Harvey A. Ziessman - Nuclear Medicine, (Case Review)

Nuclear Medicine
CASE REVIEW

Series Editor

David M. Yousem, MD, MBA

Director of Neuroradiology and Professor of Radiology

Vice Chairman of Program Development

Russell H. Morgan Department of Radiology and Radiological Science

Johns Hopkins Medical Institution

Baltimore, Maryland

Other Volumes in the CASE REVIEW Series

Brain Imaging

Breast Imaging

Cardiac Imaging

Emergency Radiology

Gastrointestinal Imaging, Second Edition

General and Vascular Ultrasound, Second Edition

Genitourinary Imaging, Second Edition

Head and Neck Imaging, Third Edition

Musculoskeletal Imaging, Second Edition

Obstetric and Gynecologic Ultrasound, Second Edition

Pediatric Imaging

Spine Imaging, Second Edition

Thoracic Imaging

Vascular and Interventional Imaging

CASE REVIEW

SECOND EDITION

Harvey A. Ziessman, MD

Professor of Radiology

Director of Nuclear Medicine Imaging

Division of Nuclear Medicine

Russell H. Morgan Department of Radiology and Radiological Sciences

The Johns Hopkins University

Baltimore, Maryland

Patrice Rehm, MD

Associate Professor of Radiology

Director of Nuclear Medicine

University of Virginia Health Science Center

Charlottesville, Virginia

Associate Editors

Twyla B. Bartel, DO, MBA

Assistant Professor of Radiology

PET Director, Chief of Nuclear Medicine Imaging

University of Arkansas for Medical Sciences

Little Rock, Arkansas

Tracy L.Y. Brown, MD, PhD

Assistant Professor of Radiology

Program Director of Nuclear Medicine Residency

University of Arkansas for Medical Sciences

Little Rock, Arkansas

CASE REVIEW SERIES

1600 John F. Kennedy Boulevard

Suite 1800

Philadelphia, PA 19103-2899

NUCLEAR MEDICINE: CASE REVIEW, SECOND EDITION ISBN: 978-0-323-05308-2

Copyright 2011, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

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Previous edition copyrighted 2001.

International Standard Book Number: 978-0-323-05308-2

Acquisitions Editor: Rebecca Gaertner

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Designer: Steven Stave

To Karen and Bob

In the last decade, no field has made more monumental clinical strides in radiology than nuclear medicine. The explosion of PET/CT scanners has been instrumental in retooling how oncologic specialists decide who receives therapy, how that therapy is affecting the patient, whether to continue treatment, and if there is evidence of residual or recurrent disease. As a head and neck radiology aficionado, I see these cases frequently in the clinic and admire the value of the functional FDG PET component of the study. Similar advances in cardiac imaging, sestamibi scanning for parathyroid adenomas, and molecular imaging have had a great impact in medicine.

The second edition of Nuclear Medicine: Case Review by Drs. Ziessman, Rehm, Bartel, and Brown builds on the success of the first edition. It brings the reader up to date with the advances in technology as it supplies 200 excellent quality cases with poignant questions and discussions. The authorship team has been successful in maintaining a balance of nuclear medicine physics, radiation safety information, and clinically based material to produce a valuable Case Review Series book for trainees and practitioners in nuclear medicine. The style of the Case Review Series continues to be the best means to learn material in an interactive fashion with selected images, provocative questions, short answers, great discussions, pertinent references, and links back to Nuclear Medicine: THE REQUISITES for those who prefer more didactic textual material.

Congratulations to Drs. Ziessman, Rehm, Bartel, and Brown for furthering the success of Nuclear Medicine: Case Review with their exceptional second edition.

David M. Yousem, MD, MBA

The second edition of Nuclear Medicine: Case Review builds on the successful first edition and emphasizes the many advances that have taken place since its publication in 2002. This new edition extensively updates the case study material to reflect these advances and encompasses the current practice of nuclear medicine. We have two new associate editors, Drs. Twyla Bartel and Tracy Brown from the University of Arkansas, who contributed many excellent cases for this new edition. It has been a challenge to limit the number of cases to 200 because we had so much good new material, but I think we have succeeded in selecting the best. Much of the material is completely new, particularly the cases on PET/CT, SPECT/CT, and radiation safety. With the first edition, F-18 FDG PET was just beginning to become a clinical imaging modality after decades of investigation and development. It was primarily indicated for oncologic imaging. FDG PET was a major advance and changed the practice of oncology and nuclear imaging. Since then, hybrid PET/CT instruments became commercially available and their clinical use grew at a rapid rate, becoming the standard PET imaging modality. FDG PET/CT is now routinely reimbursed for many different oncologic indications and increasingly for neurologic and cardiac indications. Cardiac stress imaging using rubidium-82 PET is now used at many imaging centers because of its excellent image quality. Because it is generator produced, an on-site cyclotron is not needed. Cardiac viability imaging with F-18 FDG and Rb-82 is also increasing. Brain PET/CT is growing and expected soon to achieve its long-anticipated clinical utility, particularly for Alzheimers disease, epilepsy, and Parkinsons disease. The great success of PET/CT led to the introduction of hybrid SPECT/CT for single photon imaging (e.g., somatostatin receptor imaging, I-123 MIBG, Tc-99m sestamibi parathyroid imaging, infection imaging). SPECT/CT is now showing the rapid clinical growth shown previously by PET/CT. Both hybrid technologies are leading us into the future of molecular imaging. Radiation safety, long an important topic but not emphasized in the first edition, is discussed in many cases presented in the second edition. Any case study retained from the first edition continues to prove its clinical importance and has been updated to reflect current practice. We think that the second edition will surpass the success of the first edition.