Clinical Review Fortnightly review

The role of nuclear medicine in clinical investigation

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7138.1140 (Published 11 April 1998) Cite this as: BMJ 1998;316:1140
  1. E M Prvulovich (l.prvulovich@nucmed.ucl.ac.uk), consultant, nuclear medicine,
  2. J B Bomanji, consultant, nuclear medicine
  1. Institute of Nuclear Medicine, University College London Medical School, London W1N 8AA
  1. Correspondence to: Dr Prvulovich
  • Accepted 20 November 1997

Nuclear medicine uses radioactive isotopes for the diagnosis and treatment of patients. Whereas radiology provides data mostly on structure, nuclear medicine provides complementary information about function. Limited undergraduate teaching, together with regional differences in the provision of nuclear medicine services, means that many clinicians know little about how radionuclide techniques can help in the management of patients. Consequently, patients who would benefit from such a procedure are not referred. This review highlights how nuclear medicine techniques can be used in the investigation of patients presenting with such common conditions as ischaemic chest pain, malignancy, and suspected pulmonary embolism. Many promising new tracers are being developed, particularly for the investigation of patients with malignancy and suspected infection, and readers will be directed elsewhere for information.

Fig 1

201Tl myocardial perfusion images in a patient with exertional chest pain. Reversible ischaemia of the anterior, inferior, and lateral walls suggests a high probability of future cardiac events

Summary points

  • Myocardial perfusion imaging has strong prognostic value

  • Lung scintigraphy is a simple non-invasive method for detecting pulmonary embolism

  • Bone scans are useful in assessing benign and malignant bone lesions

  • Radioisotope renal imaging is useful for detecting renal outflow obstruction, cortical scarring, and renovascular dysfunction

  • Imaging with radiolabelled white cells can detect occult infection and monitor inflammatory bowel disease

  • Thyroid scintigraphy is most commonly used to assess the nature of a thyroid nodule

  • Nuclear medicine techniques in oncology can localise primary tumours, delineate extent of disease, and monitor response to treatment

  • Radionuclide treatment is used in hyperthyroidism, thyroid cancer, palliation of bone pain, and neural crest tumours

Methods

The published articles reviewed here were chosen primarily for the clarity and simplicity with which they describe the role of nuclear medicine techniques in specific fields. Six short texts commissioned by the British Nuclear Medicine Society provide detailed reviews of the …

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