Transcript CSTCC NMT Program Adrenal Scintigraphy

VCU NMT Program
Adrenal Scintigraphy
Adrenal Cortical Pathologies:
Aldosteronism
Addison’s
Cushing’s
Virilizing Adenomas
Adrenal Cortex
Adrenal Medulla Pathologies:
Pheochormocytomas
Adrenal Medulla
Neuroblastomas
VCU NMT Program
Adrenal Scintigraphy
Adrenal cortical pathologies may be evaluated using NP-59,
which is a form of cholesterol, labeled with I131.
Since the adrenal cortex uses cholesterol to produce hormones,
the adrenal cortex will concentrate the NP-59 labeled I131.
NP-59 labeled I131 is rarely used in the clinical environment due
to poor target to background ratios, poor imaging characteristics
of I131, and difficulty in interpretation of results.
VCU NMT Program
Adrenal Scintigraphy
Specific points which you should remember:
NP-59 should only be used for Adrenal Cortical pathologies.
Before administering NP-59 the patient should be treated with
Lugol’s solution which blocks thyroid uptake of free I131.
Lugol’s administration should continue for 7 days.
Administration of NP-59 I131 should be slow to prevent
allergic reactions.
VCU NMT Program
Adrenal Scintigraphy
Adrenal Medulla imaging for determination of Medullar
metastatic lesions is performed with I131 labeled mIBG, or
I123 labeled mIBG which is not commercially available at
this time.
Detection of adrenal medulla activity is primarily used in the
evaluation of neuroblastoma and pheochromocytoma.
VCU NMT Program
Adrenal Scintigraphy
Neuroblastoma is a form of cancer that usually occurs in infancy
and childhood. The term neuro indicates "nerves," while blastoma
refers to a cancer that affects immature or developing cells.
Nearly 90% of cases are diagnosed by age 6. When detected
early, neuroblastomas can usually be treated effectively.
However, in as many as seven out of 10 cases, the disease is not
diagnosed until it has already metastasized (spread). Overall,
about 40% of children with neuroblastomas can be cured with a
combination of surgery, followed by chemotherapy and/or
radiation therapy.
VCU NMT Program
Adrenal Scintigraphy
Pheochromocytomas are vascular tumors of adrenal medulla
tissue characterized by hypersecretion of epinephrine and
norepinephrine. This condition puts the patient in a prolonged
version of flight or flight and ultimately wears the body down.
Pheochromocytomas may be found in the adrenal medulla or as
metastatic tumors along the sympathetic ganglia (throughout the
thorax and abdomen, but commonly along the vertebra and
aorta).
VCU NMT Program
Adrenal Scintigraphy
Specific points which you should remember:
•mIBG should only be used for Adrenal Medulla pathologies.
•Before administering mIBG the patient should be treated with
Lugol’s solution which blocks thyroid uptake of free I131.
•Lugol’s administration should continue for 6 -7 days.
•Administration of NP-59 I131 should be slow to prevent
reactions.
•Many drugs interfere with uptake of mIBG in medulla tissue.
1. areas
antidepressants
•Normal
of uptake include salivary glands, liver, spleen,
2. antihypertensives
heart, GI
tract, and bladder. Obtain a complete list of medications
3. sympathomimetic:
•Sequential
imaging should be
performed
toradiologist.
help identify
and
check with
decongestants
normal vs.cocaine
abnormal uptake.
•Empty bladder
speed before imaging.
VCU NMT Program
Adrenal Scintigraphy
Review
Adrenal Medulla Pathologies:
Pheochormocytomas
Neuroblastomas
mIBG
Adrenal Cortical Pathologies:
Aldosteronism
Addison’s
NP-59
Cushing’s
Virilizing Adenomas
VCU NMT Program
Adrenal Scintigraphy
24 hour mIBG I131 for Pheochromocytoma
VCU NMT Program
Adrenal Scintigraphy
48 hour mIBG for Pheochromocytoma
VCU NMT Program
Adrenal Scintigraphy
48 hour I131 mIBG for Neuroblastoma
E.
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72 hour I131 mIBG 4 year old.
VCU NMT Program
Adrenal Scintigraphy
48 hour I131 mIBG for Neuroblastoma
VCU NMT Program
Adrenal Scintigraphy
Neuroblastoma in 4 yo.
Wide spread metastatic
evolvement of bone marrow.
VCU NMT Program
Adrenal Scintigraphy
Metastatic Pheochromocytoma in liver
VCU NMT Program
Adrenal Scintigraphy
48 hour I131 mIBG for Pheochromocytoma
VCU NMT Program
Adrenal Scintigraphy
Generally, Neuroblastomas are imaged at 48 and 72 hours with
I131 mIBG.
Pheochormocytomas are generally imaged at 24 and 48 hours.
The timing difference is largely due to Pheochromocytomas being
much more vascular; therefore, they demonstrate more rapid
accumulation of the radiopharmaceutical.
Sequential imaging (subsequent days days) helps to distinguish
normal vs abnormal uptake. How?
End of Lecture
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