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PET-CT

PET / CT (abbreviation for Positron Emission Tomography-Computed Tomography) is currently the most advanced imaging technique in cancer and dementia diagnostics. The combination of PET and CT in one device allows the detection of tumours, inflammations or neurological disorders earlier and more accurately than it was possible with previous methods.

In PET scanning, patients receive a small amount of a radioactive substance, usually fluorodeoxyglucose (FDG), which is a slightly altered glucose molecule. This substance accumulates in the organism in regions of intense metabolic activity. The increased glucose consumption by tumour compared to normal cells, is lead to an increased uptake of FDG. The pathological cells are then visible as bright dots on the PET images.

At the same time, the computed tomography shows a 3 dimensional reconstruction of the anatomy of the body.

Afterwards the PET and CT images are merged together in the device. This enables the examiner to discover even the smallest tumours very early. It can also be determined whether the tumours are benign or malignant.

Picture: PET/CT of an esophageal carcinoma (esophageal cancer): the CT scan is presented on the left, the PET-image is shown on the right. The merged PT/CT image is located in the middle. The bright dot to the left is the original tumour, the smaller dot to the right a metastasis in a lymph node.

Picture: PET/CT of an esophageal carcinoma (esophageal cancer): the CT scan is presented on the left, the PET-image is shown on the right. The merged PT/CT image is located in the middle. The bright dot to the left is the original tumour, the smaller dot to the right a metastasis in a lymph node.

The early diagnosis allows the treating physician to choose the best treatment for the patient: whether surgery, chemotherapy, radiation or a combination of different treatment options. A PET/CT follow-up scan can show whether/if the patient responds to treatment.

Moreover, the PET/CT scan is currently the most sensitive method to detect numerous brain diseases. It is possible to detect dementia before other methods show abnormalities. Early diagnosis is important in the case of Alzheimer’s disease, because only timely treatment can slow down the progression of the disease. The device is also able to recognize other brain disorders such as Parkinson, even if the patient has very few symptoms.

The PET/CT method is mainly used for diagnosing the following types of tumours:

– lung cancer (bronchial carcinoma), pulmonary nodule
– colorectal cancer (colorectal carcinoma)
– breast cancer
– prostate cancer (carcinoma of the prostate)
– black skin cancer (malignant melanoma)
– malignant lymphoma (Hodgkin’s disease and non-Hodgkin’s lymphoma)
– esophageal cancer (carcinoma of esophagus)
– thyroid (carcinoma of the thyroid gland)
– pancreatic cancer (
– neuroendocrine tumours (e.g. carcinoid)
– ovarian cancer (ovarian carcinoma)
– head and neck cancer
– bone and soft tissue tumours
– testicular cancer
– cerebral tumours
– examination of metastases when primary tumour is unknown (CUP syndrome)

The PET/CT method is also used for:

– search for an inflammatory focus (fever of unknown origin)
– early detection of dementias such as Alzheimer’s disease
– distinction of different forms of dementia
– diagnosis of movement disorders
– epilepsy

Download “Patient Information PET/CET” (PDF)

Radioiodine therapy

Radioiodine therapy is a nuclear medicine procedure to treat different kinds of thyroid diseases. It is considered a [non-invasive] gentle alternative to surgery. Radioiodine therapy is used in different types of thyroid hyperfunction (hyperthyroidism), e.g. Basedow’s disease), autonomic dysfunction of the thyroid gland (e.g. autonomous adenoma) or certain kinds of thyroid cancer (papillary or follicular carcinoma). An enlarged thyroid gland (goitre) can also be treated with this therapy.

In radioiodine therapy, radioactive iodine 131 is administered. The advantage is that the substance is absorbed only by the thyroid gland and only acts there.

If the thyroid gland had to be resected /removed surgically because of a carcinoma, it is common to perform a radioiodine therapy approximately three weeks later. This allows to remove remaining healthy thyroid tissue and the destruction of the remaining malignant tissue.

 

Examination and therapy

Based on the results of the preliminary examination (blood examination, ultrasound and scintigraphy of the thyroid gland) it is decided whether radioiodine therapy is indicated.

If so, you will stay as inpatient at the DKD Helios Clinic. Radioactive iodine will be given to you in the form of one or more small capsules after a radio iodine test has been made in advance. The dose is calculated individually and the substance is well tolerated. Only a few patients noticed a slight sore throat, which disappears after a few days.

Over the next days the radioactivity of your thyroid gland will be measured. If it has decayed to a certain value, we can discharge, usually after three to seven days.
During your stay, you are not allowed to receive visits, due to radiation protection reasons. You are also not allowed to leave the station. However, you have regular contact with doctors, nurses and of course other patients. There is also a telephone, TV and internet connection (WLAN) at your disposal.

 

Preparation before and after the examination

Some patients must take a thyroid hormone before therapy. You will be informed if you need to take the hormone when arranging the appointment.

Please avoid the intake of larger amounts of iodine before therapy (for example in contrast medium or in the medicine amiodarone).

