performance, 61
PE absent, 216 ionization chamber, 23, 24f
PE present, 216 operator interaction, 38
 Index 599

Quality control (Continued) Radiation safety officer (RSO), 422

pearls and pitfalls, 68b radionuclide therapy patients, hospitalized, 569
PET, 43–53 Radioactive decay, 4–5, 485, 485f, 514
PET/CT, 61–62 radionuclide, 4–5
ambient temperature and, 61–62 Radioactive gases, ventilation imaging, 199–200
blank scan and, 62 Radioactive material
CT scanner and, 62 hazard levels, 430–431
image plane calibration, 62 labeling, 431, 431f
normalization scan and, 62 packaging, 431
PHA, 33–34 production of, 3
photon detector devices, 31–32 radioactive-white I, 431, 431f
photon transducers, 32–33 radioactive-yellow II, 431, 431f
procedures, 56t–57t radioactive-yellow III, 431, 431f
radiopharmaceutical, 15–19, 16f, 16t spills, 504, 504f, 518
PET, 17 emergency procedures for, 575, 576t
radiopharmacy, 15–19, 16f, 16t major, 575, 576t
resolution and, 34–36 minor, 575, 576t
single probe counting systems, 25–26, 26f surface contamination limits and, 576
sodium iodide well counter, 23–25, 25f TI, 431
spatial filters and, 37, 38f transportation, 430–431, 450, 450f, 457–458, 457f,
SPECT, 38–42, 39f 506–508
SPECT/CT, 42–43 Radioactive shipments, receipt of, 432–433, 432f
temporal filters and, 37 contamination test, 433
tomographic image production, 41–42 monitoring, 432
Quantitative data, GSPECT, 187 notifications for, 433
diastolic function, 187–188 record keeping, 433
systolic function, 187 Radioactive-white I, 431, 431f
Radioactive-yellow II, 431, 431f
R Radioactive-yellow III, 431, 431f
Radiation Radioactivity, 1
areas, 438 amount of present, 4
high, 438 conversion table, 521t, 523t
surveys, 439f pearls and pitfalls, 21b
carcinogenesis, 565 Radiochemicals
dose rates, 434t impurities, 18
exposure labeling, 17–19
ambient, 427 particle size, 19
radiopharmaceuticals and, 434, 434t purity of
fetus and, 565 testing, 17
therapy USP regulations, 18
bone scan, 304–305 Radiographic (CXR) interpretive criteria
defect, 280, 281f perfusion, 212t, 213
PET and, 376–377 ventilation, 213, 213t
treatments, 18F-FDG and, 376 Radioimmunotherapy, 345
Radiation safety, 421 Bexxar, 356–358
committee, 425–426 lymphoma, 356–358
contamination pearls and pitfalls, 360b
environmental, 359 Rituxan, 356
limits, surface, 576 90Y, 356

test, 433 Zevalin, 356–357, 357f

dose limits, 422b, 424–425 Zevalin, 356–357, 357f
breastfeeding, 425 Radioiodine
caregivers and, 425 hyperthyroidism therapy, 117–120, 118b–119b
embryo/fetus, 425 imaging, 112–113, 113f
family and, 425 post-, 113–114, 115f
occupational, 425 during pregnancy/breastfeeding, 120, 125
public, 425 uptake, thyroid
facility survey policies, 438–439, 439f elevated, 102–103
131I therapy, 124–125, 125f reduced, 103
myocardial perfusion imaging, patient absorbed dose Radioisotopes, safety issues, 421
considerations and, 141, 146t pearls and pitfalls, 440b–441b
palliative therapy, of painful osseous metastases, 311–312 Radiolabeled aerosols, ventilation imaging, 198–200
patient absorbed dose considerations and, 141 Radiolabeled leukocytes, 397–406
pediatric, 125 clinical applications, 400–405
PET, 434–435, 435f active arthritis, 405
pregnancy and, 475–476, 475f, 512 diabetic foot infections, 404
radionuclide therapy patients, hospitalized, 569 FUO, 401
signs, 438f gastrointestinal tract, 401, 402f
thyroid disease 131I therapy, 124–125, 125f general considerations, 400–401
Zevalin, 357 immunocompromised patients, 402–403
 600 Index

