Nuclear imaging is the radiologic examination using radiopharmaceuticals, which are radioactive substances taken up by specific types of cells. Nuclear medicine is more concerned with the functional and molecular aspects of the organ or pathology being investigated rather than the structure. Radiopharmaceuticals are administered to the patient and in vivo distribution is recorded. Nuclear imaging has been widely used to diagnose and follow up certain diseases. Multiple organ systems can be evaluated, including the cardiovascular system, where ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage is detected; endocrine system, where thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy activity is evaluated; hepatobiliary system, where cystic duct Cystic duct The duct that is connected to the gallbladder and allows the emptying of bile into the common bile duct. Cholecystitis obstruction can be seen; and skeletal system where tumors/ metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis or fractures are localized.
Last updated: 6 May, 2022
Equipment:
Imaging techniques:
A SPECT/CT system with relevant components labeled in the photograph on the right
Image: “NM19 290” by Kieran Maher. License: Public DomainImaging finding | Interpretation |
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Bile Bile An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts; cholesterol; and electrolytes. It aids digestion of fats in the duodenum. Gallbladder and Biliary Tract: Anatomy ducts visible | Normal hepatic function |
Filling of the gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy | Patent cystic duct Cystic duct The duct that is connected to the gallbladder and allows the emptying of bile into the common bile duct. Cholecystitis |
Radiotracer is seen in the duodenum Duodenum The shortest and widest portion of the small intestine adjacent to the pylorus of the stomach. It is named for having the length equal to about the width of 12 fingers. Small Intestine: Anatomy | Patent common bile duct common bile duct The largest bile duct. It is formed by the junction of the cystic duct and the common hepatic duct. Gallbladder and Biliary Tract: Anatomy |
No radiotracer is seen in the gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy | Obstructed gallbladder Gallbladder The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile. Gallbladder and Biliary Tract: Anatomy (acute cholecystitis Cholecystitis Cholecystitis is the inflammation of the gallbladder (GB) usually caused by the obstruction of the cystic duct (acute cholecystitis). Mechanical irritation by gallstones can also produce chronic GB inflammation. Cholecystitis is one of the most common complications of cholelithiasis but inflammation without gallstones can occur in a minority of patients. Cholecystitis) |
No radiotracer is seen in the duodenum Duodenum The shortest and widest portion of the small intestine adjacent to the pylorus of the stomach. It is named for having the length equal to about the width of 12 fingers. Small Intestine: Anatomy | Biliary atresia Atresia Hypoplastic Left Heart Syndrome (HLHS) |
Radiotracer outside the biliary system | Biliary leak |
Hepatobiliary iminodiacetic acid scan
Image by Lecturio.Normal hepatobiliary iminodiacetic acid scan showing the radioactive substance moving through the biliary system
Image: “HIDA” by Myohan. License: CC BY 3.0Hepatobiliary iminodiacetic acid scan in a patient with
gallbladder
Gallbladder
The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile.
Gallbladder and Biliary Tract: Anatomy pathology:
Demonstration of uptake of tracer in
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy without visualization of the
gallbladder
Gallbladder
The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile.
Gallbladder and Biliary Tract: Anatomy. Delayed images show excretion of tracer into the
small bowel
Small bowel
The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum.
Small Intestine: Anatomy.
(a) Cholescintigraphy anterior view: left: 52–56 min after tracer injection; middle: 2 hours after tracer injection; right: 5 hours after tracer injection. Biliary
atresia
Atresia
Hypoplastic Left Heart Syndrome (HLHS) (BA) was suspected and the patient was referred for a technetium-99m trimethyl bromo-iminodiacetic acid hepatobiliary
scintigraphy
Scintigraphy
Sjögren’s Syndrome (99mTc-mebrofenin hepatobiliary
scintigraphy
Scintigraphy
Sjögren’s Syndrome), which showed rapid extraction of tracer by the
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy with no excretion to the
small bowel
Small bowel
The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum.
Small Intestine: Anatomy but with suspicion of visualization of the
gallbladder
Gallbladder
The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile.
Gallbladder and Biliary Tract: Anatomy (thick black arrows). The tracer was physiologically excreted in the
urine
Urine
Liquid by-product of excretion produced in the kidneys, temporarily stored in the bladder until discharge through the urethra.
Bowen Disease and Erythroplasia of Queyrat and localized in a diaper (white arrow).
(b) MRI,
coronal
Coronal
Computed Tomography (CT) view (T2 weighted), demonstrating that the
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy is separated into several lobes, indicating a
false positive
False positive
An FP test result indicates that a person has the disease when they do not.