Usually, the stay at the hospital is about three to seven days.

The therapeutic effect usually occurs only after a few weeks. Therefore, follow-up examinations are necessary after the radioiodine therapy. These examinations can be made at our practice or at your treating physicians’ practice.

Please do not hesitate to contact us, if you have any further questions!

Radiorezeptor-Therapie (DOTATOC)

Lu-177-DOTATOC- oder Y-90-DOTATOC-Therapie

PRRT (Peptid-Radio-Rezeptor-Therapie) von Somatostatin-Rezeptor-positiven malignen Tumoren mit einem mit dem radioaktiven Betastrahler Yttrium-90 oder Lutetium-177 markierten Peptid DOTATOC.

Prof. R. P. Baum führte deutschlandweit die meisten Krebstherapien mit Lu177-DOTATOC bei neuroendokrinen Tumoren durch.

1. Welche Tumoren können behandelt werden?

Es können Tumoren und Metastasen behandelt werden, die einen vermehrten Somatostatin-Rezeptor-Besatz auf der Oberfläche der Krebszelle aufweisen. Festgestellt wird dieser Rezeptorbesatz durch die DOTATOC-PET/CT, eine notwendige Voruntersuchung, die zuvor in der Praxis durchgeführt wird. Durch die PET/CT ist es möglich, die Zahl der Andockstellen für die nachfolgende Therapie auf den Tumorzellen/Metastasen anhand sogenannter Uptake-Werte (SUV) genau zu bestimmen und damit vorherzusagen, ob eine Lu177-DOTATOC- oder Y90-DOTATOC-Therapie überhaupt sinnvoll ist und mit welcher Wahrscheinlichkeit ein Erfolg erzielt werden kann: THERANOSTIKPrinzip – bestrahlt wird gezielt das, was vorher im PET/CT sichtbar ist.

 

2. Wirkungsweise der Lu-177/Y-90-DOTATOC Therapie

Die PRRT dient zur nuklearmedizinischen Behandlung von Somatostatinrezeptor-positiven Metastasen bzw. Tumorrezidiven, die auf andere Behandlungsmethoden nicht mehr ansprechen. Hierzu wird ein mit dem Betastrahler Lu-177 oder Y-90 markiertes Molekül verwendet. Die Reichweite z.B. des Beta-Strahlers Lutetium-177 beträgt im Gewebe ca. 2 mm, behandelt werden können aber auch sehr große Tumore, da das Molekül in praktisch jede Tumortiefe vordringt. Durch die geringe Reichweite kann gesundes Gewebe weitestgehend geschont werden. Das mit dem Betastrahler markierte Molekül wird in eine Armvene appliziert und reichert sich sehr schnell in den vorher durch die DOTATOC-PET/CT nachgewiesenen Metastasen bzw. Tumorrezidiven oder auch im Primärtumor an – das was vorher im PET/CT sichtbar ist, wird auch bestrahlt – im Englischen we see what we treat. Der Therapie-Effekt hängt somit von der Speicherintensität im PET/CT ab. Durch den Therapiestrahler wird die DNA der Tumorzellen zerstört, wodurch die Tumorbefunde in ihrem Wachstum gebremst, oder sich zurückbilden sollen.

 

3. Therapieablauf

Die Dauer der stationären Aufnahme in der DKD beträgt ca. 3-4 Tage. Während Ihres stationären Aufenthaltes dürfen Sie aus Strahlenschutzgründen leider keinen Besuch empfangen und die Station nicht verlassen. Sie haben jedoch regelmäßigen Kontakt zu Ärzten, Pflegepersonal und natürlich Ihren Mitpatienten. Außerdem stehen Ihnen Telefon, Fernsehen und Internetanschluss (WLAN) zur Verfügung.

Bevor die Therapie durchgeführt wird, erfolgen notwendige Untersuchungen (Laborkontrolle, Ganzkörper-DOTATOC-PET/CT, evtl. Nieren- oder Speicheldrüsenszintigraphie, Sonographie). Die Untersuchungsergebnisse werden vor der Behandlung ausführlich besprochen.

Am Therapietag müssen mindestens 1,5 Liter Flüssigkeit getrunken werden, um die Strahlenbelastung so gering wie möglich zu halten (beschleunigte Ausscheidung).

Die Gabe der Therapiesubstanz  erfolgt intravenös über eine Armvene und dauert nur  wenige Minuten. Die nicht an die Metastasen/Tumoren angedockte, überschüssige Therapiesubstanz wird überwiegend renal ausscheiden. Zur Verringerung der Nierenbelastung erfolgt eine Infusionstherapie (parenterale Flüssigkeitszufuhr). Übelkeit trat nach der Therapie extrem selten auf.

Nach Injektion der Therapiesubstanz muß der Patient mindestens für 48 Stunden auf der Therapiestation verbleiben (dies ist eine gesetzliche Vorschrift, die nicht verhandelt werden kann).