Radiolabeled leukocytes (Continued) Radionuclides, 1. See also specific radionuclides

lung, 401 characteristics of, 519t–520t
musculoskeletal infections, 403, 403f cystogram, pediatric, 551
neuropathic joint infection, 404–405 decay, 4–5
osteomyelitis, 403–404, 404f decay tables
post-traumatic infections, 404 flourine-18, 527t
prosthetic joint infections, 404 67Ga, 527t

vascular graft infection, 405, 405f 123I, 527t

labeling principle, 399 131I, 528t

localization mechanisms, 397–399 111In, 527t

normal scan, 399–400, 400f 89Sr, 528t

technique, 399 examination, artifact caused by, 65, 65f

Radiolabeled monoclonal antibodies, 397 generator systems, 5–7
Radiolabeled peptides, 397 buildup and decay in, 6, 6f
Radiolabeled white blood cells, 397 elution column inside, 17
Radionuclide cystography, 338 elution times, 6
Radionuclide imaging, 7–15, 8t–9t. See also Renal 99Mo-99mTc, 5–6, 6f

radionuclide evaluation photon-emitting, 6–7

adverse reactions of, 14–15
brain
AD and, 85–88, 87f–89f
behavioral dysfunction and, 90
brain death and, 75–77, 78f
brain tumors and, 79–80, 81f–83f
cerebellar diaschisis and, 80
cerebral infarction, 77–78, 79f
cerebrovascular disease and, 77–79, 78f
clinical applications, 75–90
CNS, 71–90
dementia and, 84–90, 86t, 87f–89f
epilepsy and, 80–84, 84f–85f
head trauma and, 90
neuropsychiatric disorders and, 90
PET, 72–75
PET image interpretation, 75, 77f
planar brain imaging, 71–72
SPECT, 72–75
SPECT, normal, 74, 76f
SPECT image interpretation, 74–75
substance abuse and, 90
TIAs and, 78–79, 80f
cardiac function, 175–193
E-RNA, 183–193
first-pass studies of, 178–183
gated planar imaging technique for, 184–186,
184f–186f
GSPECT for, 175, 186–188, 186f
GSPECT for, clinical applications and,
purity of, 16–17
nuclear decay of, 1, 2f
nuclear medicine laboratory, characteristics of, 7
pearls and pitfalls, 21b
positron-emitting, 4
pregnancy/breastfeeding and, 12–13
production, 3–4
bombardment, 3–4
fission, 3–4
purity, 16–17, 16t
release of individuals after administering, 437–438
requirements for, 17
sealed, 19–20
therapeutic amounts
emergency autopsy of patients who have had, 576
emergency surgery of patients who have had, 576
therapy, characteristics of, 519t–520t
unsealed, therapy and, 19–21
Radiopharmaceuticals, 1. See also specific
radiopharmaceuticals
administration, safe, 433–434
adrenal glands, 315–316
glomerular filtration agents, 315–316
renal cortical agents, 316
tubular secretion agents, 316
bone imaging, SPECT, 547
bone marrow scan, 547
bone scans, 272, 294t, 295t
PET/CT, 557
99mTc, 546

188–193 brain imaging

image interpretation for, 182–183 PET FDG, 555
intracardiac shunts and, 182–183 SPECT, 534
radiopharmaceuticals and, 180, 183–184 brain perfusion imaging
right ventricular function and, 182 PET, 72–74
technique for, 180–182, 181f SPECT, 72–74, 76–77
cardiovascular system, 131 breast imaging with gamma camera, breast-specific,
characteristics of, 519t–520t 554
first-pass studies, 178–183 breastfeeding and, 566t–567t
principle of, 178–180 captopril renogram for diagnosis of renovascular
renal, 316–321 hypertension, 550
functional, 317–318 cardiac rest/stress imaging, PET, 556
Radionuclide therapy patients, hospitalized cerebral blood flow scan, 533
activities and release of, 570t–571t cisternogram, 534
dose rate and release of, 570t–571t CSF imaging, 90–91
hospital personnel and, 569 distribution, abnormal, 559t–562t
instructions to patients, 572t diuretic renography, 550
maintenance records, 572t dosages
NRC and, 569 pediatric, 529
radiation safety and, 569 dose calibrator, 27
release criteria, 572t embryo/fetus and dose of, 565t–566t
RSO and, 569 esophageal transit, 544
 Index 601

Radiopharmaceuticals (Continued) Radiopharmaceuticals (Continued)

exercise SPECT, 139–140 respiratory system, 197–200
extravasation of, 64, 65f perfusion imaging agents and, 197, 198f
gallium scan for, 552 ventilation imaging agents, 198–200
gastric emptying, 545 rest gated equilibrium ventriculography, 537
for gastric emptying, 266 salivary gland imaging, 546
gastroesophageal reflux, 544 shielding, 433
gastrointestinal bleeding scan, 543 syringe, 433–434, 433f
genitourinary system skeletal system, 271–273, 275, 276f
glomerular filtration agents, 315–316 extravasation of, 275, 276f
tubular secretion agents, 316 tourniquet phenomenon and, 275, 277f
handling, safe, 433–434 somatostatin receptor scan with 111In pentetreotide,
hepatobiliary imaging, 249–250 552
hepatobiliary scan, 542 SPECT, 72–74, 76–77
123I, thyroid scan, 535 bone imaging, 547
for imaging, 7–15, 10t brain imaging, 534
adverse reactions of, 14–15 liver imaging, 541
localization mechanisms and, 7, 11t myocardial perfusion imaging, 538
imaging agents, 197, 198f spleen imaging, 541
infection imaging, 397, 398t spleen imaging, SPECT, 541
investigational, 15 spleen scan, 541
labeling, 63–64 storage, 485, 485f, 514
leukocyte scan, 554 99mTc-pertechnetate

