non union fracture

							           Indications for Nuclear Medicine Study
             in Orthopedics and Rheumatology
                   Skeletal -                           Indications
         Orthopedics & Rheumatology
26029A   Whole body bone scan         bone metastasis, cancer staging, Tx F/U,
N29                                  osteomyelitis, avascular necrosis of femoral
           (sensitivity: high)        head, infection or loosening of total hip
           (specificity: moderate)    replacement, stress fracture, occult bone
                                      trauma, non-union fracture, Paget’s disease,
                                      arthritis, ankylosing spondylitis, primary
                                      bone tumor, bone graft, fibrous dysplasia,
                                      elevated alkaline phosphatase, bone pain of
                                      obscure origin.
26057A   Three-phase bone scan &      DDx of osteomyelitis & cellulitis,
26029A   Whole body bone scan         vascularity of bone tumor, reflex
N57                                  sympathetic dystrophy syndrome.
26058A   Quantitative sacroiliac scan R/O sacroiliitis in systemic disease such as
N58                                  ankylosing spondylitis, psoriatic spondylitis,
                                      osteoarthritis, SLE, Crohn’s disease,
                                      ulcerative colitis.
26029A   Osteomyelitis study          DDx of infection or loosening of THR
             99m              67
26030A   (Tc MDP & Ga )               prosthesis, DDx of osteomyelitis &
N29B                                 cellulitis.
26013A   Tl201 for bone tumor &       malignant bone tumor, osteogenic sarcoma,
26049A   SPECT                        Ewing’s sarcoma.
N13B
26030A   Ga67 for bony inflammation & osteomyelitis, infection of prosthesis of total
26049A   SPECT                        hip replacement.
N30D
26059A   Muscle scan                    polymyositis, dermatomyositis, muscle
N59       (sensitivity: moderate)      trauma, rhabdomyositis (alcoholism),
           (specificity: moderate)      electrical burn, frostbite, overexertion,
                                        myositis ossificans, muscular dystrophy.

                                                   耕莘醫院核醫科 蕭聿謙醫師 1998.3.14. v5.




                                           1
           Indications for Nuclear Medicine Study
                  in Cardiovascular System
              Cardiovascular                          Indications
26025A   Myocardial perfusion study   R/O CAD, angina pectoris, unstable angina,
26049A   1.Stress/Dipyridamole        F/U AMI in subacute stage, viable
26024A   2.Tl-201: exercise SPECT     myocardium post AMI, F/U PTCA, patency
26049A   3.Tl-201: Resting SPECT      of CABG graft, CAD with bundle branch
N25                                  block, hyperlipidemia due to hemodialysis,
                                      congenital heart disease.
26047A   Cardiac function - Resting   LV ejection fraction, RV ejection fraction,
N47                                  LV wall motion, pre- & post- chemotherapy,
                                      CHF, dilated cardiomyopathy, F/U CAD,
                                      apical aneurysm, left-to-right shunt, mitral
                                      regurgitation.
26023A   Myocardial infarct study     R/O AMI (10hr-10days after attack), AMI
N23                                  with equivocal ECG & CPK, AMI with
                                      bundle branch block, RV AMI, inferior wall
                                      AMI, define areas of AMI, F/U CABG.
26027A   Venography                   deep venous thrombosis, low leg edema.
N27
N27     Lung perfusion study         pulmonary embolism, F/U anti-coagulant
                                      therapy, perfusion change due to lung ca,
                                      pre-pneumonectomy evaluation.
26028A   Arteriography                SVC obstruction, IVC obstruction,
N28                                  Bud-chiari syndrome, hepatoma with IVC
                                      thrombosis.


