Diagnostics in nuclear medicine can be summarized under the general term “functional diagnostics”. It is less concerned with the anatomical structure and condition of the organ, and more concerned with whether the organs perform their special tasks or what their violation is. In addition, specific metabolic processes can be assessed; this issue plays a particularly important role in the diagnosis of tumors.
Technically, nuclear medicine research is usually done by injecting a patient with a small amount of a radioactive substance and then observing its distribution in the body. In this way, blood flow in the heart and lungs or kidney function, as well as bone and thyroid metabolism can be visualized.
Main directions of diagnostics
PET-CT studies
This modern nuclear medicine technique combines positron emission tomography (PET) with computed tomography (CT), an X-ray examination that allows for the highest level of detail. This procedure is used primarily to diagnose and stage tumors such as lung cancer. This method can also answer cardiac and neurological questions, for example in dementia. In addition, gallium-PSMA is a new substance for patients with prostate cancer.
PET/CT
What it is?
PET/CT is a test that can be used to visualize the main metabolic processes in the body.
To do this, you are given radiolabeled glucose (18FDG), which accumulates in the body depending on the metabolism of individual cells. Naturally, 18FDG accumulates in the heart and brain, but metabolically active tumor cells and inflammatory tissues take up 18FDG to a greater extent. Approximately one hour after 18FDG administration, PET/CT scans are taken to evaluate metabolism and CT scans are taken for anatomical classification.
The examination itself takes about 15 minutes. After the examination, the attending physician examines the images and, depending on the question asked, provides you with the initial result.
When is PET/CT used?
PET/CT with radiolabeled glucose is a common procedure for various tumor diseases (lung cancer, ENT tumors, lymphomas, liver metastases from intestinal tumors, esophageal tumors and many other diseases).
How is the examination carried out?
Before the study, you will have an informative conversation with your doctor, during which you will be able to discuss any questions that interest you. We will then determine the final indications and decide whether PET/CT will be performed in conjunction with low-dose CT (if a diagnostic CT has already been performed in the recent past) or whether an additional diagnostic CT study will be required.
The next step is the introduction of 18FDG (radiolabeled glucose)
About an hour after the 18FDG injection, the machine produces PET/CT images, as well as low-dose or diagnostic CT, depending on the history of the disease and the nature of the tumor.
For some types of tumors, during the examination we also record the breathing process using a special chest strap, this makes it possible to calculate the possible displacement of individual focal formations during breathing in the images.
Sometimes, immediately after the first study, additional images are taken on a special platform, in cases where the data obtained are necessary for planning subsequent radiation therapy.
18F-PSMA PET/CT
What is 18F-PSMA PET/CT?
PSMA PET/CT is used to visualize the distribution of prostate specific membrane antigen (PSMA) in the body. Prostate specific membrane antigen accumulates in prostate tumor cells and also accumulates naturally in the salivary glands, liver and spleen, kidneys and intestines.
What is 18F-PSMA PET/CT used for?
PSMA PET/CT examination is usually used for the initial diagnosis of prostate carcinoma, before a course of therapy or in the case of biochemical recurrence of prostate cancer.
In more rare cases, PSMA PET/CT is also used to study late stages of prostate cancer when there is metastasis. PSMA expression in these metastases is so high that PSMA-targeted therapy, such as the use of 177Lu-PSMA, may be promising.
Who is conducting it? 18F-PSMA PET/CT?
- Patients with no decline in PSA levels below 0.2 ng/mL within 3 months after radical prostatectomy for localized prostate carcinoma.
- Patients with PSA relapse after radical prostatectomy (PSA value > 0.2 ng/mL confirmed by two measurements) or after radiation therapy alone (PSA increase > 2 ng/mL confirmed by two measurements) of localized prostate carcinoma.
In cases 1. and 2., if the PSA value is > 10 ng/ml, to localize the tumor, it is necessary to first carry out routine examinations, including pelvic MRI and skeletal scintigraphy.
- Patients with high-risk prostate cancer (Gleason score 8-10, tumor size cT3/cT4 or PSA ≥ 20 ng/ml) to diagnose disease spread before therapy (with 18F-FDG and PSMA ligands).
- In patients with castration-resistant prostate cancer and with advanced disease to determine indications for therapy using 177Lu-PSMA
How does 18F-PSMA PET/CT study work?
At the beginning of the study, the patient is injected with radioactively labeled PSMA (18F-PSMA 1007) - more correctly called the PSMA ligand - which accumulates on tumor cells depending on the level of PSMA expression. Prostate specific membrane antigen naturally accumulates in the salivary glands, liver and spleen, kidneys and intestines, and ganglia also sometimes absorb PSMA to an increased extent. Approximately 100 minutes after administration of 18F-PSMA, PET/CT images are taken and CT images are taken for anatomical identification.
The examination itself takes about 20 minutes. Your doctor will then evaluate the images and tell you the results.
Scintigraphic diagnostics
Myocardial scintigraphy
What it is?