liver imaging, SPECT, 541 thyroid scan, 535

liver scan, 541 thyroid cancer scan, 536
liver-spleen imaging, 237 thyroid gland uptake, 99–100
lymphoscintigraphy, 553 dosimetry, 100–101
Meckel’s diverticulum scan, 543 123I for, 99–101, 100f

monoclonal imaging, 356 131I for, 99–101

myocardial perfusion imaging, 134–137 iodine uptake test, 101

Cardiolite for, 136, 137f 99mTc, 100–101

Myoview for, 136–137 thyroid scan

new, 137 123I, 535

SPECT, 538 99mTc-pertechnetate, 535

99mTc and, 135–136 Radiopharmacy, quality control, 15–19, 16f, 16t
201TI for, 135 Radium-223 chloride (Alpharadine), 311
neoplasm imaging, 345 Radius of rotation (ROR), 39
painful osseous metastases, palliative therapy of, 311 SPECT, 40–41
parathyroid scan, 537 Ramp filter, 42
pearls and pitfalls, 21b 82Rb. See Rubidium-82

peritoneal shunt patency, 545 Rb-82 CI protocol, 170–171, 171f

PET, 14–15, 72–74 186Re. See Rhenium-186

cardiac, 170–172 Recombinant human TSH (rhTSH), 113–114

cardiac rest/stress imaging, 556 Records
18F-FDG, 74, 75t dosages, 426
quality control requirements for, 17 radioactive shipments, receipt of, 433
PET FDG brain imaging, 555 radionuclide therapy patients, hospitalized and, 572t
PET/CT safety issues, 430
bone scan, 557 Red blood cell labeling techniques, 557–558
tumor imaging with 18F-FDG, 555 Redistribution, 135
pharmacologic stress imaging Reference sources, 426–427
adenosine, 539 Reflex sympathetic dystrophy (RSD), 305, 310f–311f
dipyridamole, 539 Regadenoson (Lexiscan), 158–160
positron emitter activity in, 27 patient preparation for, 160
during pregnancy/breastfeeding, 100 protocol for, 160
preparation, 63–64 Regulations
pulmonary perfusion scan, 540 NRC, 423
quality control, 15–19, 16f, 16t CRF 35.100, 424
radiation exposure and, 434, 434t CRF 35.200, 424
radionuclide cystogram in children, 551 CRF 35.300, 424
radionuclide imaging, cardiac function, 180, CRF 35.400, 424
183–184 CRF 35.500, 424
renal blood flow scan, 548 radiochemical purity, 18
renal scan Regulatory agencies, 423–424. See also Nuclear
cortical imaging, 548 Regulatory Commission
glomerular filtration, 549 license types and, 424
tubular function, 549 Renal activity, bone scans and, 288, 293, 293f
requirements for, 17 Renal blood flow scan, 548
preparation, 15–16 Renal cancers, 18F-FDG PET/CT neoplasm imaging,
USP, 15–17 391
 602 Index

