ENDOCRINOLOGY PROCEDURES

ENDOCRINOLOGY PROCEDURES

CAT endocrino01

THYROID IODINE UPTAKE AND KINETIC STUDIES

QUANTIFIED THYROID SCINTIGRAPHY

THYROID UPTAKE

DESCRIPTION

  • Evaluation of iodine effective mean time in the thyroid gland.
  • Determination of thyroid uptake both total and in 6 regions of interest.

PREPARATION

  • The patient must not be in a situation of iodic saturation, either because of intravenous or intrathecal scans with iodized contrast (pyelography, CAT scan with contrast, myelography and some angiographies) at least 3 weeks before the procedure or because of treatment with Amiodarone at least 6 months before it.
  • If possible, the patient should not be having antithyroid medication (propylthiouracil (PTU) and tapazole) for at least 3 days before the procedure.
  • Other isotopic explorations must be avoided during the procedure.

INDICATIONS

Dosimetric calculation of I-131 dose for hyperthyroidism.

DURATION OF
PROCEDURE

1 hour.

THYROID IODINE UPTAKE AND KINETIC STUDIES

QUANTIFIED THYROID SCINTIGRAPHY

THYROID UPTAKE

DESCRIPTION

  • Evaluation of iodine effective mean time in the thyroid gland.
  • Determination of thyroid uptake both total and in 6 regions of interest.

PREPARATION

  • The patient must not be in a situation of iodic saturation, either because of intravenous or intrathecal scans with iodized contrast (pyelography, CAT scan with contrast, myelography and some angiographies) at least 3 weeks before the procedure or because of treatment with Amiodarone at least 6 months before it.
  • If possible, the patient should not be having antithyroid medication (propylthiouracil (PTU) and tapazole) for at least 3 days before the procedure.
  • Other isotopic explorations must be avoided during the procedure.

INDICATIONS

Dosimetric calculation of I-131 dose for hyperthyroidism.

DURATION OF PROCEDURE

1 hour.

CAT endocrino02

PARATHYROID SCINTIGRAPHY

PARATHYROID TOMOSCINTIGRAPHY (SPET/SPET-CT)

DESCRIPTION

Localization of the parathyroid glands.

PREPARATION

  • No preparation is required.
  • It is recommended that the patient has not received studies with iodine contrasts at least 3 weeks before the procedure.
  • While the images are performed, the patient should not move his/her neck and must nor swallow saliva, and if necessary, should be immobilized with sandbags.

INDICATIONS

  • Detection and localization of adenomas and hyperplasias of parathyroid glands.
  • Evaluation of the status of parathyroid glands within hypercalcemia and hyperparathyroid disorders.
  • Detection of ectopic parathyroid glands.

DURATION OF
PROCEDURE

3 hours.

PARATHYROID SCINTIGRAPHY

PARATHYROID TOMOSCINTIGRAPHY (SPET/SPET-CT)

DESCRIPTION

Localization of the parathyroid glands.

PREPARATION

  • No preparation is required.
  • It is recommended that the patient has not received studies with iodine contrasts at least 3 weeks before the procedure.
  • While the images are performed, the patient should not move his/her neck and must nor swallow saliva, and if necessary, should be immobilized with sandbags.

INDICATIONS

  • Detection and localization of adenomas and hyperplasias of parathyroid glands.
  • Evaluation of the status of parathyroid glands within hypercalcemia and hyperparathyroid disorders.
  • Detection of ectopic parathyroid glands.

DURATION OF PROCEDURE

3 hours.

CAT endocrino03

SCINTIGRAPHY OF SUPRARENAL CORTEX (WITH OR WITHOUT STOPPING)

DESCRIPTION

Functional evaluation of the suprarenal glands’ cortex (nor-cholesterol follows the metabolic pathway of adrenal steroids).

PREPARATION

  • As a prevention, the thyroid gland must be blocked with 20 drops/3 times per day of potassium iodide, starting  5 days before the administration of the dose and extending until 3 days after the procedure is finished.
  • Some medications can produce pharmacological interaction with nor-cholesterol and it is advisable to remove them during the procedure:
  • Tricyclic Antidepressants (Amitriptyline, Imipramine).
  • Sympathomimetics (Phenylephrine, Phenylpropanolamine, Pseudoefrin, Ephedrine).
  • Antihypertensives/cardiovascular drugs (Labetalol, Reserpine, Ca-channel blockers).
  • In case of hyperaldosteronism, the gland must be stopped with 4 mg/day of dexamethasone (fortecortin 1 1 mg-comprimit/6 hours) from 7 days before the administration of nor-cholesterol, and until the end of the imaging session. Withdrawal should be progressive (progressive dose reduction in 5 days). Contraindications of stopping are those of corticoids: bleeding, alterations of the coagulation, gastroduodenal ulcers, glaucoma.
  • The acquisition of images is performed on the 2nd and 4th day (always before the 5th day).

