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Nuclear Medicine

 

DEPARTMENT OF NUCLEAR MEDICINE AT OKAN UNIVERSITY HOSPITAL

Nuclear medicine is a medical branch that makes both imaging (scintigraphy, SPECT, PET) and treatment (radionuclide treatment / molecular treatment) by giving tiny amounts of radioactive drugs (radiopharmaceuticals) to the patients’ body.

 

Department of Nuclear Medicine at Okan University Medical Faculty Hospital, offers all kinds of scintigraphic imaging including PET/CT and SPECT, by using the newest generation equipment as well as the current radionuclide therapies under the guidance of the experienced nuclear medicine physicians.

 

One of the primary mission of the Nuclear Medicine Department of Okan University Hospital is that to apply the standards at the highest level requested by JCI and Turkish Atomic Energy Agency (TAEK) accreditation programs for both the patients and the employee safety.

Scintigraphic imaging done at our department:

  • Oncological Scintigraphies
    • PET/CT scanning with Fluorine-18 FDG
    • PET/CT scanning with Gallium-68 DOTATATE
    • PET/CT scanning with Galllium-68 PSMA PET/BT
    • SPECT scintigraphies with Iodine -123 MIBG or Iodine-131 MIBG
    • Whole-body scintigraphies with Iodine-131 or Iodine-123
  • Endocrine System Scintigraphies
    • Thyroid scan and uptake with Tc-99m perthnectate or Iodine-I-123
    • Parathyroid scan
  • Cardiac Scintigraphies
    • Myocardial Perfusion SPECT (Gated)
    • Myocardial PET with Fluorine-18 FDG
  • Respiratory System Scintigraphies
    • Lung perfusion scan
    • Quantitative Lung Perfusion scan
    • Lung Ventilation scan (Technetium-99m DTPA aerosols)
  • Central Nervous System Scintigraphies
    • Brain PET scan (Fluorine-18 FDG)
    • Brain Perfusion SPECT (Tc-99m HMPAO or Tc-99m ECD)
    • Ventricular Shunt Patency Scanning
    • Radionuclide Cysternography
  • Gastrointestinal System Scintigraphies
    • Gastrointestinal Bleeding Scan
    • Gastroesophageal Reflux Scan
    • Gastric Emptying Scan
    • Esophagus Transit Time Scanning
    • Meckel Scintigraphy
  • Genitourinary System Scintigraphies
    • Dynamic Renal Scintigraphy (Tc-99m DTPA or Tc-99m MAG3)
    • Static Renal Cortical Scintigraphy - SPECT (Tc-99m DMSA)
    • Captopril enhanced Dynamic Renal Scintigraphy
    • Testicular Scintigraphy
    • Direct - Indırect Vesicoureteral Reflux Scintigraphy
  • Skeletal System Scintigraphies
    • Bone scans (Triple phase, Whole-body, SPECT)
    • Skeletal PET (Fluorine-18 NaF)
  • Others
    • Lymphoscintigraphy
    • Salivary Glands Scintigraphy
    • Dacrioscintigraphy

 

 

 

 

Positron Emission Tomography / Computed Tomography (PET/CT)

Positron Emission Tomography (PET) is a three-dimensional (tomographic) scintigraphic imaging technique that can be done by using a specific group of radionuclides called “positron emitters”. At present, PET scanning is done in the PET scanner with CT integration, what is called PET/CT scanner. Thus, the diagnostic accuracy of the modality is improved by combining metabolic data obtained from PET part with morphological information gathered from CT portion of the system.


PET/CT imaging has an important role in the diagnosis and follow-up of cancer patients, and is done by using radioactive drugs that are sensitive to different types of cancer. Radioactive drugs used in PET/CT are summarized as follows:

  1. Fluorine-18 fluorodeoxyglucose (FDG): It is a kind of radioactive sugar molecule labeled with F-18 radioisotope. It is given to the patient’s body via an antecubital vein and thereafter its distribution within the patient's body is imaged by PET/CT device. As cancer cells use much more sugar than normal cells due to increased energy requirement, cancerous tissues appear brighter (being higher counted areas) on the PET images (Figure 1). FDG-PET scanning has been used in most of the malignancies to determine; a) disease extension status (staging and re-staging), b) treatment response evaluation and c) early recurrence development, as well as d) to help diagnosing of cancer in an indeterminate mass lesion.

 

In addition, FDG-PET is widely used in the diagnosis and follow-up of some brain diseases such as dementia and epilepsy, and also in demonstrating viability of cardiac muscles with having impaired contractility.

  1. F-18 Sodium Fluoride (NAF): It is a bone seeking PET radiopharmaceutical that can only accumulate in active bone tissue. It is again injected into the patient's body through a vein and imaging is done with PET/CT device in the same way. It is used for the diagnosing of metastatic bone disease in the patients with malign cancers and follow up of the disease outcome in such patients (Figure 2).
  2. Ga-68 DOTA-TATE (Ga-68 octreotate): This is another PET radiopharmaceutical that is very useful and effective agent for neuroendocrine tumors (NETs). As neuroendocrine tumors are consist of abundant amount of octreotide sensing somatostatin receptors on their cell surface, any octreotide derivative peptide (TATE, TOC, NOC, etc.) labeled with Ga-68 via DOTA linker molecule will be able to accumulate into such tumors, allowing a successful PET imaging.

Ga-68 octreotide derivatives are used in the diagnosis, staging and follow-up of neuroendocrine tumors in which FDG-PET is often ineffective. Neuroendocrine tumors can result from a wide variety of organs and tissues. Neuroendocrine tumors and metastases can be detected with very high accuracy by PET/ CT with Ga-68 DOTA-TATE.

 

In addition, since the therapeutic equivalent of this radiopharmaceutical (Lutetium-177 DOTA-TATE) is present, Ga-68 DOTA-TATE PET/CT imaging is also important in the selection of patients who are eligible for Lu-177 DOTA-TATE treatment.

  1. Ga-68 PSMA (Prostate specific membrane antigen): PSMA is a building protein block found in the majority of prostate cancer cells. In recent years, the PSMA molecule has been effectively labeled with the Ga-68 radionuclide, making it possible to demonstrate prostate cancer and metastases very efficiently with PET/CT imaging.

At the same time, PSMA can also be labeled with Lutetium-177 radionuclide and thus is being used in the treatment of metastatic prostate cancers where other treatment options are not effective. Many studies have shown that Ga-68 PSMA PET / CT can accurately demonstrate prostate cancer and metastases over 90%.

 

Radionuclide treatment done at our department (Clinical indications):

  • Iodine-131 treatment –low-dose             (Hyperthyroidism)
  • Iodine-131 treatment – high dose           (Thyroid cancer)
  • Yttrium - 90 Microsphere treatment         (Liver tumors)
  • Lutetium-177 DOTA-TATE treatment      (Neuroendocrine tumors)  
  • Lutetium-177 PSMA treatment               (Metastatic prostate cancer)
  • Radium 223 (Xofigo) treatment               (Bone metastasis of prostate cancer)
  • Iodine-131 MIBG treatment                    (Pheochromocytoma,Paraganglioma,Neuroblastoma)