Nuclear Medicine Diagnostics & Therapy
A radionuclide scan is a way of imaging bones, organs and other parts of the body by using a small dose of a radioactive chemical. We use very small amounts of radiopharmaceuticals for the nuclear medicine functional imaging, which is non-invasive and can often identify the disorders as early as at the molecular stage. Once the radiopharmaceuticals are via bloodstream or orally administered, imaging can be started immediately or after a period of time using a special device called gamma scintillation camera. A SPECT-CT scan is a type of nuclear medicine scan where the images or pictures from two different types of scans are combined together to increase the spatial precision of metabolic changes detected in the body. However, the most commonly used molecular imaging modality in nuclear medicine is the PET/CT-Scan (hybrid imaging), which combines the molecular imaging of PET with the anatomical detail of CT. This imaging modality has therefore become an essential component of tumor staging and surveillance. Our board certified physicians and specially trained technologists ensure a high quality of service with a broad spectrum of Nuclear Medicine studies with an emphasis on oncology, cardiology, endocrinology (particularly thyroid disorders), and therapeutic services.
Radionuclide scan (Gamma-Scintillation-Camera, SPECT/CT)
The diagnosis and treatment of benign and malignant thyroid diseases is an important focus of our clinic. Regarding further clarification or follow up of thyroid nodules or other functional disorders such as Grave’s disease, you can seek advice.
The functional thyroid disorders (hyperthyroidism or hypothyroidism, over- and under-production of thyroid hormones respectively) cause symptoms such as palpitations, nervousness, feeling hot or cold, weight changes or even depressive moods (depression). Depending on the metabolic situation, clinical condition, and ultrasound findings, we perform further clarification by means of thyroid scintigraphy, or, if necessary, we plan with you the preparation of radioiodine therapy.
Our therapy ward is currently being planned. At present, the inpatient therapies of our patients for thyroid diseases are carried out in cooperation with the Clinic for Nuclear Medicine, Maria-Hilf-Krankenhaus in Mönchengladbach.
Coronary artery disease (CAD) is a chronic heart disease caused by insufficient blood flow to the heart muscle tissue (myocardium). Cardiac nuclear medicine is used in diagnosing and assessing coronary artery disease and also to evaluate cardiomyopathy and identify possible damage to the heart from chemotherapy or radiotherapy. It is the best noninvasive diagnostic modality for assessing heart diseases with comparable accuracy with percutaneous coronary intervention.
For cardiac scans are two sets of images generated in the same day or in two separate days (2-day-Protocol is preferred in our clinic): rest images and stress images. Rest images are taken while the person is resting and stress images are taken after the heart has been exercised (treadmill) or by using a medication called adenosine, regadenosine (RapiScan®), or dobutamine (Dobutrex®). If you undergo treadmill or medication stress testing, it will be decided by your medical condition. Then the resting images and the stress images are compared. By comparing both images, the localization and extent of exercise-dependent reduced blood flow or scarring in the myocardium can be assessed both qualitatively and quantitatively.
Various benign and also pathological conditions such as oncological, metabolic, degenerative and also inflammatory/infectious diseases affect the skeletal system and cause at first metabolical and then structural changes. Since the pathological bone metabolic changes occur much earlier, the nuclear bone scan can reveal these changes much earlier than other imaging modalities, leading to early diagnosis.
In nuclear bone scan, the tracer is applied intravenously and after a minimum of 2 hours waiting time, total body bone scan is performed. Depending on the referral question, for example acute inflammation or osteomylelitis, the so-called 3-phase bone scan can also be performed, which evaluates not only the tracer uptake by the bone, but also the blood flow and soft tissue uptake of the affected or examined area. For better spatial accuracy and high resolution, SPECT/CT scans are additionally performed for equivocal findings on the bone scan.
Renal scintigraphy, also known as renal scans, refers to several examinations using radiopharmaceuticals that evaluate the function and anatomy of the kidneys and also urinary tract. Excretion via kidneys takes place by glomerular filtration and tubular secretion. Depending upon the medical question, these functions of the kidney are exploited by the intravenously administration of tracer analogues to generate static (99mTc-DMSA) or dynamic (99mTc-MAG3) images.