Renal cortical agents, 316 Resolution, 34–36

Renal disease, diffuse, 321 collimator, 35
Renal function energy, 34–36
imaging, 317–318, 318f FWHM and, 35–36
quantitation, 320–321 FWHM and, 35–36, 35f
camera-based clearances, 321 gamma scintillation camera, 34–36
plasma sample-based clearances, 321 image, 36
Renal imaging, 444–445, 444f, 505 imaging, 36
anatomic (cortical), 321, 322f inherent, 35
functional, 317–318 inherent spatial, 34
perfusion, 317, 317f instrumentation, 34–36
Renal masses, 336–338 overall spatial, 35
Renal radionuclide evaluation, 316–321 PET, 51–52
clinical applications, 321–341 quality control, 34–36
ACE inhibitor renography, 328–336 spatial, 34
acute pyelonephritis, 336, 336f inherent, 34
diffuse renal disease, 321 overall, 35
hydronephrosis, pediatric, 328 quality control, 55–57
obstructive uropathy, 322–328 SPECT, 39–40
radionuclide cystography, 338 statistical variability and, 35
renal masses, 336–338 Respiratory system, 195
renal transplant evaluation, 338–341 anatomy, 195–197, 196f
urinoma, 328, 330f–331f normal lung scan, 200–203
vascular abnormalities, 322 pearls and pitfalls, 234b–235b
renal function physiology, 195–197
imaging, 317–318, 318f radiopharmaceuticals, 197–200
quantitation, 320–321 perfusion imaging agents and, 197, 198f
renal imaging ventilation imaging agents, 198–200
functional, 317–318 thrombus detection deep vein imaging, 233–235
perfusion, 317, 317f ventilation imaging agents, 198–200
renography, 319–320, 319f Rest gated equilibrium ventriculography, 537
Renal scan Restricted areas, 438
cortical imaging, 548–549 Retroperitoneal inflammation/infection imaging, 407
glomerular filtration, 549 Reverse perfusion defects, 149–150, 151f
pediatric examination, 530t Reversible defects, 149, 150f
tubular function, 549 Reversible ischemia, 490–491, 490f, 515
Renal transplant Rhenium-186 (186Re), 20–21, 311
evaluation, 338–341 characteristics, 519t–520t
imaging, pearls and pitfalls, 343b–344b Rhinorrhea, CSF, 486, 486f, 514
rejection, 338–339, 341f rhTSH. See Recombinant human TSH
Renal vein thrombosis, acute, 322 Rib fractures, bone scan, 291–292, 295f
Renography, 319–320, 319f Right ventricular activity, myocardial perfusion imaging
ACE inhibitor, 328–336 and, 152, 153f
abnormalities, 334 Rim sign, 253, 254f
99mTc-MAG3, 334 Ring artifact, 59–60
captopril, for renovascular hypertension diagnosis, Rituximab (Rituxan), 356
550–551 ROR. See Radius of rotation
clearance phase, 319 RSD. See Reflex sympathetic dystrophy
cortical concentration phase, 319 RSO. See Radiation safety officer
curves, 326, 326f Rubidium-82 (82Rb)
differential cortical retention, 319 chloride, 13
diuretic, 324–328 PET with, cardiac rest/stress imaging, 556–557
curves, 326, 326f radionuclide generator system, 5
data interpretation, 326, 327f
furosemide, 326 S
excretion Safety issues
half-time, 319 ALARA and, 435
phase, 319 AU, 421
renal uptake, relative, 319 pearls and pitfalls, 440b–441b
time to peak activity, 319 authorized personnel, 422
tubular concentration phase, 319 facility radiation survey policies, 438–439, 439f
20-minute-to-peak count ratio, 320 medical events, 429–430
typical curves, 319, 320f molybdenum concentration, permissible, 434
uropathy, obstructive, 322–328 NRC technical requirements, 426–427
diuretic, 324–328, 329f pearls and pitfalls, 440b–441b
vascular transit phase, 319 PET radiation, 434–435, 435f
Renovascular hypertension, 330–331, 334, 335f radiation, 421, 438f
captopril renogram for diagnosing, 550–551 environmental contamination, intravascular
Required reporting, 429–430 microsphere, 359
Reservoir effect, 328 facility survey policies, 438–439, 439f
 Index 603

Safety issues (Continued) Shielding

131I therapy, 124–125, 125f radiopharmaceuticals, 433
myocardial perfusion imaging, patient absorbed dose syringe, radiopharmaceuticals, 433–434, 433f
considerations and, 141, 146t Shin splints (medial tibial stress syndrome), 294,
palliative therapy of painful osseous metastases, 296f
311–312 Shoulder-hand syndrome, 305
pediatric, 125 Shunts
PET, 434–435, 435f abdominal, evaluation, 267–270, 268f
thyroid disease 131I therapy, 124–125, 125f intracardiac, 182–183
Zevalin, 357 left-to-right, 182
radiation areas, 438 right-to-left, 182
radioactive materials transportation, 430–431 LeVeen, 267, 268f
radioactive shipments, receipt of, 432–433, 432f patency
radioisotope, 421 CSF imaging and, 93–96, 94f–95f
pearls and pitfalls, 440b–441b peritoneal, 545–546
radionuclides administration and release of individuals, SI units. See International system units
437–438 Sigmoid cancer, 387–388, 387f
radiopharmaceuticals, 433–434 Signage posting, 438
record maintenance, 430 Sincalide, hepatobiliary imaging, 254
regulatory agencies, 423–424 Single probe counting systems, 25–26, 26f
required reporting, 429–430 crystal, 25–26
restricted areas, 438 handheld intraoperative probes, 26
RSO, 422 PMT, 25–26
sealed sources for diagnosis training, 429 probe size, 26
signage posting, 438 scintillation detectors, 26
unsealed byproduct material, training required for, semiconductor detectors, 26
427–429 Single-photon emission computed tomography
waste disposal, 439–442 (SPECT)
Salivary gland acquisition time, 41
18F-FDG distribution in, 365–368 attenuation correction, 41
imaging, 128–130, 546 patient-specific transmission map, 41
pearls and pitfalls, 129b bone imaging, 547
Samarium-153 (153Sm), 20–21, 311 brain imaging, 534
characteristics, 519t–520t brain perfusion imaging, 71–75
Sarcoidosis radiopharmaceuticals for, 72–74, 76–77
18F-FDG PET/CT, 412f brain scan, normal, 74, 76f
gallium imaging, 409, 410f bull’s eye display, myocardial perfusion, 142–144,
Sarcoma 145f
Ewing’s, 281, 282f CAD diagnosis and, 160–161
18F-FDG PET/CT neoplasm imaging, 394 CAD prognosis/risk stratification, 162, 189t
osteogenic, 280, 281f capable gamma camera, 28–29
osteosarcoma metastasis, bone scans and, 288f coronary stenosis and, 162–163
Sarcomatous degeneration of Paget’s disease, 300–301, 307f data acquisition, 40–41
Scaling artifact, myocardial perfusion imaging, 148–149 dedicated cardiac, 40
Scintigraphy myocardial perfusion imaging with, 137
ACE inhibitor, 330–331 exercise
abnormalities, 334 99mTc, myocardial perfusion imaging with, 139–140,