Die Kontrolle der Anreicherungsintensivität in den Metastasen sowie Messungen zum Abbau der Therapiesubstanz im übrigen Körper erfolgen in der Praxis für Nuklearmedizin als szintigraphische Ganzkörperaufnahmen sowie mittels einer SPECT/CT (Tomographie/-Schichtuntersuchung) der Tumorregionen.

Die Therapie wird üblicherweise im Abstand von 3-4 Monaten mehrfach wiederholt. Vor einem erneuten Therapiekursus erfolgt meist eine DOTATOC-PET/CT zur Erfolgskontrolle.

 

4. Potentielle Nebenwirkungen

Die Zahl der roten Blutkörperchen (Erythrozyten), der Blutplättchen (Thrombozyten) und der weißen Blutkörperchen (Leukozyten) kann abnehmen. Deshalb muss das Blutbild nach der  Therapie in bestimmten Zeitabständen kontrolliert werden. Auch nach mehrmaliger Therapie wurde gibt es in der Regel keine Einschränkung der Nierenfunktion, die renale Funktion wird überwacht. Aufgrund einer Anreicherung in den Tränen- und Speicheldrüsen kann es zu einer radiogenen Sialadenitis (Mundtrockenheit) kommen (dies wurde bisher nur selten beobachtet). Es können (theoretisch) allergische Reaktionen unter der Verabreichung auftreten (bisher nie). Langzeitnebenwirkungen oder schädliche Langzeiteffekte sind bisher nicht aufgetreten/bekannt.

 

4. Die Therapie kann nicht angewendet werden bei folgenden Erkrankungen:

– Akute Infektionen mit Fieber
– Hochgradige Knochenmarkinsuffizienz
– Hochgradige Niereninsuffizienz
– Herzinfarkt innerhalb der letzten 6 Wochen
– Rasch progrediente Zweitmalignome 

Kontakt: Prof. Dr. med. Richard P. Baum, CURANOSTICUM Wiesbaden-Frankfurt
E-Mail: baum@curanosticum.de

Radioliganden-Therapie (PSMA)

Lu177-PSMA-Therapie

RLT (Radio-Liganden-Therapie) von therapierefraktären, d.h. auf Hormontherapie nicht mehr ansprechenden, metastasierten Prostatakarzinomen mit Lutetium-177 PSMA

Prof. R.P. Baum führte die weltweit ersten Therapie mit Lu177-PSMA bei Prostatakrebs durch und hat erfolgreich bereits tausende Patienten mit dieser Methode behandelt. Wir bieten mit Prof. R. P. Baum zudem Krebstherapien mit Lu177-DOTATOC bei neuroendokrinen Tumoren an.

1. Welche Tumoren können behandelt werden?

Es können alle Metastasen behandelt werden, die PSMA (Prostata-Spezifisches Membran-Antigen) auf der Oberfläche der Krebszelle aufweisen. Festgestellt wird dies durch die PSMA-PET/CT (Positronen-Emissions-Tomographie), eine notwendige Voruntersuchung, die zuvor in der Praxis durchgeführt wird. Durch die PET/CT ist es möglich, die Zahl der Andockstellen für die nachfolgende Therapie auf den Tumorzellen/Metastasen anhand sogenannter Uptake-Werte (SUV) genau zu bestimmen und damit vorherzusagen, ob eine Lu177-Therapie überhaupt sinnvoll ist und mit welcher Wahrscheinlichkeit ein Erfolg erzielt werden kann: THERANOSTIKPrinzip – bestrahlt wird gezielt das, was vorher im PET/CT sichtbar ist.

 

2. Wirkungsweise der Lutetium-177 PSMA Therapie

Die Radio-Liganden-Therapie (RLT) dient zur nuklearmedizinischen Behandlung von PSMA-positiven, meist hormonresistenten Metastasen bzw. Tumorrezidiven, die auf andere Behandlungsmethoden (Hormontherapie, perkutane Strahlentherapie oder Chemotherapie) nicht mehr ansprechen. Hierzu wird ein mit dem Betastrahler Lu-177 markiertes Molekül (Ligand, PSMA-Inhibitor) verwendet. Die Reichweite des Beta-Strahlers Lutetium-177 beträgt im Gewebe ca. 2 mm, behandelt werden können aber auch sehr große Tumore, da das Molekül in praktisch jede Tumortiefe vordringt. Gesundes Gewebe wird weitestgehend geschont.

Das mit dem Betastrahler markierte Molekül wird in eine Armvene appliziert und reichert sich sehr schnell in den vorher durch die PSMA PET/CT nachgewiesenen Metastasen bzw. Tumorrezidiven oder auch im Primärtumor an – das was vorher im PET/CT sichtbar ist, wird auch bestrahlt – im Englischen we see what we treat. Der Therapie-Effekt hängt somit von der Speicherintensität im PET/CT ab. Durch den Therapiestrahler wird die DNA der Tumorzellen zerstört, wodurch sich die Tumorbefunde zurückbilden (in ca. 70 %) oder zumindest in ihrem Wachstum gebremst werden (in ca. 15 %). In wenigen Fällen werden die Tumorzellen völlig vernichtet.