With renal scan, we can identify and evaluate the total kidney function (and also relative kidney function), obstructions in the upper or lower urinary tract, kidney failure, and/or transplant-related complications, as well as discovering kidney-related injuries.
There are 4 parathyroid glands in the neck. They are usually located behind the thyroid gland, which are small endocrine glands producing parathyroid hormone (PTH). This hormone regulates the calcium and phosphate metabolism in body. A disturbance in the hormone production or overproduction, such as by a parathyroid tumor or hyperplasia, leads to multiple organ complications such as osteoporosis, heart arrhythmias or stone formation in kidneys.
Parathyroid scan can identify the location of an adenoma as the site of hormone overproduction. During the examination, you will have two tracers intravenously administered (Tc-99m-pertechnetate and Tc-99m-MIBI), followed by performing multiple scans at 3 timepoints (15 min., 20 min and after 2 hours) combined with SPECT/CT scan for better spatial resolution. Before you leave our clinic, the doctor will see you and perform an ultrasonography of the neck. The referring physician will be informed about the results. For the examination in our outpatient clinic, you should plan a stay of up to 4 hours.
The Lung scintigraphy or lung scan is the method of choice especially for patients with iodinated contrast agent allergy or renal insufficiency. These patients might suffer from an acute pulmonary artery embolism or chronic thromboembolic pulmonary hypertension (CTEPH), whereas an accurate diagnosis for these patient groups has been challenging. In addition, the lung scan is also very useful in precise volume determination of lung areas before surgical interventions, e.g., before the removal of a lung lobe affected by a malignant tumor, and is essential for the success of surgery.
This imaging modality has two parts: a) Ventilation: where the patient inhales a radioactive gas and b) Perfusion: where the tracer is administered intravenously and the images are generated with combination of SPECT/CT.
The referring physician will be informed about the results at the examination day, and you don’t need to take any precautions after the test.
With gastric emptying scan pathologically accelerated or delayed stomach movements can be identified and evaluated. During the test, you get a meal (Pfannkuchen/Pancake) labeled with a radioactive tracer, and after ingestion, you lie down on a special gamma camera for up to 30 Minutes for the so-called dynamic imaging series. This is followed by another 4 scans (à 5 Minutes) with 30 Minute time intervals. After 2 hours of examination, we can usually determine how fast the stomach empties food into the small bowel, and so any upper gastric motility problems will appear. For some cases, further images might be required. For the examination in our outpatient clinic, you should plan a stay of up to 3 hours.
The first lymph nodes affected by tumor spread are called sentinel lymph nodes. Therefore, the accurate diagnosis of an early sentinel lymph node involvement (or ruling out) plays a crucial role for the prognosis of disease progression and therapy decision. Since the lymph drainage is variable and lymph nodes are small and hard to find, the exact localization of the sentinel lymph node must be determined for each patient by means of a scintigraphy scan. For this procedure, on the day prior to surgery, you will get a radioactive tracer administered via skin injection, and subsequently the scan is performed and the images are presented to the surgeons. Thus, on next day during the surgery, the sentinel lymph node can easily be located and harvested with the help of a special device (hand-held gamma probe) by the surgeon.
Lymphoscintigraphy is a functional evaluation of the lymphatic channels, and allows also the evaluation of other benign lymphatic disorders in a similar approach.
Neuroendocrine cells are found primarily in the gastrointestinal tract, the lungs, and the pancreas and secrete hormones that regulate various metabolic functions. The tumors that originate from these cells are usually benign with a good prognosis and grouped under the term "neuorendocrine tumors (NET)". However, because of their small size, these tumors often escape the conventional diagnostic imaging. Somatostatin Receptor Scintigraphy exploits the overexpression of the so-called Somatostatin receptors on these tumor cells and uses the technetium-labeled somatostatin receptor analogs (Tektrotyd) to visualize the tumor foci of ≤1 cm. This imaging is suitable for imaging carcinoids and gastroentero-pancreatic neuroendocrine tumors. Although other tumors like neuroblastoma, paraganglioma, and pheochromocytoma with known SSR expression can theoretically also be visualized with this imaging, the 123-I-mIBG scintigraphy proved to be more reliable for these tumor entities (see below).