INDICATIONS

Diagnosis of the adrenal cortex pathology:

  • Localization of adenoma/adrenal hyperplasia.
  • Diagnosis of Cushing Syndrome of adrenal origin.
  • Conn: differential diagnosis between adenoma and adrenal hyperplasia.
  • Study of adrenal masses seen with other imaging techniques (TAC, NMR, ECO): incidentalomas.

DURATION OF
PROCEDURE

7 days.

SCINTIGRAPHY OF SUPRARENAL CORTEX (WITH OR WITHOUT STOPPING)

DESCRIPTION

Functional evaluation of the suprarenal glands’ cortex (nor-cholesterol follows the metabolic pathway of adrenal steroids).

PREPARATION

  • As a prevention, the thyroid gland must be blocked with 20 drops/3 times per day of potassium iodide, starting  5 days before the administration of the dose and extending until 3 days after the procedure is finished.
  • Some medications can produce pharmacological interaction with nor-cholesterol and it is advisable to remove them during the procedure:
  • Tricyclic Antidepressants (Amitriptyline, Imipramine).
  • Sympathomimetics (Phenylephrine, Phenylpropanolamine, Pseudoefrin, Ephedrine).
  • Antihypertensives/cardiovascular drugs (Labetalol, Reserpine, Ca-channel blockers).
  • In case of hyperaldosteronism, the gland must be stopped with 4 mg/day of dexamethasone (fortecortin 1 1 mg-comprimit/6 hours) from 7 days before the administration of nor-cholesterol, and until the end of the imaging session. Withdrawal should be progressive (progressive dose reduction in 5 days). Contraindications of stopping are those of corticoids: bleeding, alterations of the coagulation, gastroduodenal ulcers, glaucoma.
  • The acquisition of images is performed on the 2nd and 4th day (always before the 5th day).

INDICATIONS

Diagnosis of the adrenal cortex pathology:

  • Localization of adenoma/adrenal hyperplasia.
  • Diagnosis of Cushing Syndrome of adrenal origin.
  • Conn: differential diagnosis between adenoma and adrenal hyperplasia.
  • Study of adrenal masses seen with other imaging techniques (TAC, NMR, ECO): incidentalomas.

DURATION OF PROCEDURE

7 days.

CAT endocrino04

THYROID SCINTIGRAPHY

DESCRIPTION

Evaluation of the morphology and functionality of the thyroid gland.

PREPARATION

  • No fasting is required.
  • A brief and specific recollection of information that includes thyroid palpation should be performed.
  • Thyroid substitute medications should be removed in patients taking thyroid replacement therapy (children diagnosed with neonatal hypothyroidism, others), and in order to visualize the thyroid gland:

    • Thyroxin (T4) for at least 7 days before the scan
    • Triiodothyronine (T3) for at least 3 days before the scan.
  • The patient must not be in a situation of iodic saturation, either because of intravenous or intrathecal scans with iodized contrast (pyelography, CAT scan with contrast, myelography and some angiographies) at least 3 weeks before the procedure or because of treatment with Amiodarone at least 6 months before it.

INDICATIONS

  • Morphological evaluation of the thyroid gland.
  • Thyroid location and evaluation of thyroid ectopies.
  • Study of goiter, endothoracic goiter and thyroid nodules.
  • Diagnosis of subacute thyroiditis.
  • Evaluation of thyroid post-surgical remnants.

DURATION OF
PROCEDURE

30 minutes.

THYROID SCINTIGRAPHY

DESCRIPTION

Evaluation of the morphology and functionality of the thyroid gland.

PREPARATION

  • No fasting is required.
  • A brief and specific recollection of information that includes thyroid palpation should be performed.
  • Thyroid substitute medications should be removed in patients taking thyroid replacement therapy (children diagnosed with neonatal hypothyroidism, others), and in order to visualize the thyroid gland:

    • Thyroxin (T4) for at least 7 days before the scan
    • Triiodothyronine (T3) for at least 3 days before the scan.
  • The patient must not be in a situation of iodic saturation, either because of intravenous or intrathecal scans with iodized contrast (pyelography, CAT scan with contrast, myelography and some angiographies) at least 3 weeks before the procedure or because of treatment with Amiodarone at least 6 months before it.

INDICATIONS

  • Morphological evaluation of the thyroid gland.
  • Thyroid location and evaluation of thyroid ectopies.
  • Study of goiter, endothoracic goiter and thyroid nodules.
  • Diagnosis of subacute thyroiditis.
  • Evaluation of thyroid post-surgical remnants.

DURATION OF PROCEDURE

30 minutes.

CAT onco04

THYROID METASTASES DETECTION SCAN

123I SCINTIGRAPHIC SCAN (WITH OR WITHOUT rhTSH)

131I SCINTIGRAPHIC SCAN (WITH OR WITHOUT rhTSH)

123I TOMOSCINTIGRAPHY (SPET/SPET-CT)

DESCRIPTION

Evaluation of the metabolic activity of thyroid tissue remnants of differentiated thyroid neoplasms.