 

3. Therapieablauf

Die Dauer der stationären Aufnahme in der DKD beträgt 2 bis 3 Tage. Während Ihres stationären Aufenthaltes dürfen Sie aus Strahlenschutzgründen leider keinen Besuch empfangen und die Station nicht verlassen. Sie haben jedoch regelmäßigen Kontakt zu Ärzten, Pflegepersonal und natürlich Ihren Mitpatienten. Außerdem stehen Ihnen Telefon, Fernsehen und Internetanschluss (WLAN) zur Verfügung.

Bevor die Therapie durchgeführt wird, erfolgen notwendige Untersuchungen (Laborkontrolle einschl. PSA-Bestimmung, Ganzkörper-PSMA PET/CT, evtl. Nieren- oder Speicheldrüsenszintigraphie, Sonographie, urologische Vorstellung). Die Untersuchungsergebnisse werden vor der Behandlung ausführlich besprochen.

Am Therapietag müssen mindestens 1,5 Liter Flüssigkeit getrunken werden, um die Strahlenbelastung so gering wie möglich zu halten (beschleunigte Ausscheidung). Die Gabe der Therapiesubstanz Lutetium-177 PSMA erfolgt intravenös über eine Armvene und dauert nur wenige Minuten. Die nicht an die Metastasen/Tumoren angedockte, überschüssige Therapiesubstanz wird überwiegend renal ausscheiden. Zur Verringerung der Nierenbelastung erfolgt eine Infusionstherapie (parenterale Flüssigkeitszufuhr). Übelkeit trat nach der Therapie extrem selten auf.

Nach Injektion der Therapiesubstanz muss der Patient für 48 Stunden auf der Therapiestation verbleiben (dies ist eine gesetzliche Vorschrift, die nicht verhandelt werden kann).

Die Kontrolle der Anreicherungsintensivität in den Metastasen sowie Messungen zum Abbau der Therapiesubstanz im übrigen Körper erfolgen in der Praxis für Nuklearmedizin als szintigraphische Ganzkörperaufnahmen sowie mittels einer SPECT/CT (Tomographie/- Schichtuntersuchung) der Tumorregionen.

Die Therapie wird üblicherweise nach 8 bis 12 Wochen wiederholt. Vor einem erneuten Therapiekursus erfolgt eventuell eine PSMA-PET/CT zur Erfolgskontrolle.

 

4. Potentielle Nebenwirkungen

Die Zahl der roten Blutkörperchen (Erythrozyten), der Blutplättchen (Thrombozyten) und der weißen Blutkörperchen (Leukozyten) kann abnehmen. Deshalb muss das Blutbild nach der Therapie in bestimmten Zeitabständen kontrolliert werden. Auch nach mehrmaliger Therapie wurde gibt es in der Regel keine Einschränkung der Nierenfunktion, die renale Funktion wird überwacht. Aufgrund einer Anreicherung in den Tränen- und Speicheldrüsen kann es zu einer radiogenen Sialadenitis (Mundtrockenheit) kommen (dies wurde bisher nur selten beobachtet). Es können (theoretisch) allergische Reaktionen unter der Verabreichung auftreten (bisher nie). Langzeitnebenwirkungen oder schädliche Langzeiteffekte sind bisher nicht aufgetreten/bekannt.

 

5. Die Therapie kann nicht angewendet werden bei folgenden Erkrankungen:

– Akute Infektionen mit Fieber
– Hochgradige Knochenmarkinsuffizienz
– Hochgradige Niereninsuffizienz
– Herzinfarkt innerhalb der letzten 6 Wochen
– Rasch progrediente Zweitmalignome

 

Kontakt: Prof. Dr. med. Richard P. Baum, CURANOSTICUM Wiesbaden-Frankfurt
E-Mail: baum@curanosticum.de

 

 

Publikationen (Auswahl)

Baum RP, Kulkarni HR, Volkmer B, Bohuslavizki KH, Schuchardt C, Klette I, Singh A, Wester HJ
Theranostik des metastasierten Prostatakarzinoms mittels Lu-177 PSMA-Liganden in Kombination mit Ga-68 PSMA PET/CT
Nuklearmediziner 2015; 38:145-152

 Baum RP, Kulkarni HR, Schuchardt C, Singh A, Wirtz M, Wiessalla S, Schottelius M, Mueller D,Klette I, Wester HJ
177Lu-Labeled Prostate-Specific Membrane Antigen Radioligand Therapy of Metastatic Castration-Resistant Prostate Cancer: Safety and Efficacy
J Nucl Med. 2016l;57:1006-13

Kulkarni HR, Singh A, Schuchardt C, Niepsch K, Sayeg M, Leshch Y, Wester HJ, Baum RP
PSMA-Based Radioligand Therapy for Metastatic Castration-Resistant Prostate Cancer: The Bad Berka Experience Since 2013
J Nucl Med. 2016;57(Suppl 3):97S-104S