one-stage protocol for, 333 140f

protocols for, 332 thallium, myocardial perfusion imaging with,
single-day protocol for, 333 138–139, 139f
two-stage protocol for, 333 exercise radiopharmaceutical, 139–140
esophageal transit, 262–263 gamma camera, 39–40
hepatobiliary, 260, 261f–262f image display
Scintillation detectors, 26 myocardial perfusion, 142, 144f
PET, 48–49 image interpretation, 74–75
Scintillation events image matrix size, 41
photon transducers, 33 instrumentation, 38–42, 39f
PMTs and, 33 liver-spleen, 237–238
SDS. See Summed difference score myocardial infarction and, 164–165
Sealed sources for diagnosis, training, 429 myocardial perfusion imaging, 538
Segmental defects display image processing, 142–144, 142f–143f
perfusion, 206, 207f–211f, 212t false-positive scan, 161
mismatch, 206–207 myocardial revascularization, 163–164, 164f
triple match, 206–207 myocardial viability determination and, 165–166
PIOPED concept of, 206 noncardiac surgery, preoperative risk assessment and,
Semiconductor detectors, 26 167, 168f
photon solid, 32 number of views, 41
Septic arthritis 180-degree arc, 40
bone scan, 296–300, 303f quality control, 38–42, 59–61
18F-FDG PET/CT, 417f radiopharmaceuticals, 72–74, 76–77
 604 Index

Single-photon emission computed tomography Spleen scan, 541

(Continued) abnormal, 244–245
redistribution, 139 focal lesions and, 244
resolution, 39–40 splenomegaly and, 244–245
ROR, 40–41 trauma and, 245, 246f
skeletal imaging with, 273 nonvisualization of spleen and, 245, 247
360-degree arc, 40 normal, 243–244, 245f
201TI, 74 Splenic imaging, 243–245, 559t–562t. See also
Skeletal system, 271 Liver-spleen imaging
adolescent, 273–274, 275f abnormal, 244–245
anatomy, 271 normal, 243–244, 245f
bone marrow imaging, 305 Splenic infarction, bone scans, 286–287, 291f
bone mineral measurements, 305–309 Splenomegaly, spleen scan and, 244–245
bone scan clinical applications, 275–305 Splenosis, 470–471, 470f, 511
metastatic disease, 276–280 Spontaneous osteonecrosis of knee, bone scan,
diphosphonates, 271 304
four-phase study, 273 Squamous cell lung cancer, 480–482, 480f, 513
gamma camera imaging, 273 87mSr. See Strontium-87m

metastatic disease 89Sr. See Strontium-89

chemotherapy, 280 89mSr. See Strontium-89m chloride

diffuse, 456, 456f, 508 SSS. See Summed stress scores

neoplasms, 277–278 Standardized uptake values (SUVs), 50, 368–369
normal scan, 273–275, 274f–275f artifact, 66–67, 66f
painful osseous metastases, palliative therapy of, factors affecting, 375
309–314 18F-FDG PET/CT, 375

