Radioactive pertechnetate (99mTcO4-) is uptaken up in the thyroid tissue and the rate of its accumulation approximately 20 min after application is directly proportional to the functional state of the thyroid tissue and the activity of sodium iodide symporters. Ide o funkčno- morfologické zobrazenie tkaniva štítnej žľazy. Posudzuje sa tvar, lokalizácia a veľkosť lalokov štítnej žľazy. Detekujú sa ložiská so zníženou akumuláciou rádiofarmaka – studené uzly (cysty, nádory) alebo ložiská so zvýšenou akumuláciou rádiofarmaka – horúce uzly (hyperfunkčné tkanivo – autonómny adenóm) alebo sa diagnostikuje ektopické tkanivo štítnej žľazy. Rádiofarmakum (99mTcO4 – ) sa aplikuje i.v., vyšetruje sa 15-20 min po aplikácii v ľahu na chrbte.

Method of application: intravenous injection

Indications: unilocular goiter, polynodous goiter (before surgery), evidence of functional thyroid autonomy (autonomous adenoma), diagnosis of retrosternal goiter, differential diagnosis of neck or intrathoracic formations, thyroiditis, lingual goiter, evidence of the presence of functional thyroid tissue to exclude or confirm congenital hypothyroidism

The method allows only enlarged parathyroid glands (parathyroid adenoma or hyperplasia, or carcinoma) to be imaged, even in atypical localization. Available radiopharmaceuticals that accumulate in the parathyroid tissue also accumulate in the thyroid tissue. Therefore, our department uses biphasic scintigraphy. Biphasic scintigraphy is based on the observation that 99mTc-MIBI/ Tetrofosmin is more rapidly cleared from thyroid tissue than from hyperplastic tissue or parathyroid adenoma. Thus, a recording is made at 5-30min and then at 2-3h after radiopharmaceutical application. Usually for a more accurate diagnosis we also complement the thyroid scintigraphy for comparison with the parathyroid scintigram. Radiopharmaceuticals (99mTcO4- , 99mTc-MIBI/ Tetrofosmin) are injected intravenously, the examination is performed in supine position, the total examination takes about 3 h. Imaging is performed in anterior and in two anterior oblique projections using a pinhole collimator, if necessary also by SPECT/CT.

Radiopharmaceuticals: 99mTc-MIBI – methoxy-isobutyl-isonitrile, 99mTc-Tetrofosmin (Myoview) – for parathyroid scintigraphy

Pertechnetate (99mTcO4-) – for thyroid scintigraphy

Method of application: intravenous injection

Indications: local diagnosis (preoperatively) in suspicion of parathyroid adenoma or parathyroid carcinoma, high parathyroid hormone levels -hyperparathyroidism (primary secondary, tertiary), differential diagnosis of hypercalcemia

Functional and morphological examination of the salivary glands based on their ability to uptake 99mTcO4- from the bloodstream , uptake of the radiopharmaceutical corresponds to the activity of sodium iodide symporters. It is performed as a dynamic recording, with static recordings supplemented as needed. The radiopharmaceutical (99mTcO4-) is administered i.v., the examination is performed in the supine position, the examination starts immediately after application, lasts 40 min, in the second half of the examination a salivation stimulus (lemon juice) is administered orally. The intensity and symmetry of the accumulation of the radiopharmaceutical in the salivary glands and the speed and intensity of the response to the salivation stimulus are assessed.

Radiopharmaceutical: 99mTcO4- – pertechnetate (sodium technetistate)

Method of administration: intravenous injection

Indications: Sjogren’s syndrome, diagnosis of functional status and drainage of salivary glands, inflammation, sialolithiasis, tumors, abscesses, cysts, lymphatic infiltration

After oral administration of 99mTc-DTPA (diethylenetriaminepentaacetic acid)-labeled fluid, we assess for impaired motility, possible retention, and the presence of gastroesophageal reflux.

Radiopharmaceutical: 99mTc-DTPA (diethylenetriaminepentaacetic acid)

Method of application: the patient, after being placed on the examination bed, has the detector set to the whole oesophagus and stomach area. Before swallowing the marked fluid, a fast dynamic recording (0.2s/image) is initiated using the gamma camera and then the patient swallows the active fluid. The speed and fluency of the swallowing act, any motility disturbances, and retention are assessed. During the examination of gastroesophageal reflux, the gastric volume is added and then the esophageal area is scanned with dynamic recording for 30 minutes (10s/image). In doing so, we try to increase the intra-abdominal pressure using the Valsalva manoeuvre or by coughing to induce gastroesophageal reflux.

