Nuclear medicine studies of the digestiv system. Zámbó Katalin Department of Nuclear Medicine

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1 Nuclear medicine studies of the digestiv system Zámbó Katalin Department of Nuclear Medicine

2 Anatomy of the liver

3 Liver scintigraphy The labelled colloid (200 MBq 99mTc-Fyton) is phagocyted by the Kuppfer-cells of the liver Static imaging (20 minutes later) from 6 directions + SPECT or SPECT/CT examination is very useful The focal defect is indicated by the decreased and/or the lack of the activity Indications: primary tumors, metastases, cysts, hemangioma, FNH

4 Focal parenchymal defect Static imaging

5 Liver SPECT/CT fused image CT SPECT SPECT/CT

6 Liver blood-pool scintigraphy The blood-pool of the liver is labelled by 99mTcpyrophosphate-red blood cells: At first: inactive pyrophosphate is injected i.v., 20 minutes later: 500 MBq 99mTc-pertechnetate is injected i.v., too Imaging is performed in equilibrium from 6 directions (similar to colloid scan) + SPECT or SPECT/CT Hemangioma is seen by increased activity

7 Liver colloid and blood-pool SPECT/CT fused image in hemangioma Colloid scintigraphy Blood-pool scintigraphy CT SPECT SPECT/CT CT SPECT SPECT/CT Focal parechymal defect Increased blood pool

8 Hepatobiliary scintigraphy I. The goal of the examination: secretion function of the liver from the blood excretion function of the bile through the hepatocytes function of the gall bladder (contraction by Sorbitol, ejection fraction) The way of the radioactive subject 200 MBq 99mTc- HIDA - from the blood to the bowels: parenchymal part of the liver ductus hepaticus ductus choledochus cholecysta bowels

9 Normal hepatobiliary dynamics

10 Hepatobiliary scintigraphy II. Indications: Post - cholecystectomical syndrome Focal nodular hyperplasy Cholecysta dyskinesis Bile excretion disorders Acut or chronic cholecystitis Flow of the bile to the abdomen cavity Atresie of the ductus hepaticus or choledochus Transplantation of the liver

11 Obstruction of the papilla Vateri

12 Normal ejection fraction of the gall bladder: >1%/min

13 Failed contraction of the gall bladder

14 Focal nodular hyperplasy (FNH): - higher perfusion - normal, lower or higher colloid activity - higher blood-pool activity - higher hepatobiliary activity

15 Somatostatin receptor scintigraphy Injected subject: 111-Indium-pentetreotide (somatostatine analog peptid are binding to the receptors overexpressed on the surface of tumor cells) Imaging time: 24 and 48 hours after the intravenous injection, SPECT/CT at the delayed time Indications: - neuroendocrine tumors (NET) - gastroentero-pancreatic (GEP) tumors

16 Carcinoid in the pancreas head, st. p. surgery, metastases? Static imaging by 111-In-pentetreotide

17 Multiplex bone and liver metastases of carcinoid by 111-In-pentetreotide CT SPECT SPECT/CT CT SPECT SPECT/CT

18 CT SPECT SPECT/CT NET in the small intestine with multiplex liver metastases by 111-Inpentetreotide CT SPECT SPECT/CT

19 Pancreas carcinoid with orbital, lung and mediastinal metastases CT SPECT SPECT/CT CT SPECT SPECT/CT CT SPECT SPECT/CT

20 Adrenerg receptor scintigraphy Injected subject: 123-iodine or 131- iodine-mibg (metaiodobenzylguanidine) is binding to adrenerg receptors Imaging time: 6 and 24 or 24 and 48 hours after the intravenous injection, SPECT/CT at the delayed time Indications: - neuroendocrin tumors - pheochromocytoma - neuroblastoma

21 Liver metastases of GEP tumor by 123-I-MIBG (examination before 131-I-MIBG therapy) CT SPECT SPECT/CT

22 Paraaortic lypmh node metastasis after operation of NET of small intestine by 123-I-MIBG CT SPECT SPECT/CT

23 Indication of PET/CT examination 18F-FDG Oesophagus carcinoma Colorectal cancer Stomach cancer GIST (gastrointestinal stroma tumor) Pancreas adenocarcinoma Gallbladder cancer Dedifferenciated NET

24 Oesophagus carcinoma 18F-FDG PET/CT fused image

25 Multiplex metastases of pancreas tail cancer 18F-FDG PET/CT fused image Image of Pozitron Kft

26 Liver metastasis of colorectal cancer Increased glucose metabolism with central necrosis in the liver metastasis 18F-FDG PET/CT fused image

27 Local recidiva of sigma carcinoma 18F-FDG PET, CT and fused images Image of Pozitron Kft

28 Therapeutic effect of multiplex liver metastases by 18F-FDG PET Before therapy SUV is high After therapy SUV is decreased (SUV: standard uptake value) Image of Pozitron Kft

29 Oesophagus scintigraphy and gastric emptying study Radiopharmaceutical: the patient drinks water for oesophagus study and/or eats a test meal in which a solid component of the meal (scrambled egg), a liquid component of the meal (water), or both for gastric emptying study, are mixed with a small amount of radioactive material MBq 99mTc-DTPA Dynamic examination is started immadiately at the time of swallow up the test meal Generation of time-activity curves by software program Calculation of parameters: half time, emptying speed of the radioactive meal through to the stomach and bowels Indications: motility failures of eosophagus and/or stomach, cardiac and pyloric stenosis, tumors

30 Gastro-oesophageal stenosis Slow passage through the oesophagus cardia

31 Gastric emptying study stomach Normal examination

32 Pyloric stenosis stomach

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