pearls and pitfalls, 313b–314b image quantitation, PET, 374–375

PET/CT, 272–273 Stannous agents, 18–19, 20f
physiology, 271 Stenosis
radiopharmaceuticals, 271–273, 275, 276f bilateral renal artery, 499–500, 499f, 517
extravasation of, 275, 276f coronary, 162–163
tourniquet phenomenon and, 275, 277f GSPECT functional data and, 163
SPECT imaging, 273 SPECT imaging data and, 162–163
symmetry, 274, 276f Sternal metastasis, bone scan, 278–279, 279f
technique, 273 Stomach, 18F-FDG distribution in, 372–373
three-phase study, 273 Stress fractures, 294, 297f–298f
153Sm. See Samarium-153 fatigue, 297f–298f
Sodium iodide (NaI), 48 insufficiency, 294, 298f
well counter, 23–25, 25f metatarsal, 461–462, 461f, 509
electronic dead time and, 25 Stripe sign, 217, 217f
geometric efficiency, 24 Stroke
Sodium pertechnetate, 7 acute phase of, 77–78
Soft-tissue neoplasms, 285–286 chronic phase of, 78
Solitary pulmonary nodules, 18F-FDG PET/CT neoplasm subacute phase of, 78, 79f
imaging, 378–381, 380t volumes, 131
Somatostatin (Octreotide), 351–353, 353f images, 177, 178f
Somatostatin receptor scan, 111In pentetreotide, Strontium-87m (87mSr)
552–554 characteristics, 519t–520t
Spatial filters, 37, 38f radionuclide generator system, 5
Spatial resolution, 34 Strontium-89 (89Sr), 20–21
inherent, 34 characteristics, 519t–520t
overall, 35 decay table, 528t
quality control, 55–57 Strontium-89m (89mSr) chloride (Metastron),
SPECT. See Single-photon emission computed tomography 311
SPECT equilibrium radionuclide angiography Stunned myocardium, 174–175, 174f
(SPECT-E-RNA), 175. See also Radionuclides Substance abuse, radionuclide brain imaging, 90
SPECT/CT, 43f Sudeck’s atrophy, 305
instrumentation, 42–43 Sulfur colloid 99mTc, 559t–562t
quality control, 42–43 Summed difference score (SDS), 162
SPECT-E-RNA. See SPECT equilibrium radionuclide Summed stress scores (SSS), 162
angiography Superscan, 279–280, 279f
Spills, radioactive material, 504, 504f, 518 metabolic bone disease, 302–303
emergency procedures for, 575, 576t Surface contamination limits, 576
major, 575, 576t Surgery
minor, 575, 576t complications, 340
surface contamination limits and, 576 emergency, of patients who have had therapeutic
Splanchnic activity, myocardial perfusion imaging and, amounts radionuclide, 576
152–153, 153f hepatobiliary imaging post, 260–261
Spleen Survey instruments, 426
18F-FDG distribution in, 373–374 SUVs. See Standardized uptake values
SPECT imaging, 541–542 Syringe shields, 433–434
 Index 605

Systole Temporal filters, 37

function, GSPECT quantitative data, 187 Temporal glioma, low-grade, 467–468, 467f, 510
LV during, 131–132 Temporal lobe epilepsy, 500, 500f, 517
Testicular cancers, 18F-FDG PET/CT neoplasm imaging,
T 391–392
Tagamet. See Cimetidine Tetrofosmin, 167
99mTc. See Technetium 99m Thallium-201 (201TI)
99mTc-ECD. See Bicisate characteristics, 519t–520t
99mTc-HMPAO. See Exametazime for imaging, 12
99mTc-iminodiacetic acid (IDA), 249 myocardial perfusion imaging with, 135
hepatobiliary imaging, 559t–562t dual isotope, 140–141
99mTc-MAG3, ACE inhibitor renography, 334 neoplasm imaging
Technetium AIDS and, 348
flood-field and mixing of, 58–59, 59f brain neoplasm, 348
label, 135–136 clinical applications of, 348–349
Technetium 99m (99mTc), 2–3, 197. See also 99Mo-99mTc physical characteristics of, 135
generator systems SPECT, 74
bone scan, 546–547 exercise, myocardial perfusion imaging with,
characteristics, 519t–520t 138–139, 139f
colloids, 240t Thorax
gastroesophageal reflux, 264 inflammation/infection imaging, 407
decay chart, 525t 99mTc HMPAO leukocytes and, 406

diphosphonates, bone imaging, 519t–520t Three-dimensional imaging, PET, 48, 48f

DTPA, 198 Thrombus detection, deep venous imaging,
excretion, 7–8, 11f 233–235
exercise SPECT, myocardial perfusion imaging with, Thymus, 18F-FDG distribution in, 368, 370f
139–140, 140f Thyroid
gastrointestinal bleeding studies, 245–246 18F-FDG distribution in, 365–368, 369f

generation tables, 526t lingual, 500–501, 500f, 517

for imaging, 7–8 tissue, ectopic, 104–105, 105f–106f
ion, 7 Thyroid cancer
leukocytes, 397 18F-FDG PET/CT neoplasm imaging, 378