Indications: evidence of impaired swallowing in various pathological conditions, quantitative assessment of the rate of passage of a bite of food through the oesophagus, evidence of gastroesophageal reflux

After oral administration of a diet labeled with the radiopharmaceutical 99mTc-DTPA (diethylenetriaminepentaacetic acid), we assess impaired gastric motility and gastric emptying capacity, quantitatively by gastric emptying half-time. Examination is performed immediately after dietary administration by 90-minute dynamic recordings and static minute scans at 2, 3, and 4 hours after dietary administration. After the patient is placed on the examination bed, the detector is set to the lower oesophageal region, stomach and bowel region.

Radiopharmaceutical: 99mTc-DTPA (diethylenetriaminepentaacetic acid)

Method of administration – orally in the form of a standardised breakfast

Indications: pathological conditions that may be associated with impaired gastric evacuation (diabetic neuropathy, conditions after gastric resection), monitoring the effectiveness of surgery for obesity before and after treatment

Patient preparation: the examination is performed fasting (8 hours without food intake), the patient must not smoke before the examination. Diabetic patients must be given a dose of antidiabetic medication or insulin before the meal. During the examination for diagnosis, the patient must discontinue any medication that affects gastric motility. When assessing the effect of the treatment, the treatment should be retained.

Note: Meal for the examination in the form of a standardised breakfast (2 egg whites, white bread and jam)

Detection of the location and extent of bleeding, especially from the lower GIT, shows bleeding with an intensity as low as 0.1-0.2 ml/min. A focus of increased accumulation of labelled erythrocytes in the abdomen is detected, the subsequent change in the location of the focus due to intestinal motility is indicative of GIT bleeding. The examination allows long-term monitoring of the patient for several hours, it is also suitable for intermittent bleeding. It is also possible to complete the recording the following day. After blood collection and labelling of the patient’s erythrocytes, the labelled autologous erythrocytes are injected i.v. The examination starts immediately after the injection, the patient is examined in the supine position, the examination lasts 240 min. In case of a negative finding on the initial dynamic recording, further static recordings are performed approximately every hour, possibly the following morning. If necessary, a SPECT/CT recording is also performed to determine a more precise anatomical localization of the bleeding source. The examination is only relevant if the patient currently has signs of gastrointestinal bleeding present.

Radiopharmaceutical: 99mTc – labelled vital autologous erythrocytes

Method of administration: intravenous injection.

Indications: evidence and determination of the site of bleeding mainly from the lower and middle part of the alimentary canal (polyps, diverticula, bleeding Meckel’s diverticulum, arteriovenous malformations, inflammations, tumors)

After intravenous administration of the radiopharmaceutical, its uptake by myocardial cells occurs. The distribution of the radiopharmaceutical in the myocardium reflects the degree of regional perfusion of the heart muscle, depending on the regional blood flow through the coronary sinus and on the functional state of the myocardial cells. Radiopharmaceutical accumulation does not occur in necrotic or scarred areas of the myocardium. In ischaemic areas, the accumulation of radiopharmaceutical is reduced. The examination is performed in two phases, first a stress study and then a rest study. The presence of reversible or fixed defects of radiopharmaceutical accumulation, representing ischaemic or necrotic deposits in the myocardium or postinfarction scars, is evaluated by comparing the stress and rest studies. Stress examination may reveal hitherto latent myocardial blood flow disturbances. The examination is usually performed as a one-day protocol in our department.

Radiopharmaceutical: 99mTc-MIBI – methoxy-isobutyl-isonitrile, 99mTc-Tetrofosmin (MYOVIEW®)

Route of administration: intravenous

Indications: diagnosis of the presence, location, extent and severity of ischemia, detection of post-infarction myocardial scarring, ambiguous interpretation of ECG changes (e.g. in BHRT), risk stratification of coronary events, differential diagnosis of chest pain, determination of the functional significance of coronary artery stenosis confirmed by coronary angiography, monitoring of the effect of therapy and the effect of revascularization

