Methods of nuclear medicine Per Wollmer Dept. of Translational Medicine Lund University
Gamma camera Positron camera Both frequently combined with CT
Ventilation/perfusion scanning Perfusion: Albumin macroaggregates labelled with 99m Tc Ventilation: Wash-in, wash-out of poorly soluble gas ( 133 Xe) Continuous inhalation short-lived gas ( 81m Kr, 19 Ne) Aerosols labelled with 99m Tc 81m Kr
Nebulised 99m Tc-DTPA vs. Technegas Nebulised 99m Tc-DTPA Technegas Jögi et al. J Nucl Med 2010; 51: 735
SPECT V/Q for diagnosis of pulmonary embolism Roach et al. Semin Nucl Med 2010; 40: 397 Phillips et al. Eur J Radiol 2015; 84: 1392
SPECT/CT V/Q Perfusion Ventilation
V/Q ratios measured by injection/wash-out of 13 N Harris et al. J Nucl Med 2003; 44: 1982
Changes in V and Q in response to methacholine challenge in asthma Harris et al. Am J Respir Crit Care Med 2006; 174: 245
Direct measurement of V/Q ratio using poorly soluble gas Breathing valve C A Apical lung Basal lung At steady state: C A reflects V/Q Anthonisen et al. J Clin Invest 1966; 45: 1349
Direct measurement of V/Q ratio using 13 N Normal subject Normal subject with airway closure Brudin et al. Thorax 1992; 47: 914
Direct measurement of V/Q ratio using 133 Xe Normal subject Patients 1 Mean of normal subjects 2 Almquist et al. Clin Physiol 1999; 19: 475
Extracellular space Cytosol ATP ADP Glu Glu+P i Glu-6P GluT Hexokinase 18 FDG 18 FDG+P i 18 FDG-6P ATP ADP Glu-6Pisomerase Glycolysis
Quantification of tracer uptake in PET/CT
Quantification of tracer uptake in the lung
Lymph node staging of lung cancer Stamatis. Eur Respir J. 2015; 46: 521
SUVmax: Hazard ratio for recurrence Liu et al. PLoS One 2016; 11: 1
SUVmax: Hazard ratio for death Liu et al. PLoS One 2016; 11: 1
18 FDG is taken up by leukocytes: problem and opportunity Tuberculosis
Pulmonary 18 FDG uptake in sepsis model 8 7 6 5 4 3 2 1 0 Leukocyte count Blood glucose (mmol/l) Septic Control Lung weight (g) 18 FDG uptake (% inj. activity/g tissue) 0,6 0,5 0,4 0,3 0,2 0,1 0 Sepsis Control Lung Muscle Blood Hansson et al. Eur J Nucl Med 1999; 26: 1340
Inflammation in the lungs of smokers measured with 18 FDG Patients referred for staging of (bladder) cancer. No history of pulmonary disease. No evidence of pulmonary metastasis at CT. Smokers Non-smokers Age (years) 64±11 58±16 Pack years 34±16 0 Weight (kg) 73±16 76±16 P-glucose (mmol/l) 6.1±1 5.6±1 Uptake time (min) 65±4 65±4
Inflammation in the lungs of smokers measured with 18 FDG 3 p<0.05 2,5 2 1,5 1 0,5 0 Lung density (g/l) SUV SUV/Lung density Smokers Non-smokers
Lung uptake of 18 FDG in emphysema FEV 1 (%pred) 112±10 59±17 52±18 Subramanian et al. Am J Respir Crit Care Med 2012; 186: 1125
Glucose uptake rate V, Q and uptake of 18 FDG in response to segmental allergen challenge 25 20 15 10 5 0 Diluent Allergen Harris et al. J Nucl Med 2011; 52: 1713
Anti-inflammatory effect of lovastatin after segmental endotoxin challenge Chen et al. Am J Respir Crit Care Med 2009; 180: 533
18 FDG for evaluation of patients with sarcoidosis Teirstein et al. Chest 2007; 132: 1949 Sobic-Saranovic et al. Semin Nucl Med 2013; 43: 404
18 FDG for evaluation of patients with interstitial lung disease Retrospective study 90 patients Mixed bag of ILD Outcome: transplant-free survival Nobashi et al. J Nucl Med 2016; doi:10.2967/jnumed.116.174946
18 FDG for evaluation of patients with interstitial lung disease Nobashi et al. J Nucl Med 2016; doi:10.2967/jnumed.116.174946
Summary Pulmonary V/Q scanning retains its role in diagnosis of pulmonary embolism SPECT preferred over planar imaging Ample opportunities for pathophysiological studies of V/Q relationships PET/CT using 18 FDG is the method for staging lung cancer PET/CT contributes important prognostic information in lung cancer Pulmonary uptake of 18 FDG is a sensitive indicator of inflammation Ample opportunities for pathophysiological studies Clinical indications to be established