Dr Iain Duncan

Indication

Scan

Comments

Arthritis & joint symptoms Bone scan Helps assess distribution, activity and extent
Back and neck pain Bone scan Useful in determining whether focal abnormalities are present (facet joint arthritis, fractures) or to determine the level and location of symptoms
Bile leak
or obstruction
HIDA scan
Biliary disease HIDA scan This scan detects gallbladder dysfunction and abnormal excretion patterns in the biliary tree
Bone metastasis Bone scan High sensitivity & moderate specificity in PLANAR scans and high sensitivity and specificity with SPECT-CT
Cerebrovascular disease Neurolite Brain scan Useful in determining whether significant ischaemia is present in early dementia or cognitive impairment. Poor specificity in dementia
Chest pain Myocardial Perfusion Study To assess for presence of significant myocardial ischaemia
Cholecystitis –acute HIDA scan This scan will demonstrate obstruction of the cystic duct
Cholecystitis –chronic HIDA scan In cases where U/S is negative this scan can detect acalculic cholecystitis
Constipation Colonic Transit Study
Coronary artery disease Myocardial Perfusion Study To assess for extent or distribution of significant myocardial ischaemia
Dementia Neurolite Brain scan Useful in determining whether significant ischaemia is present
Dry Mouth Salivary Scan  Assess function of salivary glands
Fracture Bone scan Useful when x-ray negative but clinical moderate or high risk. SPECT-CT distinguishes subtle degenerative disease from small stress injuries -especially useful in the feet or spine.
Gastric motility disorder Gastric Motility Study   In diabetes or in those with prior surgery
Haemangiomas Red cell scan  Only lesions greater than 2cm in size can be reliably detected. Smaller lesions (>1cm) can be detected with SPECT-CT
Heart Failure Gated heart study Calculates the left ventricular ejection fraction accurately and reliably. Most reliable as a serial study in those on chemotherapy
Hepatic lesions RED CELL or HIDA or Liver/SPLEEN SCAN with SPECT_CT All three scans are used and it is best to discuss each case with a nuclear medicine physician
Hyperparathyroidism Parathyroid scan Depicts hypertrophied parathyroid tissue. Poor sensitivity and specificity on planar scans but much better when done as  a dual isotope SPECT-CT scan. Should be combined with neck ultrasound
Hypertension DTPA renal scan By comparing baseline and post-captopril scans can detect renal artery stenosis
Hyperthyroidism Thyroid scan Can differentiate Graves disease from other causes
Infection White cell scan or leukoscan  Better than gallium for more recent infection and for joint prostheses. May need to be done in conjunction with bone scan
Infection –chronic Gallium Requires injection and scan 48hrs apart
Inflammatory bowel disease White cell scan
Inflammatory disease –chronic Gallium Requires injection and scan 48hrs apart
Joint pain Bone scan Can be regional or whole body
Joint prosthesis Bone scan To assist in the detection of loosening, stress fracture, or infection. SPECT-CT has improved the accuracy of this scan.
Liver dysfunction HIDA scan Can demonstrate biliary atresia and hepatic dysfunction
Liver lesions Discuss  with Dr There are multiple scans used and it is best to discuss each case with a nuclear medicine physician
Lymphoma Gallium Not all lymphomas are seen on gallium scans
Meckel’s diverticulum Meckel’s Study Detects ectopic gastric mucosa
Multinodular goitre Thyroid scan Usually best in combination with thyroid ultrasound
Oesophageal reflux Oesophageal motility study Helps differentiate gastro-oesophageal reflux from motility disorders.
Pain –musculoskeletal Bone scan May help localize focal bone/joint pathology where the symptoms are not specific.
Preoperative cardiac assessment Myocardial Perfusion Study To assess for presence of significant myocardial ischaemia. Strong prognostic value.
Pulmonary embolus Lung scan High accuracy rate if no underlying lung disease. Scan of choice in young and those with renal impairment. Lower radiation exposure than CT scan but if underlying lung disease consider CT pulmonary angiogram first.
In pregnancy it is the scan of choice but if CXR is abnormal then CTPA is scan of choice -more info here.
PUO Gallium Requires injection and scan 48hrs apart
Renal function DTPA renal scan Relative and qualitative function but not absolute function
Renal infection DMSA renal scan Shows parenchymal change such as site of recent infection
Renal location DMSA renal scan Shows location of kidneys and split function
Renal Obstruction DTPA renal scan Gives information about relative (R v L) function and whether obstruction is functionally significant
Renal scarring DMSA renal scan Shows parenchymal change such as scarring
Salivary function Salivary scan Assess hypofunction or gland failure
Spleen Liver-spleen scan Detects ectopic splenic tissue, absent spleen, and splenic infarcts
Thyroid metastases Iodine scan Should be discussed with nuclear physician
Thyroid nodule Thyroid scan Hot v cold nodules. Usually best in combination with thyroid ultrasound
Watery Eyes Dacrocystogram Assesses the patency of the lacrimal ducts