The radiopharmaceutical in the form of 99mTc-labelled albumin macroaggregate is retained in the capillaries of well-perfused areas of the lung after i.v. administration, whereas it does not reach non-perfused areas. These appear as areas of radioactivity dropout on the lung scintigram. The perfusion defect often has a shape corresponding to the segmental or lobar subdivision of the lung. This is to show the distribution of pulmonary capillary perfusion and to detect disturbances in blood flow through the pulmonary vasculature. The specificity of the examination is increased by simultaneous ventilation scintigraphy of the lungs. The radiopharmaceutical ( 81mKr) is inhaled in the form of an inert gas using a mask, examined during inhalation while lying supine. A perfusion defect without ventilation disturbance is typical of pulmonary embolism; a perfusion defect with concomitant ventilation disturbance is not indicative of pulmonary embolism. A negative finding on perfusion pulmonary scintigraphy excludes pulmonary embolism. The examination is performed in the supine position and starts a few minutes after i.v. application of a radiopharmaceutical (99mTc albumin macroaggregate) and lasts 15-20 min. In our department, the examination of pulmonary perfusion is performed by tomographic method SPECT ev. SPECT/CT, which significantly increases the sensitivity and specificity of the examination. It is ideal to perform lung perfusion scintigraphy as soon as possible after the onset of clinical symptoms (within 5-7 days).

Radiopharmaceutical: 99mTc – macroaggregate of human serum albumin, 81mKr – krypton

Method of administration: intravenously

Indications: diagnosis of pulmonary embolism and monitoring of the effect of therapy (assessment of r

Imaging the distribution of osteotropic radiopharmaceutical in the skeleton. Osteotropic radiopharmaceutical accumulates to an increased extent in sites of increased bone metabolism, and to a reduced extent in osteolytic deposits. The examination has high sensitivity but lower specificity. Scintigraphically, the etiology of bone metabolic changes cannot be distinguished in some cases, and osteomyelitis and fracture or metastasis and degenerative lesions in the spine may also be depicted. In the case of ambiguous lesion findings, we supplement targeted SPECT or SPECT/CT imaging, which significantly increases the sensitivity and specificity of the examination and in many cases allows differential diagnosis between degenerative lesions and metastases. However, scintigraphy shows metabolically active bone process several months earlier than X-ray examination, which is of particular importance in the early detection of bone mts. The first two phases are imaged immediately after radiopharmaceutical application and last up to 10 min. They serve to assess the vascularity of the pathological process. The 3rd bone phase is scanned 2-5 h after application.

Radiopharmaceutical: 99mTc-MDP – methylenediphosphonate

Method of application: intravenous

Indications: osteomyelitis, avascular necrosis, traumatic bone changes, occult fractures, vertebrogenic algic syndrome, postoperative control of endoprostheses, extent and nature of joint structure involvement in rheumatic and arthritic diseases, metabolic bone diseases, abused child syndrome – evidence of multiple bone fractures

The sentinel lymph node is the first lymph node in the lymphatic basin that receives lymphatic drainage directly from the tumor. The aim of sentinel lymph node lymphoscintigraphy is to determine the number and location of sentinel lymph nodes together with their drainage basin to demonstrate lymphatic basins that are potential sites of lymphogenous metastasis. Subsequently, surgical biopsy of the scintigraphically detected sentinel nodes and their histological examination are performed. The next procedure is based on the assumption that if the sentinel lymph node does not contain metastatic cells, the other LUs in the basin do not have them either. Thus, patients with negative histological findings in sentinel lymph nodes do not have to undergo subsequent lymphadenectomy with possible perioperative and postoperative complications. The examination is mainly used to detect sentinel LU in malignant melanoma and breast cancer. It can also be used in cervical cancer, colon cancer, penile cancer and other cancers. Radioactive colloid is injected intracutaneously into the scar area after extirpation of the lesion – in malignant melanoma or periareolarly – in breast tumour, from where the colloid particles are transported via lymphatic pathways to the underlying lymph nodes. The location of the sentinel lymph nodes is marked on the patient’s skin in the surgical position, i.e. in the position in which the patient will be during surgery. Surgery is usually performed the following day using a peroperative gamasonde.

Radiopharmaceutical: 99m

Autologous radionuclide-labeled leukocytes rapidly migrate out of the circulation after intravenous administration and accumulate massively at the site of leukocyte infiltration. The accumulation of labeled leukocytes depends on the intensity of the chemotactic stimulus, the amount and type of labeled leukocytes, and the major cellular components responsible for the inflammatory response. In the morning, a larger volume of blood is collected from the patient from which autologous leukocytes are separated and subsequently labelled under aseptic conditions. After intravenous administration, we perform static recordings, whole-body scintigraphy and, if necessary to better localize the lesion, we complete SPECT/CT of the selected area.