Epidemiological Values of Diagnostic Tests on the hepatobiliary iminodiacetic acid scan for
gallbladder
Gallbladder
The gallbladder is a pear-shaped sac, located directly beneath the liver, that sits on top of the superior part of the duodenum. The primary functions of the gallbladder include concentrating and storing up to 50 mL of bile.
Gallbladder and Biliary Tract: Anatomy visualization. This was a confirmed case of biliary
atresia
Atresia
Hypoplastic Left Heart Syndrome (HLHS).
Category | Findings |
---|---|
High probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability of pulmonary embolism Pulmonary Embolism Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs. Pulmonary Embolism | More than 2 large mismatched segmental defects |
Intermediate probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability of pulmonary embolism Pulmonary Embolism Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs. Pulmonary Embolism |
|
Low probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability for pulmonary embolism Pulmonary Embolism Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs. Pulmonary Embolism |
|
Normal | No matched or mismatched defects |
Normal pulmonary ventilation Ventilation The total volume of gas inspired or expired per unit of time, usually measured in liters per minute. Ventilation: Mechanics of Breathing and perfusion (VQ) scan. The nuclear medicine VQ scan is useful in the evaluation of pulmonary embolism Pulmonary Embolism Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs. Pulmonary Embolism.
Image: “Ventperf” by Myohan. License: CC BY 3.0High
probability
Probability
Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially.
Basics of Probability for
pulmonary embolism
Pulmonary Embolism
Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs.
Pulmonary Embolism:
Decreased perfusion is seen to the right lung and is particularly evident in the right lower lobe on the right posterior oblique (RPO) image (perfusion scan was performed using Tc-99m macroaggregated
albumin
Albumin
Serum albumin from humans. It is an essential carrier of both endogenous substances, such as fatty acids and bilirubin, and of xenobiotics in the blood.
Liver Function Tests).
High
probability
Probability
Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially.
Basics of Probability for
pulmonary embolism
Pulmonary Embolism
Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs.
Pulmonary Embolism:
No significant
ventilation
Ventilation
The total volume of gas inspired or expired per unit of time, usually measured in liters per minute.
Ventilation: Mechanics of Breathing defect (
ventilation
Ventilation
The total volume of gas inspired or expired per unit of time, usually measured in liters per minute.
Ventilation: Mechanics of Breathing scan performed using Xe-133 gas)
High
probability
Probability
Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially.
Basics of Probability for
pulmonary embolism
Pulmonary Embolism
Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs.
Pulmonary Embolism:
Ventilation-perfusion
scintigraphy
Scintigraphy
Sjögren’s Syndrome in a woman taking oral contraceptives and valdecoxib
A:
Ventilation
Ventilation
The total volume of gas inspired or expired per unit of time, usually measured in liters per minute.
Ventilation: Mechanics of Breathing phase: uniform
ventilation
Ventilation
The total volume of gas inspired or expired per unit of time, usually measured in liters per minute.
Ventilation: Mechanics of Breathing to
lungs
Lungs
Lungs are the main organs of the respiratory system. Lungs are paired viscera located in the thoracic cavity and are composed of spongy tissue. The primary function of the lungs is to oxygenate blood and eliminate CO2.
Lungs: Anatomy
B: Perfusion phase: This and other views show decreased activity in the apical segment of right upper lobe, anterior segment of right upper lobe, superior segment of right lower lobe, posterior basal segment of right lower lobe, anteromedial basal segment of left lower lobe, and lateral basal segment of left lower lobe.
Results | Description | Accuracy | Examples |
---|---|---|---|
Normal |
|
True negative | False negative False negative An FN test result indicates a person does not have the disease when, in fact, they do. Epidemiological Values of Diagnostic Tests |
Normal skeleton | Purely lytic metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis | ||
Abnormal | Asymmetric increased uptake | True positive | False positive False positive An FP test result indicates that a person has the disease when they do not. Epidemiological Values of Diagnostic Tests |
|
|
Normal bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types scan with 2 views and no asymmetric increased uptake
Image: “Nl bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types scan2” by Myohan. License: CC BY 3.0A:
Bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types
scintigraphy
Scintigraphy
Sjögren’s Syndrome during interferon-α treatment: Multiple
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types metastases are visible (red arrows).
B:
Bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types
scintigraphy
Scintigraphy
Sjögren’s Syndrome at present state: Abnormal accumulations are less visible.
