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CURRENT PATHOLOGY IMAGING GUIDELINES

GENERAL CONTENTS

A. Neck and thorax

B. Upper abdomen

C. Genitourinary system

D. Vascular system

E. Central nervous system

G. Extremities

H. Imaging resources in Nuclear Medicine

  1. Musculoskeletal system
  2. Respiratory system
  3. Cardiovascular system
  4. Urogenital system
  5. Gastrointestinal tract
  6. Central nervous system
  7. Varied scintigraphic techniques
  8. Targeted studies - Oncology
  9. PET-CT imaging
  10. Radioactive source treatment

1. Musculoskeletal system

Total body bone scintigraphic scanning:

  • Bone metastases work-up and follow-up
  • Local extension work-up of primary bone tumors
  • Diagnosis and follow-up of Paget disease of bone
  • Metabolic disorders (hypercalcemia, hyperparathyroidism,…)
  • Bone pain of unknown origin

Bone scintigraphy with dynamic phase:

  • Diagnosis of traumatic lesions (fracture, bone contusion...)
  • Diagnosis of infectious/inflammatory disorders (osteomyelitis, osteoarthritis,…)
  • Diagnosis and follow-up of reflex sympathetic dystrophy syndrome (Südeck)
  • Diagnosis of prosthesis loosening/infection
  • Diagnosis of aseptic necrosis (Perthes disease, other osteochondroses)

2. Respiratory system

Ventilation & perfusion lung scan:

  • Diagnosis and follow-up of lung embolism
  • Preoperative work-up and estimation of residual capacity after resection
  • Follow-up after lung transplantation
  • Functional regional ventilation/perfusion ratio

3. Cardiovascular system

SPECT stress & resting myocardial tomoscintigraphy (thallium or MIBI):

  • Detection and work-up of coronary disease extension
  • Depiction of residual ischemia after myocardial infarct or after revascularisation

Isotopic resting ventriculography:

  • Measurement of cardiac function and regional contraction deficiencies
  • Myocardial chemotherapy toxicity detection and follow-up

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4. Urogenital system

Simple isotopic nephrogram:

  • Measurement of renal function - separate kidneys
  • Residual function of a traumatised kidney
  • Functional monitoring in paraplegic or tetraplegic patients
  • Renal graft monitoring

Isotopic nephrogram with furosemide test:

  • Investigation of hydronephrosis or megaureter
  • Obstructive uropathy
  • Control after surgical repair

Isotopic nephrogram with captopril test:

  • Arterial hypertension investigation
  • Confirmation of renal artery stenosis
  • Renal work-up before introduction of a prolonged treatment with ACE inhibitors

DMSA renal scintigraphy:

  • Suspicion of acute pyelonephritis
  • Depiction of renal cortical scars after pyelonephritis
  • Scar imaging in malformative uropathy
  • Evaluation of relative function of both kidneys

5. Gastrointestinal tract

Salivary glands scintigraphy:

  • Functional evaluation of the salivary glands
  • Obstruction of salivary ducts

Stomach solid and liquid contents clearing:

  • Dysfunction of gastric emptying and motility

Hepatobiliary scintigraphy:

  • Hepatobiliary function measurement
  • Cholestasis investigation
  • Diagnosis of a biliary fistula, particularly in post-operative patients
  • Suspicion of biliary tract atresia

Labeled red blood cells scintigraphy:

  • Acute gastrointestinal tract hemorrhage localisation
  • Investigation of an haemorrhage originating from outside the gastrointestinal tract

Free Technetium scintigraphy:

  • Meckel's diverticulum diagnosis

Milk-scan scintigraphy in a child:

  • Gastro-oesophageal reflux diagnosis
  • Bronchopulmonary aspiration detection

6. Central nervous system

Brain SPECT tomoscintigraphy:

  • Brain ischemic attack
  • Localisation of a epileptogenic focus
  • Diagnosis of brain tumors
  • Dementia work-up
  • Evaluation of AIDS-related diseases
  • Functional vascular residual capacity test (Acetazolamide test)

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7. Varied scintigraphic techniques

Thyroid scintigraphy:

  • Thyroid function test
  • Thyroid nodule diagnosis
  • Iodine organification defect diagnosis by perchlorate test
  • Functional thyroid disorders diagnosis
  • Iodine extraction rate calculation before radioiodine therapy

Localisation of infectious/inflammatory focus:

  • Scintigraphy with antigranulocyte antibodies
  • Scintigraphy with HIG (polyclonal Human Immunoglobulin G )
  • Gallium Scintigraphy

Lymphoscintigraphy :

  • Sentinel lymph node localisation in case of malignant melanoma
  • Sentinel lymph node localisation for breast cancer
  • Peripheral lymphatic backflow disorders

8. Targeted tests - Oncology

MIBG scintigraphy :

  • Localisation of medullo-adrenal gland tumors (pheochromocytoma)
  • Neuroectodermic neoplasms work-up and follow-up (neuroblastoma)
  • Neuroendocrin tumors (gastro-entero-pancreatic, pulmonary)

Octreotide scintigraphy:

  • Neuroendocrin tumors (gastro-entero-pancreatic, pulmonary)
  • Small cell lung cancer
  • Thyroid medullary cancer

Gallium scintigraphy:

  • Hodgkin's lymphoma work-up and follow-up with early recurrence detection
  • Work-up and follow-up of non hodgkin lymphomas

MIBI scintigraphy:

  • Parathyroid adenoma localisation
  • Malignant melanoma dissemination work-up
  • Mammary gland neoplasia

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9. PET-CT imaging

PET-CT in oncology :

  • Diagnosis of a solitary lung nodule
  • Diagnosis between recurrence/residual tumor and radionecrosis/scar tissue
  • Treatment monitoring
  • Radio-oncologic treatment planning
  • Non small cell lung cancers (NSCLC)
  • Otolaryngologic cancers
  • Breast cancer
  • Hodgkin's lymphoma and non hodgkin lymphomas
  • Rectocolic cancer
  • Esophagus cancer
  • Malignant melanoma
  • Germinal cell tumors in males
  • Brain tumor diagnosis and follow-up
  • Other tumors (ovaries, uterus, pancreas, sarcomas of bone and soft parts, SCLC, mesothelioma, …)

Brain PET-CT:

  • Epileptogenic focus localisation
  • Preoperative brain tumor test
  • Early tumor recurrence detection and differential diagnosis from radionecrosis
  • Dementia diagnosis

10. Radioactive source treatment (after medical agreement)

  • Palliative antalgic treatment of bone metastases (breast, prostate):
    • Strontium 89m
    • Samarium 153 EDTMP
  • Thyroid hyperfunction treatment: Iodine 131

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Institut d'Imagerie Médicale - Clinique de Genolier - CH-1272 Genolier
Dr Jean-Pierre Papazyan Tél: +41.22.366.94.84 - Fax: +41.22.366.94.82