After IV administration of the radioactive tracer, you will get a total body scan at two timepoints (1 h and 4 h after tracer administration) with a subsequent SPECT/CT imaging to increase the spatial resolution and thus the diagnostic accuracy. For the examination in our outpatient clinic, you should plan a stay of up to 5 hours.
123-I-mIBG Scintigraphy is used in the diagnosis of tumors of the neuroectodermal system such as pheochromocytoma, paraganglioma, and neuroblastoma which produce specific hormones called catecholamines. MIBG-Scan is able to detect these tumors because the compound MIBG is very similar to norepinephrine/noradrenaline, a neurotransmitter chemical that is taken up by these cells. It is also very suitable for the diagnosis and therapy monitoring of neuroblastoma which is one of the most common malignant tumor diseases in childhood. Beyond that, MIBG Scan can also be employed for the study of disorders of sympathetic innervation. In addition, other tumors such as Merkel cell tumor or medullary thyroid carcinoma can also be visualized with this imaging technique. Though, 18F-DOPA-PET/CT is better suited for the diagnosis of medullary thyroid carcinoma.
After intravenous administration, the overaccumulation in the tumor foci allows us to identify and evaluate the exact location and size of the tumors. The scan is performed at three time points (immediately, 4 h, and 24 h after IV administration of the radioactive tracer, and thus you should visit our outpatient clinic on two consecutive days.
Due to the demographic transition, the number of patients with neurological diseases increases steadily, and thus early differentiation of these disorders plays a crucial role for further therapy management and maintenance of acceptable life quality. Parkinson’s disease is the most common form of Parkinsonian syndrome that is accompanied by the loss of dopamine producing nerve cells in the brain. It leads to a slowing of movement sequences and increased tremors.
The scan is performed 4 h after the IV administration of the radioactive tracer (I-123-FP CIT or DatScan). The radioactive tracer binds to dopamine transporters in the brainstem ganglia, and thus they can be visualized and quantified in order to distinguish the parkinsonian syndrome from other neurological entities at the molecular level, even before structural changes occur. For the examination in our outpatient clinic, you should plan a stay of up to 5 hours.
PET/CT Hybrid Imaging
Nowadays, FDG-PET/CT has become one of the most important cornerstones of patient management due to its excellent diagnostic performance in oncological and inflammation imaging. Positron emission tomography (PET) is a combination of nuclear medicine and biochemical analysis that measures metabolic activity of cells of body tissues. The CT (computed tomography) component of the exam provides complementary structural high spatial resolution. Thus, this procedure combines the advantages of molecular imaging by PET and radiological-morphological imaging by CT to provide 3-D fusion images of the body or the affected body area with excellent temporal and spatial resolution using modern, powerful computer-based systems.
The excellent diagnostic performance of the FDG-PET/CT is based upon increased metabolism of inflammatory or infectious tissue, and it is especially used in oncological diseases due to the so-called Warburg effect. The Warburg effect describes in some cases up to 200 times increased demand of cancerous cells toward glucose than in normal healthy cells. This pathological cell mechanism is exploited by the intravenous injection of the radiolabeled glucose molecule (18F-FDG) which accumulates over proportionally in the tumor foci, and thus helps to visualize and evaluate them. In addition, this imaging modality plays an important role for neurological imaging (see below).
Before the exam, you should follow some instructions (please see FDG-PET/CT under FAQ) and plan a stay of up to 3 hours in our PET-CT Hybrid Imaging Center.
Arranging Appointments and Requests:
Tel +49 (0) 211-81-16318
Fax +49 (0)211-81-17050
PET-Anmeldung@med.uni-duesseldorf.de
Prostate-specific membrane antigen (PSMA) is a transmembrane protein with significantly increased expression in the cells and metastases of prostate cancer. The novel imaging modality of 18F-labeled PSMA (PET/CT) exploits this characteristic feature of prostate cancer and allows us to visualize and evaluate even the small tumor foci of < 1 cm in size, which would have otherwise escaped the conventional imaging modalities.
The scan is performed 90 minutes after IV administration of the radionuclide, and the scan duration is about 30 minutes. No side or adverse effects are known. In some cases, further imaging might be required. For the examination in our PET-CT Hybrid Imaging Center, you should plan a stay of up to 4 hours.