Kulkarni HR, Singh A, Langbein T, Schuchardt C, Mueller D, Zhang J, Lehmann C, Baum RP
Theranostics of prostate cancer: from molecular imaging to precision molecular radiotherapy targeting the prostate specific membrane antigen
Br J Radiol. 2018; 91(1091):20180308

Rahbar K, Ahmadzadehfar H, Kratochwil C, Haberkorn U, Schäfers M, Essler M, Baum RP, Kulkarni HR, Schmidt M, Drzezga A, Bartenstein P, Pfestroff A, Luster M, Lützen U, Marx M, Prasad V, Brenner W, Heinzel A, Mottaghy FM, Ruf J, Meyer PT, Heuschkel M, Eveslage M, Bögemann M, Fendler WP, Krause BJ
German Multicenter Study Investigating 177Lu-PSMA-617 Radioligand Therapy in Advanced Prostate Cancer Patients
J Nucl Med. 2017;58:85-90

Fendler WP, Kratochwil C, Ahmadzadehfar H, Rahbar K, Baum RP, Schmidt M, Pfestroff A, Lützen U, Prasad V, Heinzel A, Heuschkel M, Ruf J, Bartenstein P, Krause BJ
Therapie mit 177Lu-PSMA-617, Dosimetrie und Nachsorge beim metastasierten kastrationsresistenten Prostatakarzinom
Nuklearmedizin. 2016 Jun 28;55:123-8

Thyroid diagnostics and therapy

The thyroid gland is a butterfly-shaped organ that is in the front neck region. It produces the vital thyroid hormones. The most frequent thyroid disease in Germany is the “goitre”, an enlargement and / or nodulous change of the thyroid gland. This is usually caused by iodine deficiency. Besides, there are often immune diseases of the thyroid gland and less frequent thyroid cancer. If the level of the thyroid hormones is too high or low it might cause functional disorders in different organs. An overactive thyroid (hyperthyroidism) can manifest itself in nervousness, sleep disturbances, sweating, heart palpitations or weight loss. An underactive thyroid (Hypothyroidism) may be e.g. being cold or fatigue.

The size of the thyroid gland as well as different disorders of the thyroid gland can be detected with thyroid gland ultrasound. The disorders include thyroid nodules as well as inflammation or enlargement of the thyroid gland. An ultrasound may also be necessary for therapy monitoring and for tumour search. As a special method, we offer the ultrasound elastography of nodes, which can be used to examine how hard or soft a node is. This can help in assessing the benignancy or malignancy of a node.

Figure: Thyroid scintigraphy displays the butterfly shape of the thyroid gland

Figure: Thyroid scintigraphy displays the butterfly shape of the thyroid gland

Thyroid scintigraphy is a nuclear medical examination in which the function of thyroid nodules and the entire thyroid gland can be visualized. For this purpose, a small amount of a low-radioactive substance is administered to you. This substance will accumulate in the thyroid gland and emit rays. The rays can then be measured as an image (scintigram) with a gamma camera.

The examination makes it possible to assess the nodular changes of the thyroid gland and to determine whether normal, cold or hot nodes are present. “Hot” nodes work too much and can cause hyperthyroidism. “Cold” nodes work too little and can be malignant. Scintigraphy of the thyroid gland becomes necessary if nodular structures are detected in the thyroid gland or if we need additional information about thyroid’s function.

 

Examination procedure

To determine if your thyroid gland is infected, we first ask you about your complaints and your medication. We then examine you physically. In most cases, blood samples are taken, e.g. thyroid hormones and antibodies. The laboratory values indicate whether there is an over or under function of the thyroid gland. They can also indicate the cause of the functional disorder.

Thyroid ultrasound

The examination takes place in lying position. If it shows abnormalities, scintigraphy may be necessary to clarify the findings.

Scintigraphy of the thyroid

First, a small amount of a low-radiation marker substance will be injected. This substance will accumulate in the thyroid cells short time after the injection.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

About fifteen minutes later images of the thyroid are recorded with a gamma camera. The recording takes about five to ten minutes.

 

Fig. 1: thyroid scintigraphy shows an over activity of the hot node in the thyroid gland (left), the healthy tissue is suppressed

Fig. 1: thyroid scintigraphy shows an over activity of the “hot” node in the thyroid gland (left), the healthy tissue is suppressed

Figure 2: the healthy tissue is active after a radioiodine therapy, the hot node is no longer active

Figure 2: the healthy tissue is active after a radioiodine therapy, the “hot” node is no longer active

 

Puncture of the thyroid gland

If a cold node – which might be malignant – is found it is often useful to take a tissue sample / biopsy. Cells are taken with a very fine needle (similar as when taking blood) and are examined microscopically.

 

Preparation before and after the examination

You may have your meals before the examination.

Please do not take your thyroid gland medication on the day of the examination.