liver-spleen imaging, 237 non-iodine avid, 114–116, 115f–117f

molybdenum-99 generator yield and, 526t scan, 536–537
myocardial perfusion imaging with, 135–136 Thyroid disease, 131I therapy, 116–125
nuclear decay of, 3, 3f functioning metastases and, 123–124
preparation, 18 patient preparation for, 120–121
production, 18 postsurgical ablation and, 121–123
purity, 16–18 principle of, 116–117
radionuclide generator system, 5 radiation safety aspects and, 124–125, 125f
reactive reduced, 18 Thyroid gland, 99
sulfur colloid, 559t–562t carcinoma, 111–114, 112f
thyroid gland imaging, 104 therapy for, 118b–119b, 121
thyroid gland uptake, 100–101 congenital organification defect, 105, 106f
valence states, 7 diffuse toxic goiter, 109, 111f
Technetium 99m HMPAO leukocytes, 405–406. See also ectopic thyroid tissue, 104–105, 105f–106f
Hexamethylpropyleneamine oxime imaging, 99–116
abdomen/pelvis and, 406 clinical applications of, 104–114
clinical applications of, 406 clinical protocol for, 104
labeling, 405 congenital organification defect, 105, 106f
normal distribution of, 406 diffuse toxic goiter and, 109, 111f
technique for, 405–406 ectopic thyroid tissue and, 104–105, 105f–106f
thorax and, 406 123I, 104

Technetium 99m pertechnetate, 18, 19f multinodular gland and, 109, 110f
Meckel’s diverticulum imaging with, 249, 250f non-iodine avid thyroid cancers, 114–116,
parathyroid gland imaging and, 126–128, 129b 115f–117f
thyroid scan, 535 normal, 104
Technetium 99m sestamibi (Cardiolite) post-radioiodine therapy, 113–114, 115f
myocardial perfusion imaging with, 136, 137f 99mTc, 104

dual isotope, 140–141 technique for, 104

neoplasm imaging, 349–351, 350f thyroid carcinoma and, 111–114, 112f
breast cancer, 349–351 thyroid nodules, 105–109
parathyroid gland imaging, 126–128, 126f post-thyroidectomy, 112–113, 113f
Technetium 99m tetrofosmin (Myoview), 136–137, thyroiditis and, 109–111
140–141 multinodular gland, 109, 110f
Technical artifacts, 62–69 pearls and pitfalls, 129b
areas of decreased activity, 62–64, 63f thyroid nodules, 105–109
areas of increased activity, 64–69, 65f uptake, 99–116
myocardial perfusion imaging, 148 clinical considerations for, 102–103
Teletherapy, external beam, 309–311 dosimetry, 100–101
 606 Index

Thyroid gland (Continued) Triple matches, 493, 515

123I for, 99–101, 100f lung scan and location of, 219
131I for, 99–101 TSH. See Thyroid-stimulating hormone
imaging, 559t–562t Tuberculosis, 229–232, 232f
iodine uptake factors and, 101–102, 102t, mycobacterium, 408
103b Tubular function, renal scan, 549
iodine uptake test, 101 Tubular secretion agents, 316
principle of, 101 Tumor, node, metastasis (TNM) classification, 376
radioiodine uptake, elevated and, 102–103 Tumor imaging
radioiodine uptake, reduced and, 103 adrenal, 353
radiopharmaceuticals, 99–100 monoclonal antibodies for, 14
99mTc, 100–101 pediatric examination, 530t
technique for, 101 PET/CT
Thyroid nodules, 105–109, 106t, 107f with 18F-FDG, 555
cold, 105–107, 106t, 107f, 475, 475f, 511–512 pediatric examination, 530t
discordant, 108, 109f, 447–448, 447f, 506 Tumors
hot, 107–108, 108f bone
warm, 108–109 18F-FDG PET/CT neoplasm imaging, 394,

Thyroid scan 394f

123I, 535–536 malignant, 280–281
99mTc-pertechnetate, 535 bone scan, 449, 449f, 506
Thyroid storm, 120–121 gallium scan for, 551–552
Thyroidectomy, imaging post-, 112–113, 113f gastrointestinal stromal, 18F-FDG PET/CT neoplasm
Thyroiditis, 482–483, 482f, 513 imaging, 387
imaging, 109–111 miscellaneous, 18F-FDG PET/CT neoplasm imaging,
Thyroid-stimulating hormone (TSH), 101 392–394, 392f
postradioiodine therapy imaging, 113–114 occult, 18F-FDG PET/CT neoplasm imaging,
TI. See Transportation index 394–395
201TI. See Thallium-201 of unknown primary origin, 18F-FDG PET/CT neoplasm
TIAs. See Transient ischemic attacks imaging, 394–395
Time-activity curve, 132, 132f Warthin’s, 128, 128f
TNM classification. See Tumor, node, metastasis Two-dimensional imaging, PET, 47–48, 47f
classification
Tomographic image production U
image display, 42 Ulcerative colitis, 18F-FDG PET/CT, 414f
image filtering, 42 Unobstructive patulous collecting system, 460–461, 460f,
image reconstruction, 41–42 509
instrumentation, 41–42 Unsealed byproduct material
quality control, 41–42 dilution studies, 427
Tonsils, 18F-FDG distribution in, 365–368 excretion studies, 427
Tositumomab (Bexxar), 356–358 imaging studies, 427–428
Toxic nodular goiter (Plummer’s disease), 120 131I-sodium iodide and, 429

