Information for Doctors

Indications for Nuclear Medicine Scans

MYOCARDIAL PERFUSION SCAN (STRESS THALLIUM):

• Screening for Ischemic Heart Disease
• Baseline ECG abnormalities, Bundle branch blocks etc
• False +ve / -ve Stress (TMT) test; (females, obese patients)
• Pharmacological stress in patients unable to exercise
• High risk individuals (smokers, Family history, hyperlipidemia, thrombogenic states etc.)
• Diabetics
• Hypertensive patients
• Microvascular angina
• Renal failure patients
• Indeterminate Conventional / Coronary CT Angiogram (25-75% stenosis)
• Follow up of patients after Angioplasty/ Bypass surgery
• Preoperative work up of major non cardiac surgeries (joint replacements/organ transplants/Gastrointestinal and genitourinary surgeries etc.)
• Viability Studies*- combined with cardiac FDG PET scan
• After Heart attack
• Before angioplasty / bypass surgery
• Heart Failure Patients: to Differentiate ischemic vs. non-ischemic cardiomyopathy

RADIONUCLIDE VENTRICULOGRAPHY (MUGA) SCAN:

• Baseline study before chemotherapy
• Assessment of LV function and wall motion
• Assessment of Right Ventricular ejection fraction

BONE SCAN:

• Metastatic work up
  • Prostate, Breast, Lung, Renal, Urinary bladder and other cancers
  • Primary bone tumors: Osteoid osteoma, osteochondroma, Ewing’s sarcoma, Osteosarcoma, multiple myeloma etc.
  • Orthopedic Indications
  • Backache : Screening for patients without radiculopathy, failed conservative methods, Initial investigations normal but still refractory pain
  • Hip pain: Avascular necrosis / transient osteoporosis
  • Skeletal trauma
  • Sports/Athletic injuries
  • Bone infection/Osteomyelitis
  • Osteochondritis/Osteonecrosis
  • Unexplained limb pain/swelling: Reflex Sympathetic Dystrophy, Complex Regional Pain Syndrome (RSD / CRPS)
  • Metabolic bone diseases
  • Assessment of Bone Graft Viability
  • Suspected Child abuse
  • Pain in children with speech/cognitive problems ( Cerebral palsy, Down’s etc)
  • Assessment of mandibular growth and asymmetry
  • F-18 Bone Scan: NewMedd Diagnostics has whole-body F-18 PET Bone Scan facilities, which has much higher sensitivity and specificity compared to conventional bone scan for all of the above mentioned indications; while conventional bone scan is a planar study, F-18 bone scan is a whole body tomographic study.

RENAL DYNAMIC SCAN (EC / DTPA SCAN):

• Renal perfusion and function
• Diuretic RDS (Lasix renal scan)
• Evaluate functional significance of hydronephrosis
• Determine need for surgery
• obstructive hydronephrosis – surgical Rx
• non-obstructive hydronephrosis – medical Rx
• Renovascular Hypertension (Captopril renal scan)
• Pre-surgical quantitation (nephrectomy)
• Renal transplant evaluation
• Immediate
• Chronic follow up
• Congenital anomalies, masses
• Split (Differential) renal function

Measuring renal function:

• TC-99m DTPA to measure GFR
• TC-99m EC to measure ERPF

RENAL CORTICAL SCAN (DMSA SCAN):

• Infection (renal morphology scan)
• Determine involvement of upper tract in acute UTI (acute pyelonephritis)
• Detect cortical scarring (chronic pyelonephritis)
• Follow-up post treatment
• Congenital anomalies
• Ectopic Kidney, evaluation of single kidney etc

RADIONUCLIDE CYSTOGRAM:

• Evaluation of children with recurrent UTI
• Follow up after initial voiding cystogram (Nuclear MCU)
• Assess effect of therapy / surgery
• Screening of siblings of reflux patients
• UTI in girls
• To calculate Post void residual volume

THYROID SCAN:

• Patients with frank thyrotoxicosis or suppressed TSH on screening tests
• To differentiate Dequervain’s or silent thyroiditis from Grave’s disease
• Solitary thyroid nodules (functioning or non-functioning)
• Search for ectopic thyroid tissue (thyroid hemiagenesis, lingual thyroid etc)
• Diagnosis of congenital athyreosis
• Determination of the nature of abnormal neck or chest (mediastinal) masses

I-131 Thyroid Scan – Whole Body Scan

• Evaluation of thyroid remnants after surgery
• Detection of functioning thyroid metastases
• Perchlorate discharge test

PARATHYROID SCAN:

• Detection of single / multiple / ectopic adenoma before surgery
• Confirmation of adenoma before surgery
• Localisation of adenoma after unsucceful surgery (ectopic glands)

I-131 MIBG SCAN:

• Suspected Pheochromocytoma
• Evaluation of adrenal incidentalomas/masses
• Neuroblastoma
• Characterization of retroperitoneal/ mediastinal masses (supected neuroendocrine origin)

BRAIN SPECT:

• Neuroreceptor SPECT
• Movement disorders: TRODAT SPECT
• Differentiation of viable brain tumor v/s radiation necrosis
• Work up of dementias

GASTROINTESTINAL SCAN:

• Gastric Emptying and Gastroesophogeal Reflux Studies
• Gastrointestinal Bleeding Studies
• Meckel’s Diverticulum
• Duplication cyst
• Inflammatory Bowel disease

HEPATO-BILIARY (HIDA) SCAN:

• Cholecystitis
• Acute
• Chronic Calculus/Acalculus
• Gallbladder Ejection fraction
• Rt subcostal pain: USG normal
• Rec post prandial dyspepsia
• Further evaluation of pts with Gall stones on USG
• F/u after surgical interventions to evaluation Bile leak
• Spontaneous biliary peritonitis
• Biliary enteric pathway patency
• Neonatal hepatitis vs EHBA/ Inspissated bile syndrome
• Evaluation Congenital anomalies / Choledochal cysts

SULPHUR COLLOID LIVER SCAN

• Early detection of cirrhosis (liver dysfunction)
• Evaluation of portal hypertension
• Hepatic versus extra hepatic causes
• Differentiate Reidel’s lobe versus pathological hepatomegaly
• Accurate liver dimension measurement

LUNG SCAN:

• Pulmonary embolism
• Pre Pneumonectomy Evaluation

OTHER SCANS:

• Lymphoscintigraphy for sentinel lymph node detection,
• detection of Chyluria, Evaluation of Lymphoedema
• Venography for Evaluation of Deep vein thrombosis
• Scintimammography for Breast cancer detection
• Infection imaging
• Fever of unknown origin
• Osteomyelitis