Please inform us if you had had any tests or treatments using iodinated contrast material (for example X-ray/CT) or medication with high iodine load such as cordarex, as this might affect the accuracy of the scintigraphy.

We will send the examination results to your treating physician as soon as possible. He will then contact you to discuss the results as well as the possibility of a treatment.

Please do not hesitate to contact us if you have any further questions!

Myocardial scintigraphy
Figure: the blood flow of the heart is presented in different levels - above you can see the images under physical strain and below the stress and the rest images

Figure: the blood flow of the heart is presented in different levels – above you can see the images under physical strain and below the stress and the rest images

Myocardial scintigraphy is a nuclear medical examination of the heart muscle. It allows to detect blood flow disturbances of the heart at an early stage.

The coronary vascular disease is the most common cause of such circulatory disorders. Plaques can narrow the coronary arteries and trigger a heart attack.

The myocardial scintigraphy is performed by applying a small amount of a low-radioactive marker substance. Depending on the blood flow, it accumulates in the heart muscle and emits radiation. The radiation can be measured as image (scintigram) with a gamma camera. The measurement is done under physical strain and at rest.

 

Examination procedure

Stress phase

First, you will be physically strained either on a bicycle ergometer or through medication.

Then, a small amount of a low-radiation marker substance will be injected. This substance will accumulate depending on the blood flow of the heart muscle. The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.
.
After the injection, you should have a rich breakfast and drink the sparkling water we provide. This is necessary to empty the gallbladder. With an empty gallbladder, the image quality will be decisively improved.

After a short time of waiting (about twenty to thirty minutes), we will make so-called scintigrams, which means that a gamma camera will take pictures from the heart. This will only take a few minutes.

Rest phase

This time the examination is carried out without any previous physical exertion (for some patients this part of the examination is no longer necessary).

The two examinations usually take place the same day.

 

Preparation before and after the examination

Please do not take any heart or blood pressure medication or caffeine-carrying medication on the day of the examination and the evening before.

Caution: Some medication must be discontinued some time before the examination, but only after consultation with your doctor or cardiologist. These are especially some beta-blockers and nitro-glycerine. Please do not discontinue this medication without your doctor’s permission. If the examination at rest is carried out on another day, you can take your medication on this day as usual.

Please have only a small breakfast (half a roll, no banana, no chocolate).

Please DO NOT drink the following beverages in the morning: coffee, black or green tea, cola, cocoa (you should also not drink these beverages the day before).

Please bring a high-fat meal (e.g., rolls with cheese or cold cuts); After the injection, you can also have breakfast in the cafeteria of the DKD Helios Clinic.

Please wear comfortable clothes and shoes for cycling.

Please bring a towel with you.

We will send the examination results to your treating physician as soon as possible. He will then contact you to discuss the results as well as the possibility of a treatment.

Please do not hesitate to contact us if you have any further questions!

 
Download “Patient Information Myocardial Scintigraphy” (PDF)

Bone scintigraphy
Figure: Skeletal scintigraphy without pathological findings

Figure: Skeletal scintigraphy without pathological findings

The skeletal or bone scintigraphy is a nuclear medical examination which can be used to detect pathological changes in the skeleton. For this purpose, a small amount of a low-radiation marker substance is administered. The substance accumulates in the bone structure and emits radiation. The radiation can be recorded as picture (scintigram) with a gamma camera.

It is possible to detect abnormal changes of the skeleton such as inflammation, bone fractures, signs of wear, bone tumours or bone metastases of a tumour at a very early stage due to this examination. It also detects loosening of joint prostheses.

 

Examination procedure

First, a small amount of a low-radiation marker substance will be injected. This substance will accumulate in areas where the metabolic level of the bones is elevated.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

After that, first images of the skeleton are taken with a gamma camera for about twenty minutes.

Images of the skeleton will be taken once again about two to three hours later, as the metabolism of the bones is relatively slow.

The examination lasts approximately three to four hours, including waiting time. You do not have to stay at the practice while waiting. You may go home, to work or go at the cafeteria.

 

Preparation before and after the examination

You may have meals in advance to the examination, as well as take your medication as usual.

After the injection of the low-radiation marker substance, please drink at least half a litre of water.

Please empty your bladder shorty before the pictures are taken. Patients with urine bags should replace the bag with a new one.

We will send the examination results to your treating physician as soon as possible. He will then contact you to discuss the results as well as the possibility of a treatment.

Please do not hesitate to contact us if you have any further questions!

 
Download “Patient Information Bone Scintigraphy” (PDF)

Pulmonary scintigraphy

A pulmonary scintigraphy is a nuclear medical examination with which the blood circulation and ventilation conditions of the lung can be detected. Thereto, a small amount of a low-radiation marker substance is administered. It accumulates in the lung and emits radiation. The radiation is recorded as a picture (scintigram) with a gamma camera.

Pulmonary embolism is one of the most frequent reasons for pulmonary scintigraphy. With this examination, even the smallest pulmonary embolism can be detected. If blood clots occlude pulmonary vessels, life-threatening embolisms occur.