Toxic thyroid adenoma, 492–493, 492f, 515 localization studies, 427–428

Transient equilibrium, 6 related procedures, 428–429
Transient ischemic attacks (TIAs), 78–79, 80f training required for, 427–429
Transient ischemic dilation (TID), 152 uptake studies, 427
myocardial perfusion imaging and, 152, 153f written directive not required for, 427–428
Transitional cell carcinoma, 477, 477f, 512 written directive required for, 428–429
Transmission, 426–427 related procedures, 428–429
Transmutation, 1 required training for, 428
Transplant evaluation, renal, 338–341 Uptake
cyclosporin nephrotoxicity, 340 18F-FDG, 376

pearls and pitfalls of, 343b–344b factors influencing, 381

rejection, 339–340 studies, unsealed byproduct material, 427
surgical complications, 340 thyroid gland, 99–116
Transplant rejection clinical considerations for, 102–103
acute, 339 dosimetry, 100–101
chronic, 339–340 123I for, 99–101, 100f

hyperacute, 339 131I for, 99–101

renal, 338–339, 341f imaging, 559t–562t

Transportation, radioactive materials, 430–431 iodine uptake factors and, 101–102, 102t, 103b
Transportation index (TI), 431 iodine uptake test, 101
Trapping, 99 principle of, 101
Trauma radioiodine uptake, elevated and, 102–103
bone scan, 288–296, 294f, 294t, 295t radioiodine uptake, reduced and, 103
head, 90 radiopharmaceuticals, 99–100
hepatobiliary imaging post, 260–261 99mTc, 100–101

infection post-, radiolabeled leukocytes and, 404 technique for, 101

muscle, bone scans and, 286–287, 291f Urecholine. See Bethanechol
spleen scan and, 245, 246f Urinoma, 328, 330f–331f
 Index 607

Uropathy, obstructive, 322–328 White blood cells (WBC)

renography, 322–324 radiolabeled, 397
diuretic, 324–328, 329f scanning, 403–404
routine functional imaging, 322–324 Whole-body imaging
USPSee Pharmacopeia, U.S activity distribution on, 443t
18F-FDG PET/CT neoplasm imaging, 375–395

V Window
Valvular lesions, 167–168 asymmetric, 34, 34f
Vascular abnormalities, 322 coincidence time, 43–44
Vascular graft infection, radiolabeled leukocytes, 405, energy
405f asymmetric, 34, 34f
Vasculitis, 233, 233f field uniformity assessment and centering, 59, 60f
diffuse, 484–485, 484f, 514 Written directive, 421–422, 494, 494f, 516
Vasotec. See Enalaprilat unsealed byproduct material training and, 427–428
Ventilation, 196 unsealed byproduct material training and required,
CXR interpretive criteria, 213, 213t 428–429
imaging related procedures, 428–429
diagnostic principle, 204–205 required training for, 428
DTPA, 203, 204f
imaging agents, 198–200 X
radioactive gas, 199–200 133Xe. See Xenon-133

radiolabeled aerosol, 198–200 Xenon-127, 519t–520t

technique for, 200 Xenon-133 (133Xe)
lung scan, 201–203, 202f characteristics, 519t–520t
133Xe, 201–203, 202f–203f for imaging, 9
modified PIOPED II criteria, 213–215 pulmonary ventilation scan, 539–540
high probability, 213, 214f–215f scan, 465–466, 465f, 510
normal, 215 ventilation imaging, 199
very low probability, 213–214 administration of, 199–200
Ventilation scan, pulmonary single-breath phase, 199
DTPA aerosol, 540 ventilation scan, 201–203, 202f–203f
133Xe, 539–540 X-ray peak, lead, 33–34
Ventricular function, 131
Ventriculography, rest gated equilibrium, 537 Y
Vocal cords, 18F-FDG distribution in, 365, 369f 90Y. See Yttrium-90
V/Q scans, 195 Yttrium-90 (90Y), 20
lung, 203–204 microspheres, 358–360, 359f
radioimmunotherapy, 356
W Zevalin
Warthin’s tumor, 128, 128f radioimmunotherapy, 356–357, 357f
Waste disposal, 439–442
WBC. See White blood cells Z
Well counters Zevalin. See Ibritumomab tiuxetan
geometric efficiency, 24
sodium iodide, 23–25, 25f