Radiopharmaceutical: 99mTc-HMPAO labeled autologous leukocytes

Method of administration: intravenous

Indications: osteomyelitis in the peripheral skeleton and localization of musculoskeletal infections, diabetic foot, periprosthetic infection in the vicinity of joint replacements, localization and determination of inflammatory activity of non-specific inflammatory bowel disease, M. Croohn, Colitis ulcerosa, fevers of unknown etiology

Dynamic renal scintigraphy

It is a functional-morphological examination of the kidneys, it allows an indicative assessment of the size, shape and localization of the kidneys, renal perfusion, assessment of outflow parameters, the program calculates the separated renal function and the value of the total GF. Dynamic recording of the kinetics and distribution of the radiopharmaceutical in the renal parenchyma, its intrarenal transport, excretion into the calyx-funnel system and its outflow into the ureters and bladder are monitored.

Radiopharmaceutical: 99mTc-DTPA – diethylenetriaminepentaacetic acid, 99mTc-MAG3 – mercaptoacetyltriglycine

Method of application: intravenous injection

Indications: suspicion of renal parenchymal damage or outflow disorder, assessment and monitoring of renal function, dif dg of obstructive and non-obstructive hydronephrosis, diagnosis of post-transplant renal complications, renal artery thrombosis, urinoma, hematoma, lymphocele, damage to transplanted kidney by immunosuppressive therapy

Static renal scintigraphy

The radiopharmaceutical is accumulated and fixed for a certain period of time in the cells of the proximal tubules of the kidneys depending on their functional state, which allows imaging of the state of the functional renal parenchyma, assessment of the localization, shape and size of the kidney, calculation of the separated function and detection of focal lesions.

Radiopharmaceutical: 99mTc-DMSA – dimercaptoacetic acid

Method of administration: intravenous injection

Indications: confirmation of affunction, renal agenesis, dystopia, renal ptosis, renal migrans, shape anomalies

The radiopharmaceutical 99mTc-Nanocoll is phagocytosed by macrophages in active (red) bone marrow. At 30 minutes after its intravenous administration, a whole-body scintigraphy is performed; we will complete the case with a SPECT/CT of the selected area where pathological lesions are suspected or the image is not well evaluable from planar images. We assess changes in the extent of active bone marrow: grade I-III enlargement, grade IV central attenuation and peripheral activation, grade V complete attenuation when we find no activity in the bone marrow. Focal defects of activity in the bone marrow may be a consequence of metastases or more extensive after external radiotherapy. They are also found in patients with localized inflammation. In these cases, bone marrow scintigraphy is indicated as a complementary examination to scintigraphy using labelled leukocytes.

Radiopharmaceutical: 99mTc-NANOKOLL – technetium-99m-labelled colloid

Method of administration: intravenously

Indications: assessment of bone marrow distribution in hematological diseases (peripheralization of bone marrow distribution) marrow attenuation in the central skeleton, detection of bone marrow lesions in primary hematological malignancy or metastatic process, confirmation of the extent of undesirable bone marrow attenuation after radiotherapy.

The activity of presynaptic dopamine transporters (DaT) in the striatum can be evaluated using 123I-labeled ioflupane – FP-CIT (DaTSCANT), which accumulates in the striatum. The intensity and symmetry of radiopharmaceutical uptake in the nc. caudatus and putamen are assessed. The main indication is to differentiate Parkinson’s disease and Parkinson plus syndrome group diseases that have pathological findings using 123I-ioflupane (DaTSCAN) from other forms of Parkinsonian syndromes and essential tremor. The test also helps to differentiate dementia with Lewy bodies, in which the density of dopamine transporters is reduced, from Alzheimer’s disease, in which the findings of this test are normal.

Radiopharmaceutical: 123I-ioflupane – FP-CIT (DaTSCANT)

Method of administration: intravenous injection.

Indications: differential diagnosis of Parkinson’s disease and Parkinson plus syndrome from other Parkinson syndromes and essential tremor

The radioactive colloid is injected into the interstitium in the distal parts of the upper or lower limbs, from where the colloid particles are transported via lymphatic pathways to the inferior lymph nodes. This allows imaging of the lymphatic system in the respective catchment area. The radiopharmaceutical (99mTc-nanocoll) is injected into the interstitium and imaging is initiated immediately after application, with further recordings being made at intervals as required.

Radiopharmaceutical: 99mTc-nanocoll

Method of application: intradermal

Indications: differential diagnosis of limb oedema, lymphatic passage disorders, evidence of lymphoid tissue involution, evidence of lymphogenous metastases