Pulmonary scintigraphy may also be necessary prior to planned pulmonary operations (e.g., lung cancer) to estimate the postoperative remaining pulmonary function. This examination can also be used to calculate pathological changes in blood circulation, diseases of the cardio-pulmonary circulation or in congenital pulmonary malformations.

Figure: front view (RVL) and back view (LDR) from the lung - a pulmonary embolism is not existent and the blood supply is normal

Figure: front view (RVL) and back view (LDR) from the lung – a pulmonary embolism is not existent and the blood supply is normal

 

Examination procedure

First, a small amount of a weakly radioactive substance is injected and shortly after it accumulates in the lungs.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

Then images are recorded from the lung for approximately thirty minutes with a gamma camera.

The examination takes approximately one to two hours.

 

Preparation before and after the examination

A special preparation is not necessary. You do not need to be sober and can take your medication as usual.

We will send the examination results to your treating physician as soon as possible. The doctor will then contact you to discuss the results and any possible therapy.

If you have further questions, do not hesitate to contact us!

Kidney scintigraphy
Figure: the renal scintigram shows a normal finding.

Figure: the renal scintigram shows a normal finding.

Renal scintigraphy is a nuclear medical examination, which can be used to detect pathological changes in the kidneys. Thereto we will inject you a small amount of a low-radiation marker substance, which accumulates in the kidneys and emits radiation. According to the functional condition of the kidneys, the substance is excreted into the bladder via the ureters. This process is continuously tracked by a gamma camera in images (scintigrams).

The examination permits to draw conclusions about the blood flow, the function and urine flow of both kidneys and might be necessary in case of unexplained hypertension, in cases of urinary stasis (e.g., kidney stone), in congenital obstructive urinary flow disorders, in cases of tumours, impaired renal function, and after kidney transplantation.

 

Examination procedure

First, a small amount of a low-radiation marker substance is injected. After a while it accumulates in the kidneys.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

A gamma camera records pictures of the kidney, which takes about thirty to forty-five minutes. During the examination, your blood will be collected and maybe you will get injected a diuretic.

The examination takes about an hour.

 

Preparation before and after the examination

Prior to the examination, please drink at least a half to one litre water.

You may have some meals before the examination.

If it is necessary to clarify a hypertension, you might need to discontinue some medication. If this is the case, we will discuss it with you or the referring physician.

We will send the examination results to your treating physician as soon as possible. He will then contact you to discuss the results as well as the possibility of a treatment.

Please do not hesitate to contact us if you any further questions!

Brain scintigraphy

The scintigraphy of the dopamine transport density (DaTSCAN) is a nuclear medical examination in which the functionality of certain structures in the brain, so-called dopamine transporter, is examined. A low-radiation marker substance is administered and its distribution in the brain can then be tracked with a gamma camera and displayed as an image (scintigram).

The aim of the examination is to clarify an existing movement disorder. With DaTSCAN it is possible to visualize diseases such as Parkinson’s disease or Parkinson’s syndrome at a very early stage. They can be distinguished from harmless forms of “trembling” (Essential Tremor). The Essential Tremor is one of the most frequent movement disorders, which increases with age. Parkinsonian syndromes, on the other hand, are characterized by the fact that nerve cells are destroyed or altered in a certain area of the brain. These pathological modified cells can be detected with the DaTSCAN because the radiotracer accumulates there in a reduced form.

Figure left: normal findings.

Figure left: normal findings.

Figure right: There is a reduced dopamine transporter density in the putamen which reveals the existence of Parkinson’s disease.

Figure right: There is a reduced dopamine transporter density in the putamen which reveals the existence of Parkinson’s disease.

 

Examination procedure

First, you will get some drops of the drug Irenat® to protect the thyroid gland. Then a small amount of a low-radiation marker substance is injected, which accumulates in central brain regions (the striatum) within three to four hours.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

After about three to four hours, we will take pictures of the brain with a gamma camera. You will lie on a stretcher as the camera rotates slowly around your head. These recordings will take approximately thirty minutes.

The entire examination will take about five to six hours. For the waiting period of three to four hours you do not have to stay at the practice. You may go home or go to work or to the DKD cafeteria.

 

Preparation before and after the examination

You may eat in advance to the examination.

You can take your medication as usual. However, we kindly ask you to bring a list of your medications with you.

Please drink a lot between injection of the substance and the images.

If a MRI has already been performed, please provide the images and the results beforehand.

The radiotracer is individually ordered for each patient and is not storable (the costs run several hundred euros). Hence we kindly ask you to always keep your appointment on time and if for any reason you need to reschedule or cancel your appointment please do this at least two days in advance.

We will send the examination results to your treating physician as soon as possible. He will then contact you to discuss the results as well as the possibility of a treatment.

Please do not hesitate to contact us if you have any further questions!

Parathyroid scintigraphy

The parathyroid scintigraphy is a nuclear medical examination with which possible malfunctions of the parathyroid gland (the so-called epithelium, which produce an important hormone for bone metabolism and calcium level) can be detected at a very early stage.

