Adrenal Gland

• What Rf are used in adrenal medullary scintigraphy?

  Iodine-131 MIBG for diagnosis

  Iodine-123 MIBG for therapy
• what is the principle of adrenal medullary scintigraphy?

  MIBG is an analogue of norepinephrine/noradrenaline and guanethidine so it accumulates in adrenergic tumors and organs with sufficient sympathetic innervation.
• Indications of adrenal medullary scintigraphy

  • localization of adrenal pheochromocytomas and neuroblastoma,
  • localize carcinoid and medullary thyroid carcinoma,
  • evaluation of patients with suspected neuroblastomas
• what equipment is used in adrenal medullary scintigraphy?

  gamma camera with high energy collimator
• how is the patient prepared in adrenal medulla scintigraphy?

  • Discontinuation of drugs that affect MIBG uptake (reserpine, antidepressants, pseudoephedrine, amphetamines)
  • Administration of iodine mixture before or during test to prevent the thyroid gland from absorbing too much of the RF
• Contraindications of adrenal medullary scintigraphy?

  pregnancy and breastfeeding
• adrenal medullary scintigraphy procedure

  • Administration of I-123 MIBG
  • Whole body images of head and body + SPECT of suspected areas
  • Images are taken 6-24 hours after RF administration
  • Before or during the test, the patient may be given an iodine mixture
• adrenal medullary scintigraphy interpretation

  • norm = adrenal not visible; activity decreases with time
  • pheochromocytoma = focal accumulation that increases with time; metastases in lungs, bones, liver
  • neuroblastoma = high accumulation; metastasis in bone marrow
• what Rf is used in somatostatin receptor scintigraphy / 111-Octreoscan?

  • 111-In-DTPA-tyr-octreotide
  • 99mTc-DTPA-tektrotyd
• what disease is somatostatin receptor scintigraphy / 111-Octreoscan used for?

  adrenal carcinoma + adenoma
• what is the principle of somatostatin receptor scintigraphy / 111-Octreoscan?

  Rf is similar to somatostatin and attaches to tumour cells with somatostatin receptors
• 111-In-DTPA-tyr-octreotide

  • Application of RF at 200 MBq
  • Imaging is taken the next day, takes 90-120min
  • Whole body scan
• 99mTc-DTPA-tektrotyd

  • Application of RF at 740 MBq
  • Patient has to be fasting
  • First picture is done after 2h
  • Whole body scan is done after 4 hours + SPECT/CT, takes 90-120min
  • In some cases, two images are taken after 24h
• I-123 MIBG vs. 111-In-Octreoscan in Paraganglioma?

  Paraganglioma with metastasis is better shown in the MIBG scan. Using 111-In-Octreoscan we risk not seeing it if the size Is less than 1cm
• Can PET/CT be used to identify adrenal gland diseases?

  PET/CT, in the case of adrenal tumors, can be used to differentiate between benign, malignant, and metastatic tumors
• Is PET/CT effective in imaging cancer biology?

  PET/CT combines structural + functional info of the organ/tissue and is the most effective tool in the imaging of cancer biology because it combines the anatomic and metabolic-molecular info in a single image.
• What are the indications of PET/CT?

  oncology, cardiology, brain, inflammation, infectious lesions
• what method of imaging and pathology is shown?

  MIBG scintigraphy; pheochromocytoma

  
• what method of imaging and pathology is shown?


  MIBG scintigraphy; NEUROBLASTOMA