PREPARATION

  • The patient must suspend his/her hormonal treatment:

    • Thyroxin (T4) for at least 21 days.
    • Triyodothyronine (T3) for at least 10 days.

If hormonal suppression is not advised, TSH can be stimulated with two intramuscular injections in two consecutive days of rhTSH (Thyrogen).

  • The patient must not be in iodic saturation, either because of  intravenous or intrathecal scans with iodized contrast (skinography, TAC with contrast, myelography and some angiographies) at least 3 weeks before the procedure, or because of  treatment with amniodarone at least 6 months before the procedure.

INDICATIONS

  • Evaluation functioning thyroid tissue remnants after a thyroidectomy.
  • Study of the spread of differentiated thyroid carcinoma.
  • Detection of recurrences of differentiated thyroid carcinoma.

DURATION OF
PROCEDURE

3 days.

THYROID METASTASES DETECTION SCAN

123I SCINTIGRAPHIC SCAN
(WITH OR WITHOUT rhTSH)

131I SCINTIGRAPHIC SCAN
(WITH OR WITHOUT rhTSH)

123I TOMOSCINTIGRAPHY (SPET/SPET-CT)

DESCRIPTION

Evaluation of the metabolic activity of thyroid tissue remnants of differentiated thyroid neoplasms.

PREPARATION

  • The patient must suspend his/her hormonal treatment:

    • Thyroxin (T4) for at least 21 days.
    • Triyodothyronine (T3) for at least 10 days.

If hormonal suppression is not advised, TSH can be stimulated with two intramuscular injections in two consecutive days of rhTSH (Thyrogen).

  • The patient must not be in iodic saturation, either because of  intravenous or intrathecal scans with iodized contrast (skinography, TAC with contrast, myelography and some angiographies) at least 3 weeks before the procedure, or because of  treatment with amniodarone at least 6 months before the procedure.

INDICATIONS

  • Evaluation functioning thyroid tissue remnants after a thyroidectomy.
  • Study of the spread of differentiated thyroid carcinoma.
  • Detection of recurrences of differentiated thyroid carcinoma.

DURATION OF PROCEDURE

3 days.

CAT onco05

SOMATOSTATIN RECEPTORS SCINTIGRAPHY

111In OR 99mTc-OCTREOTIDE SCINTIGRAPHY-SPECT-CT

SOMATOSTATIN RECEPTORS SCINTIGRAPHIC SCAN

SOMATOSTATIN RECEPTORS TOMOGRAPHY-SPECT-CT

DESCRIPTION

Evaluation of somatostatin receptor activity in tumors.

PREPARATION

  • No scans with barium or iodine contrast should be performed during the procedure.
  • For the study of abdominal tumors, it is advisable to use laxatives, and even the use of enemas.

INDICATIONS

  • Evaluation of tumors that express somatostatin receptors (extension study, follow-up, control of therapeutic response and recurrence detection) in neuroendocrine tumors, such as carcinoid, enteropancreatic tumors and tumors derived from the neural crest (medullary of thyroid, neuroblastomas, paragangliomas and pheochromocytomas).
  • Evaluation of other types of neoplasms that may have expression of somatostatin receptors, such as breast cancer, lung cancer, lymphomas and thyroid cancer.

DURATION OF
PROCEDURE

 1 to 2 days.

SOMATOSTATIN RECEPTORS SCINTIGRAPHY

111In OR 99mTc-OCTREOTIDE SCINTIGRAPHY-SPECT-CT

SOMATOSTATIN RECEPTORS SCINTIGRAPHIC SCAN

SOMATOSTATIN RECEPTORS TOMOGRAPHY-SPECT-CT

DESCRIPTION

Evaluation of somatostatin receptor activity in tumors.

PREPARATION

  • No scans with barium or iodine contrast should be performed during the procedure.
  • For the study of abdominal tumors, it is advisable to use laxatives, and even the use of enemas.

INDICATIONS

  • Evaluation of tumors that express somatostatin receptors (extension study, follow-up, control of therapeutic response and recurrence detection) in neuroendocrine tumors, such as carcinoid, enteropancreatic tumors and tumors derived from the neural crest (medullary of thyroid, neuroblastomas, paragangliomas and pheochromocytomas).
  • Evaluation of other types of neoplasms that may have expression of somatostatin receptors, such as breast cancer, lung cancer, lymphomas and thyroid cancer.

DURATION OF PROCEDURE

2 days.

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Josep Irla & Bosch Street, 5-7, Basement, Barcelona 08034, Catalonia, Spain
(+34) 93 204 6439, (+34) 93 205 7708 Fax (+34) 93 204 8641 info@simm.barcelona

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Logo-SIMM-Largo

Josep Irla & Bosch Street, 5-7, Basement, Barcelona 08034, Catalonia, Spain
Phones (+34) 93 204 6439 & (+34) 93 205 7708 Fax (+34) 93 204 8641
E-mail info@simm.barcelona

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