                            Pulmonary System
                 Pulmonary                            Indications
26014A   Lung perfusion study &      pulmonary embolism, F/U pulmonary
26049A   SPECT                       embolism after anti-coagulant therapy,
N14                                 perfusion change secondary to lung tumor,
                                     pre-operative evaluation for pneumonectomy,
                                     post-operative F/U, pulmonary hypertension.
26030A   Ga67 for chest inflammation lung abscess, TB, pneumonia, pneumonitis,
26049A   & SPECT                     pulmonary fibrosis.
N30C

                                          2
           Indications for Nuclear Medicine Study
                  in Nephrology & Urology
          Nephrology & Urology                       Indications
                         99m
26020A   Renal scan Tc    DMSA & pyelonephritis, renal scarring, UTI, renal
26049A   SPECT                   infarct, renal trauma, horseshoe kidney,
N20                             ectopic kidney, renal cyst, renal abscess, renal
                                 tumor, relative renal function, fetal
                                 lobulation, cortical nodular hyperplasia.
            99m
26050A   Tc DTPA renal function GFR, quantitative renal function, urinary
N50     study                   stone, acute renal failure, R/O ATN, chronic
                                 renal failure, acute & chronic rejection,
                                 neurogenic bladder, renal transplant.
26020A   Diuresis renography     GFR, quantitative renal function, obstructive
26050A                           uropathy, ddx of non-obstructive dilatation &
N20A                            mechanical obstruction, urinary stone.
26020A   Captopril renography    renovascular hypertension.
26050A
N20B
26020A   Renal scan                  effective renal plasma flow (ERPF), relative
26050A   Renal function study        renal function, obstructive uropathy, ATN,
N20C                                transplant renal function.
26019A   Scrotal scan                scrotal varicocele, hydrocele.
N19
26022A   Testicular scan             testicular torsion, epididymo-orchitis, DDx of
N22                                 the above, hydrocele, hematocele, abscess,
                                     scrotal pain.
26030A   Ga67 for renal tumor/       renal TB, UTI.
26049A   inflammation survey &
N30A    SPECT




                                         3
           Indications for Nuclear Medicine Study
                in Neurology and Psychiatry
          Neurology & Psychiatry                    Indications
           99m
26063A   Tc HMPAO brain perfusion cerebral infarction, cerebral hemorrhage,
26049A   scan & SPECT             TIA, cerebral ischemia, Alzheimer’s
N63                              disease, senile dementia, multiple infarct
                                  dementia, head injury, AIDS related
                                  dementia, SLE vasculitis, epilepsy,
                                  encephalitis, cerebellar degeneration,
                                  convulsion disorder, Parkinson’s disease,
                                  DDx of recurrent brain tumor & radiation
                                  necrosis.
           201
26013A   Tl for brain tumor &     primary brain tumor, residual tumor s/p
26049A   SPECT                    operation or radiation therapy.
N13A
26052A   V-P shunt patency study     V-P shunt obstruction.
N52
26003A   CSF dynamic test            normal pressure hydrocephalus
N03                                 (communicating hydrocephalus),
                                     CSF leakage.
26030A   Ga67 for brain inflammation brain abscess, meningitis.
26049A   & SPECT
N30B


                 Hematology and Ga-67 Imaging
           Hematology & Ga-67                       Indications
26017A   Bone marrow scan            ectopic hemopoiesis, bone marrow abscess,
N17                                 bone marrow metastasis, bone marrow
                                     atrophy, anemia, polycythemia, leukemia.
26036A   Spleen scan with Tc99m      accessory spleen, autosplenosis, splenic
N36     Tagged RBC                  infarction, spleen trauma, spleen hematoma,
                                     spleen abscess, splenic tumor, functional
                                     asplenism.
26030A   Ga-67 tumor survey          Hodgkin’s disease, non-Hodgkin’s
N30                                 lymphoma, melanoma, lung cancer,
                                     hepatoma, leukemia, gastric cancer,
                                     esophageal cancer.

