Nuclear medicine in endocrinology

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1 Nuclear medicine in endocrinology Thyroid gland: anatomy, function, inflammation, Nuclear medicine in endocrinology tumor dignitiy Parathyroid gland: localisation Adrenal cortex: function Adrenal medulla: localisation Source T1/2 Energy (kev) 99m Tc Generator 6h Uptake of different isotopes into thyroid cell Thyroid scintigraphy Isotope Use Comment -daily routine Thyroid imaging -cheap -low dose -best 123I Cyclotrone 13.3 h 159 Thyroid imaging -expensive -poorly avai-lable 131I Reactor 8.1 days γ: 364 ß: 606 -Thyroid imaging -uptake -therapy -high dose -ß-emission 3 Thyroid uptake 4 Thyroid scintigraphy - indications goiter hyperthyroidism Graves disease autonomous adenoma subacute thyroiditis (dequervain) (Hypothyroidism?) palpable nodule in the neck: function? evaluation of substernal mass postoperative search for functioning metastases 5 Normal thyroid scintigraphy 6 Normal variants - size - homogenous appearance - sharply defined borders - straight or convex lateral margins - ductus thyreoglossus remnant - sublingual thyroid - congenital absence of one lobe 7 8

2 Non-visualizing thyroid Nodules hot nodules - low thyroid uptake - thyroiditis - suppressing or antithyroid medication - surgical or radioiodine ablation Goiter diffuse goiter Goiter nodular goiter 15 16

3 Goiter nodular goiter Goiter multinodular goiter Radioiodine therapy of thyroid Goiter nodular goiter + nodule 131I-NaI: β-emission: 606 kev γ-emission: 364 kev penetrance in soft tissues: mm Indications hyperthyroidism (diffuse: Graves, focal: autonomous adenoma) goiter mass reduction differentiated thyroid cancer tumor remnant ablation after surgery tumor recurrence, metastasis elimination Activitiy to administer (dosage) benign thyroid diseases: calculation (estimated mass, absorption dose in Gy, maximal uptake, effektive halflife) MBq cancer: 3700 MBq (100 mci) or higher After radio-iodine therapy 19 Parathyroid scintigraphy 20 Parathyroid scintigraphy - subtraction Purpose: localisation of parathyroid adenoma (in case of hyperparathyroidism) 99m Tc-MIBI: accumulates in thyroid and parathyroid Techniques: - washout - subtraction 21 Parathyroid scintigraphy 22 Parathyroid scintigraphy washout (mediastinal localisation) anterior mediastinal view washout Thyroid (Practice) 23 24

4 Adrenocortical scintigraphy Adrenocortical scintigraphy (NP59) Radiopharmaceutical: 75Se-Cholesterol/Scintadren 131I-Iodocholesterol /NP59 Indications localisation of hormon overproduction hypercortisolism: Cushing s syndrome hyperaldosteronism: Conn s syndrome adrenal hyperandrogenism incidentalomas benign adenoma vs. metastasis anterior 25 posterior 26 Adrenomedullar scintigraphy Adrenomedullar scintigraphy (123I-MIBG) Radiopharmaceutical: MIBG (metaiodobenzylguanidine) uptake by chatecholemine producing cells: sympathoadrenal system labeled with 123I 131I : diagnosis (γ-emission) : therapy (β-emission) Indications: pheochromocytoma paraganglioma pheochromocytoma neuroendocrine tumors: paraganglioma, neuroblastoma, ganglioneuroma, etc. extraadrenal pheo 27 Thyroid #1 28 Thyroid #2 Thyroid #1 29 Thyroid #3 30 Thyroid #

5 Thyroid #5 Thyroid #6 99m Tc-pertechnetate 99m Tc-MIBI Thyroid #7 Thyroid #

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