SWISSRADIOLOGY.COM	SWISSRADIOLOGY.COM
SWISS RADIOLOGY PORTAL

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

Musculoskeletal system

Respiratory system

Cardiovascular system

Urogenital system

Gastrointestinal tract

Central nervous system

Varied scintigraphic techniques

Targeted studies - Oncology

PET-CT imaging

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, pulmonary hypertension
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

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:

Neurodegenerative diseases
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)

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

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

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

SWISS RADIOLOGY PORTAL