You will get a small amount of a low-radiation marker substance, which accumulates in the pathologically altered parathyroid gland and emits radiation. With a special gamma camera, the radiation can be visualized as image (scintigram).

With the examination, e.g. parathyroid gland nodes (adenomas) or hyperplasia can be detected and localized at a very early stage. This can facilitate the planning of surgical procedures. Adenoma is a benign neoplasm of glandular tissue. Hyperplasia is an increase of the glandular tissue, and consequently, an increased production of the Parathyroid hormone.

 

Examination procedure

First, a low-radiation marker substances radioactive substance is injected, which will accumulate after a while in the parathyroid glands.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

After about half an hour we will take images with a gamma camera and repeat this procedure after one and after two hours.

The examination will take a total of about three hours and you may leave the practice during the waiting period.

 

Preparation before and after the examination

No special preparation is required and you can eat something in advance to the examination and can take your medication as usual.

We will send the examination results to your treating physician as soon as possible. He will then contact you to discuss the results as well as the possibility of a treatment.

Please do not hesitate to contact us if you have any further questions!

Sentinel lymph node scintigraphy

A scintigraphy of the sentinel lymph node (Sentinel Lymph Node) is a nuclear medical examination, which is used to detect the lymph node, which will be reached first by the lymphatic fluid of a malignant tumour. Hereto, a small amount of a low-radiation marker substance is administered and it accumulates in the lymphatic system on the way to the sentinel lymph node and emits radiation, which is subsequently recorded with a gamma camera as an image (scintigram). This allows to locate the sentinel lymph node.

Thousands of lymph nodes are connected by the lymphatic system. They form part of the body’s immune system. The lymph nodes are constructed like a filter which clears particles from the lymphatic fluid. Tumour cells can disseminate from a malignant tumour and be transported in the lymphatic system. The first lymph node reached by these cells stops them, enabling them to develop to a lymph node metastasis. This first lymph node is called the sentinel lymph node or “sentinel”. If this lymph node contains tumour cells it is very probable to find further metastases in the surrounding. However, if the sentinel lymph node is free from tumours, it is unlikely to find further metastases.

The scintigraphy of the sentinel node is especially used in breast cancer (breast carcinoma) and malignant melanoma. Prior to a tumour surgery, the sentinel lymph node is made visible and marked for removal. If it turns out that the sentinel lymph node contains no tumour cells, it can be assumed that all other lymph nodes are healthy/ free from tumour cells. By the targeted removal of the sentinel lymph node, most patients are spared from the removal of unaffected / healthy lymph nodes.

 

Examination procedure

The examination is usually done on the day of the surgery. First, a small amount of a low-radiation marker substance is injected into the area of the tumour. The substance is tracked her way through the lymphatic system to the sentinel lymph node by a gamma camera. This procedure takes a few minutes. The first lymph node reached by the substance (“the sentinel”) is marked on the patient’s skin.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

A few hours later, the tumour and sentinel lymph nodes are removed surgically.

 

Preparation and time

No special preparation is required and you may have had something to eat during the day. You are also allowed to take your medication as usual.

The examination takes approximately one and a half hours.

Please do not hesitate to contact us, if you have any further questions!

Scintigraphy of the salivary glands

The scintigraphy of the salivary glands is a nuclear medical examination, with which the function of the salivary glands can be evaluated. Hereto, a low-radiation marker substance is administered. The substance accumulates in the salivary glands and emits radiation. A gamma camera records the radiation as image (scintigram).

With this examination, the function and secretion dysfunction of the four large salivary glands (parotid gland and submandibular gland) can be diagnosed, as well as inflammation or salivary stones. It is also performed to diagnose an oral dryness (e.g., Sjögren’s syndrom).

 

Examination procedure

First, we inject you a small amount of a low-radiation marker substance, which accumulates in the salivary glands after a few minutes.

The substances used are very well tolerated; allergic reactions are not known. The radiation load is low and quickly degraded.

Fifteen minutes later you will get some liquid, which you should swirl around in your mouth and then swallow. During injection and after receiving the liquid a gamma camera tracks images of the salivary glands.

The recording takes about twenty-five minutes.

 

Preparation before and after the examination

You should not eat one hour prior to the examination and only drink water.

Please do not take your medication for the salivary gland on the day of the examination. Other medication can be taken.

The examination takes about an hour.

We will send the examination results to your treating physician as soon as possible. He will then contact you to discuss the results as well as the possibility of a treatment.

Please do not hesitate to contact us if you have any further questions!

Others

Apart from the already described examinations, we also provide the following examinations:

Identification of the source of bleeding

Search of Inflammatory source (see also PET-CT and bone scintigraphy)

liver scintigraphy

Gastric emptying during scintigraphy

Adrenal glands scintigraphy

esophageal scintigraphy

Somatostatin receptor scintigraphy

 

Please do not hesitate to contact us if you need any further information!