Nuclear Medicine Diagnosis and Therapy

Benign and Malignant Thyroid and Parathyroid Disorders (Thyroid Carcinoma)

The most commonly used molecular imaging procedure for diagnosing and guiding the treatment of thyroid disorders and thyroid cancer are radioiodine scans and PET scanning, which is often used in conjunction with computed tomography (CT) scanning. I-131 radiotherapy may typically also used to treat thyroid cancer after the thyroid is surgically removed.

Parathyroid – UCSF Medical
SPECT/CT of the parathyroid gland, searching for a small parathyroid adenoma.

There are four kinds of thyroid cancer including papillary, follicular, medullary and anagplastic.  Symptoms may not be due to thyroid cancer but tell your doctor if you have:

  • A lump in the neck or enlarged lymph glands in the neck
  • Neck pain, sometimes going up to the ears
  • Hoarseness or difficulty swallowing or breathing

Your doctor will examine your neck to look for lumps or abnormalities and may order testing such as fine needle aspiration to take fluid and cells from a thyroid nodule for more examination or a thyroid scan taken after radioactive iodine is injected into the blood or ultrasound using sound waves to examine thyroid nodules.

Image studies for a patient with potential thyroid carcinoma involves both examination of the thyroid as well as careful assessment of the regional lymph nodes for the presence of metastases. Imaging exams may include ultrasound  studies, CT, MRI and nuclear as well as biopsies to diagnose or evaluate the stage of thyroid disorders.

Cancer

UCSF nuclear medicine imaging specialists are experienced in the early detection of cancer with the goal for the patient to receive the most accurate treatment and for the physicians to be able to assess the result of the therapy. This gives the referring doctor valuable information for what to do next for his or her patient.

Lymphoma or Lymphatic Cancer

The most commonly used molecular imaging technique for diagnosing and treating lymphoma is PET scanning and PET in conjunction with computer-aided tomography (CT) scanning (PET-CT).  Non-Hodgkin’s lymphoma patients who do not respond to chemotherapy may be referred to undergo radioimmunotherapy (RIT).

Neuroblastoma

Neuroblastoma is a cancer that forms in nerve tissues. It usually begins in the adrenal glands. It may also begin in the neck, chest or spinal cord. Possible signs of neuroblastoma include bone pain and a lump in the abdomen, neck, or chest. Doctors may order testing such as urine, blood or other lab tests, bone marrow or a biopsy, ultrasound, CT exams, and injection of radioactive material to identify tumor cells.

Many neuroblastomas are diagnosed in pediatric patients, under 5 years of age but it is not only a disease of children. These tumors commonly occur in the adrenal glands, abdomen, pelvis or neck. Imaging exams may include ultrasound, MRI, CT and the expert use of nuclear imaging with radiopharmaceuticals for diagnosis and monitoring of response to treatment for this disease.  UCSF is one of the two largest referral centers in the nation for patients with neuroblastomas.

Heart Diseases

Coronary artery disease (CAD) is the leading cause of death in the United States in both men and women.  When there is buildup of cholesterol and plaque on the inner walls of the heart, the arteries that supply blood to heart muscle become hardened and narrowed and less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs and this can lead to chest pain or a heart attack and contribute to heart failure and arrhythmias. UCSF’s experts in nuclear m edicine have advanced techniques including nuclear medicine exams for diagnosis and treatment of cardiac diseases.

UCSF’s nuclear medicine service provides multimodality imaging including PET/CT, SPECT/CT and Cardiac PET, which is an advanced test used for cardiac disease or coronary artery disease. PET/CTA is a non-invasive assessment of ischemic coronary artery disease (disease where there is reduced blood flow to the heart). The exam goes beyond the typical standard SPECT exam, and provides non-invasive quantitative cardiac PET imaging with Rb-82 and N13-ammonia. The benefit is that in the combined exam, the PET scan provides an assessment of function including the amount of blood supply to the heart, while the CT scan shows the structures in the heart. This combination merges the molecular imaging information provided by the PET imaging with the anatomic information furnished by the CT scan.  In one exam, the combined technology allows for abnormal function to be detected and then mapped, and this leads to more accurate diagnosis for cardiac disease and the potential for better patient outcomes.

Cardiac Images – UCSF Medical
(Left image) Stress/Rest myocardial perfusion imaging study showing reversibility in the distal inferior wall. (Right image) Bull's eye circunferential profile of the same patient evaluating the degree of myocardial ischemia. 

Nuclear Medicine Exam – UCSF Medical