Oval-shaped increased osteoblastic activity on the metaphyseal region of both tibias (arrows) ( stress fractures Stress Fractures Fractures due to the strain caused by repetitive exercise. They are thought to arise from a combination of muscle fatigue and bone failure, and occur in situations where bone remodeling predominates over repair. The most common sites of stress fractures are the metatarsus, fibula, tibia, and femoral neck. Chronic Apophyseal Injury due to marathon running)
Image: “Stress fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures of bilateral tibial metaphysis Metaphysis Bones: Structure and Types due to ceremonial march training: A case report” by Kurklu M, Ozboluk S, Kilic E, Tatar O, Ozkan H, Basbozkurt M. License: CC BY 2.0Normal myocardial perfusion scan with thallium-201 for the rest images (bottom rows) and technetium-sestamibi for the stress images (top rows)
Image: “Nl mpi2” by Myohan. License: CC BY 3.0A patient with multiple perfusion defects with different degrees of severity.
The upper images are stress phase and lower images are rest or delayed images. There is moderate
ischemia
Ischemia
A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation.
Ischemic Cell Damage in the mid anterolateral and mid inferolateral walls.
There also is severe
ischemia
Ischemia
A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation.
Ischemic Cell Damage in the basal inferior wall. Mild
ischemia
Ischemia
A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation.
Ischemic Cell Damage in the apex, apical septal, and basal anterolateral regions are also noted.
Uptake | Pattern | Diagnosis |
---|---|---|
Increased | Nodular (hot nodule Nodule Chalazion) | Toxic adenoma Toxic Adenoma Thyrotoxicosis and Hyperthyroidism |
Diffuse | Graves’ disease Graves’ disease A common form of hyperthyroidism with a diffuse hyperplastic goiter. It is an autoimmune disorder that produces antibodies against the thyroid stimulating hormone receptor. These autoantibodies activate the TSH receptor, thereby stimulating the thyroid gland and hypersecretion of thyroid hormones. These autoantibodies can also affect the eyes (Graves ophthalmopathy) and the skin (Graves dermopathy). Thyrotoxicosis and Hyperthyroidism | |
Normal | Symmetric uptake with no defects | |
Decreased | Nodular (cold nodule Nodule Chalazion) | Thyroid cancer Thyroid cancer Thyroid cancer is a malignancy arising from the thyroid gland cells: thyroid follicular cells (papillary, follicular, and anaplastic carcinomas) and calcitonin-producing C cells (medullary carcinomas). Rare cancers are derived from the lymphocytes (lymphoma) and/or stromal and vascular elements (sarcoma). Thyroid Cancer |
Diffuse | Hashimoto thyroiditis Thyroiditis Thyroiditis is a catchall term used to describe a variety of conditions that have inflammation of the thyroid gland in common. It includes pathologies that cause an acute illness with severe thyroid pain (e.g., subacute thyroiditis and infectious thyroiditis) as well as conditions in which there is no clinically evident inflammation and the manifestations primarily reflect thyroid dysfunction or a goiter (e.g., painless thyroiditis and fibrous Riedel’s thyroiditis). Thyroiditis |
Normal thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy scan
Image: “ Thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy scan” by Myohan. License: CC BY 3.0Technetium-99 pertechnetate (99mTcO4)
thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy scan:
A: A large hot
nodule
Nodule
Chalazion with
suppression
Suppression
Defense Mechanisms of the rest of the
thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy
B: A large cold
nodule
Nodule
Chalazion in the left lobe of the
thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy
On cytology, the hot
nodule
Nodule
Chalazion was reported as a “follicular neoplasm” and the cold
nodule
Nodule
Chalazion was reported as a “
colloid
Colloid
Colloid solutions include large proteins or cells that do not readily cross capillary membranes. They remain in the ecf and do not distribute into the icf (similar to crystalloids).
Intravenous Fluids
nodule
Nodule
Chalazion.”
Initial
thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy ultrasound scanning and 99m-Technetium scintiscan
A:
Thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy ultrasonography reveals an ill-defined, solid,
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography)
nodule
Nodule
Chalazion (15 Ă— 0.8
mm
MM
Multiple myeloma (MM) is a malignant condition of plasma cells (activated B lymphocytes) primarily seen in the elderly. Monoclonal proliferation of plasma cells results in cytokine-driven osteoclastic activity and excessive secretion of IgG antibodies.
Multiple Myeloma) with an irregular border in the left
thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy lobe (indicated by a white arrow).
B:
Thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy
scintigraphy
Scintigraphy
Sjögren’s Syndrome with 99m-Tc shows focal accumulation of radiotracer uptake in the lower lobe of the left
thyroid
Thyroid
The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck.
Thyroid Gland: Anatomy, which represents the palpable tender
nodule
Nodule
Chalazion (indicated by a black arrow).