This method is used to study blood flow and pumping function of the heart muscle, and also allows for assessment of the patency of the coronary arteries.
What is myocardial scintigraphy used for?
This type of diagnosis is extremely informative both in case of suspected circulatory disorders and in case of already known changes in the coronary vessels (for example, after bypass surgery or vasodilator measures).
How is the examination carried out?
In order to assess the functioning of the coronary vessels, a scintigraphic study of myocardial perfusion is carried out under load and, if necessary, at rest.
The exercise is carried out either with the help of an ergometer system or, alternatively, with the use of drugs (adenosine or regadenoson), which increase coronary blood flow and thus replace or complement the exercise on an exercise bike. During the exercise, the patient is injected with a small amount of radioactive substance, which is distributed in the tissues of the heart muscle depending on the blood flow. Using a modern cardiac camera, the measuring heads of which slowly rotate around the chest, the distribution of this radioactive substance and the blood circulation in the heart muscle are visualized.
All types of thyroid diagnostics (sonography, scintigraphy, laboratory diagnostics)
As part of the diagnosis of the thyroid gland, for example, in case of functional disorders of the thyroid gland (autonomies, hot/cold nodes), a blood test, ultrasound examination and, depending on the problem, scintigraphy are usually performed. Fine needle aspiration biopsy of cold nodes is performed as a standard procedure. Patients with thyroid enlargement and/or nodules (goiter), autoimmune diseases and inflammation (Graves' disease, Hashimoto's thyroiditis), as well as thyroid tumors can be examined and treated both on an outpatient basis and, if necessary, in a hospital.
Fine needle aspiration biopsy (FNAB) is a low-traumatic procedure with minor side effects, which is an important component in the diagnosis of thyroid nodules. In the hands of an experienced specialist in combination with an experienced pathologist, the diagnostic value of the procedure is extremely high, therefore, with the help of TAPB, a significant number of diagnostic operations on the thyroid gland can be avoided.
Thyroid scintigraphy
What is this?
This is a diagnostic test that uses radioactive markers and a gamma camera to study the function and structure of the thyroid gland and parathyroid glands (parathyroid glands or parathyroid glands).
For what?
Thyroid and parathyroid scintigraphy is widely used to diagnose various conditions such as hyperthyroidism, hypothyroidism, thyroid and parathyroid tumors, and to plan surgical interventions related to these organs. This is a safe procedure and the radioactive doses are usually very low and do not pose a threat to the patient's health.
Scintigraphy of the thyroid gland and parathyroid glands with 99Tc-Technetril (MIBI)
What is this?
MIBI scintigraphy of the thyroid gland is a type of radionuclide diagnostics that allows you to monitor the accumulation of a radioisotope in the thyroid tissue by studying layer-by-layer sections of the organ and their volumetric reconstruction.
For what?
Using the study, areas of reduced accumulation of radiopharmaceuticals (“cold” nodes) and foci of hyperfixation (“hot” nodes) are identified, and a quantitative assessment of the functioning and non-functioning parenchyma of the thyroid gland is made.
Ventilation scintigraphy - diagnosis of the lungs using nuclear medicine
What is ventilation scintigraphy used for?
This procedure uses modern SPECT/CT technology to diagnose pulmonary embolism. In addition, quantitative CT assessment can be performed before lung surgery, such as for cancer, COPD, or emphysema, to assess the lung function that can be expected after surgery.
How is it carried out?
Using the TECHNEGAS-Plus generator, the patient is injected with a radioactive inhalation aerosol, which is distributed in the lungs depending on their ventilation. The lungs are then scanned using a special camera, which detects the radioactive signal and creates an image of the ventilation of the lungs, which can identify any abnormalities. The new 3D assessment method allows you to calculate the ratio of the function of individual pulmonary lobes to overall lung function.
Brain scintigraphy - Diagnosis of the brain using nuclear medicine
What it is?
Brain scintigraphy is a diagnostic procedure in which a radioactive substance is injected (usually through a vein), which is then detected and recorded by a special camera called a gamma camera or positron emission tomography (PET) scanner. This allows doctors to image brain activity, determine blood flow, metabolic activity and functional aspects of brain activity.
What is brain scintigraphy used for?
Brain scintigraphy is used to diagnose and evaluate various brain pathologies such as tumors, strokes, epilepsy, Parkinson's disease, Alzheimer's disease and other neurological disorders.
The focus is on research into Parkinson's disease using DaTSCAN®. This special radioactively labeled substance is used to molecularly image the density of dopamine receptors in the brain, allowing the details of signal transduction to be assessed.
Scintigraphy of skeletal bones (Osteoscintigraphy)
What it is?
Bone scintigraphy is a diagnostic technique that uses radioactive substances to visualize bones. The patient is given small doses of a radioactive drug, which then accumulates in the bones. A special camera (gamma camera) records the radiation, and based on this data, an image of the bone tissue is created.
What is osteoscintigraphy used for?
This method allows you to detect various bone pathologies, such as fractures, tumors, bone metastases, inflammatory or infectious processes.
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