Arranging Appointments and Requests:
Tel +49 (0) 211-81-16318
Fax +49 (0)211-81-17050
PET-Anmeldung@med.uni-duesseldorf.de
As aforementioned, FDG-PET/CT imaging modality plays an important role in neurological imaging. We use FDG PET/CT scan mostly for differentiation of benign neurological disorders such as Parkinson diseases, Lewy body disease, or Alzheimer’s disease. It is also used for the further diagnosis of malignant brain tumors. To be able to visualize and quantify even the slight changes in brain metabolism, an analysis of its pattern provides us an important diagnostical advantage. On request, besides the tracer FDG, we can also offer a broad spectrum of rather rarely used tracers for further brain imaging such as the tracer of 18F-Florbetaben.
Before the exam, you should follow some instructions (please see FDG-PET/CT under FAQ) and plan a stay of up to 2 hours in our PET-CT Hybrid Imaging Center.
Arranging Appointments and Requests:
Tel +49 (0) 211-81-16318
Fax +49 (0)211-81-17050
PET-Anmeldung@med.uni-duesseldorf.de
Radionuclide Therapy
Selective Internal Radiation Therapy (SIRT) is a novel radionuclide therapy for the treatment of nonresectable primary and secondary malignant tumors in the liver. This method foresees the image guided direct delivery of the 90Y-microspheres into the microvasculature of the tumor while limiting the impact on healthy tissue via the hepatic artery and is suitable even for patients with high tumor load. Ideally, patients should achieve stable disease progression or even reduction in tumor burden after this therapy, which may even allow surgical resection of the liver tumors in some cases. The therapy planning needs very meticulous preparation and involves multiple clinical and imaging steps. One important preparation step is the performing of SPECT scan after intraarterial test-injection of 99mTc albumin particles (MAA) to determine the extent of arteriovenous shunting to the lungs and to confirm the absence of gastric and duodenal flow. After completion of the preparatory steps, the therapy decision is made on an interdisciplinary basis.
Radium-(Ra-223)-dichloride (Xofigo®) is a targeted alpha therapy approved for the palliative treatment of prostate cancer (CRPC) with symptomatic bone metastases. The skeleton is the most common metastatic site in patients with advanced prostate cancer. Bone metastases are a clinically significant cause of morbidity and mortality, often resulting in bone pain, pathologic fracture, or spinal cord compression necessitating treatment. 223Radium is selectively accumulated in the bone, specifically in areas of high bone turnover, by forming complexes in the bone. The alpha radiation generated during the radioactive decay of 223Radium produces a palliative anti-tumor effect on the bone metastases with evidence of a significant benefit for the patients.
For this therapy you need up to six appointments in four-week intervals, and during each appointment, you receive an intravenous injection of the radionuclide (Xofigo®) on an outpatient basis. For this therapy, no acute side or adverse effects are known. For each appointment, you should plan a stay of up to 2 hours in our outpatient clinic.
Radioactive iodine (RAI) is a radionuclide treatment for overactive thyroid (hyperthyroidism) and certain types of thyroid cancer. The thyroid produces thyroid hormone that regulates body metabolism. An overactive thyroid (Hyperthyroidism) speeds up the body’s processes causing nervousness and anxiety, rapid heartbeat, missed or light menstrual periods, sleep problems, hand tremors, and other problems. For the hormone production, the thyroid gland needs large amounts of iodine. In case of local (autonomous adenomas) or diffuse overactivity (Graves' disease) of the thyroid gland, RAI is administered in oral capsule form, which accumulates predominantly in the overactive area. Consequently, RAI treats hyperthyroidism by damaging or destroying thyroid cells through radiation.
Papillary and follicular thyroid cancers are the most frequently seen thyroid cancers. They possess the ability of iodine uptake. After the primary surgery and completion of wound healing, these patients undergo an RIA treatment with high doses in order to destroy or eliminate the remnant cells.
According to national regulations, in Germany the Radioiodine therapy of thyroid disorders may take place only in an inpatient clinic and to this purpose we offer this therapy to our patients in Cooperation with the Department of Nuclear Medicine, Maria-Hilf-Krankenhaus in Mönchengladbach. Our therapy ward is currently in planning.