                                        4
           Indications for Nuclear Medicine Study
                     in Gastroenterology
              Gastroenterology                         Indications
26051A   Sialoscintigraphy             parotid tumor, sialoadenitis, mumps,
N51                                   salivary obstruction, xerostomia, NPC post
                                       radiation therapy, dry mouth.
26053A   Esophageal transit study      reflux esophagitis, dysphagia, esophageal
N53                                   motor abnormality, achalasia, achalasia post
                                       balloon dilatation.
26062A   Gastric emptying time         DM gastroparesis, s/p vagotomy, delayed
N62                                   gastric emptying, gastrinoma.
26054A   Enterogastroesophageal reflux reflux esophagitis, aspiration in children,
N54                                   duodenogastric reflux, gastroesophageal
                                       reflux, F/U medical or surgical treatment.
26018A   Retained gastric antrum study retained gastric antrum s/p Billroth-II
N18                                   gastrectomy, recurrent ulceration, increased
                                       serum gastrin level.
26026A   Meckel’s diverticulum scan Meckel’s diverticulum, Barret’s esophagus.
N26     Barret’s esophagus
26060A   GI bleeding scan              lower GI bleeding, internal bleeding.
N60
26060A   RBC scan for hemangioma & hepatic cavernous hemangioma.
N60A    SPECT
26016A   Liver and spleen scan &      liver cirrhosis, hepatoma, liver metastasis,
26049A   SPECT                        chronic hepatitis, liver abscess, liver
N16                                  rupture, focal nodular hyperplasia, splenic
                                      infarct, splenomegaly, accessory spleen.
26040A   HIDA cholescintigraphy       acute cholecystitis, chronic cholecystitis,
N40A                                 gall bladder ejection fraction, biliary
                                      obstruction, gall bladder dyskinesia bile
                                      leakage, biliary reflux, DDx of biliary
                                      atresia and neonatal hepatitis, choledochal
                                      cyst, hepatic adenoma, biliary diversion.
26052A   Shunt patency study (LeVeen) Le-Veen shunt obstruction.
N52A
26060A   Hepatic hydrothorax           hepatic hydrothorax, pleural effusion due to
N60B                                  ascites.

                                           5
           Indications for Nuclear Medicine Study
                      in Endocrinology
                  Endocrine                          Indications
26004A   Tc-99m thyroid scan         goiter, nodule goiter, hyperthyroidism,
N04                                 exophthalmos, Graves’ disease, thyroiditis,
                                     children with thyroid disease.
26005A   I-131 thyroid scan & 24 hrs thyroid cancer, sublingual thyroid,
N05     uptake                      intrathoracic goiter, ectopic thyroid,
                                     hypothyroidism, thyroiditis, goiter, nodule
                                     goiter, hyperthyroidism, exophthalmos,
                                     Graves’ disease.
26011A   I-131 neck & chest scan     ectopic thyroid, sublingual thyroid,
N11                                 intrathoracic goiter.
26012A   I-131 cancer work-up        detection of metastasis of thyroid cancer of
N12     (sensitivity: high)         papillary & follucular types.
26038A   I-131 treatment (xx mCi)    treatment of metastasis and thyroid cancer
N38                                 of papillary & follucular types,
                                     hyperthyroidism in old age.
26013A   Tl-201 cancer work-up       medullary thyroid cancer, undifferentiated
N13                                 thyroid cancer, breast cancer, osteogenic
                                     sarcoma, cancer treatment response.
26055A   Parathyroid scan            hyperparathyroidism, hypercalcemia,
N55                                 parathyroid hyperplasia, parathyroid
                                     adenoma, shorten operation time after one
                                     or more previous surgical exploration.
26021A   Adrenocortical scan (Np-59) Cushing’s syndrome, aldosteronism, adrenal
N21     Adrenomedullary scan (I-131 adenoma, adrenal hyperplasia.
         MIBG)                       Pheochromocytoma, extra-adrenal
                                     metastasis, medullary thyroid cancer,
                                     paraganglioma, neuroblastoma.




                                         6