EDUCATION EXHIBIT - Continuing Medical Education

Pharmacologic Interventions in Nuclear Radiology: Indications, Imaging Protocols, and Clinical Results

Published Online:May 1 2002https://doi.org/10.1148/radiographics.22.3.g02ma20477

Abstract

Nuclear radiology is valuable in assessing pathophysiology of a variety of organ systems. Pharmacologic interventions are often employed in radionuclide imaging to monitor the physiologic changes, which in turn facilitate the diagnosis. Metoclopramide, erythromycin, and cisapride have been used for gastric emptying studies. To overcome false-negative results, cimetidine, pentagastrin, and glucagon have been used in imaging of Meckel diverticula. Pharmacologic intervention with either cholecystokinin-8 or morphine is used primarily for the assessment of diseases of the gallbladder, common bile duct, and sphincter of Oddi. Pharmacologic interventions performed during renography include diuretic administration, angiotensin-converting enzyme inhibition, and aspirin renography. Recombinant thyrotropin can be used in patients with previously treated thyroid carcinoma who require lifelong follow-up for recurrent disease. Cardiac pharmacologic stress agents fall into two categories: coronary vasodilating agents, such as dipyridamole and adenosine, and cardiac positive inotropic agents, such as dobutamine and arbutamine. Measurement of hemodynamic responses to pharmacologic flow augmentation with carbon dioxide or acetazolamide is valuable in cerebrovascular perfusion studies.

References

1 Fine EJ. Interventions in renal scintirenography. Semin Nucl Med 1999; 2:128-145.
Google Scholar
2 Datz FL, Christian PE, Hutson WR, et al. Physiological and pharmacological interventions in radionuclide imaging of the tubular gastrointestinal tract. Semin Nucl Med 1991; 21:140-152.
Medline Google Scholar
3 Urbain JL, Vekemans MC, Parkman H, et al. Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia. J Nucl Med 1995; 36:1579-1586.
Medline Google Scholar
4 Watkins PJ. Diabetic autonomic neuropathy. N Engl J Med 1990; 322:1078-1079.
Medline Google Scholar
5 Janssens J, Peeters TL, Vantrappen G, et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin: preliminary studies. N Engl J Med 1990; 322:1028-1031.
Medline Google Scholar
6 Urbain JL, Vantrappen G, Janssens J, et al. Intravenous erythromycin dramatically accelerates gas-tric emptying in diabeticorum and normals and abolishes the emptying discrimination between solids and liquids. J Nucl Med 1990; 31:1490-1493.
Medline Google Scholar
7 Delatour F, Le Guludec D, Caron F, et al. Effect of a single oral dose of two erythromycin ethylsuccinate formulations on gastric emptying in healthy volunteers: a scintigraphic study. Fundam Clin Pharmacol 1998; 12:292-297.
Medline Google Scholar
8 Urbain JL, Siegel JA, Debie NC, et al. Effect of cisapride on gastric emptying in dyspeptic patients. Dig Dis Sci 1988; 33:779-783.
Medline Google Scholar
9 Richards RD, Valenzuela GA, Davenport KG, et al. Objective and subjective results of a randomized, double-blind, placebo-controlled trial using cisapride to treat gastroparesis. Dig Dis Sci 1993; 38:811-816.
Medline Google Scholar
10 Connolly LP, Treves ST, Bozorgi F, O’Conner SC. Meckel’s diverticulum: demonstration of heterotopic gastric mucosa with technetium-99m-pertechnetate SPECT. J Nucl Med 1998; 39:1458-1460.
Medline Google Scholar
11 St-Vil D, Brandt ML, Panic S, Bensoussan AL, Blanchard H. Meckel’s diverticulum in children: a 20-year review. J Pediatr Surg 1991; 26:1289-1292.
Medline Google Scholar
12 Sfakianakis GN, Anderson GF, King DR, Boles ET, Jr. The effect of gastrointestinal hormones on the pertechnetate imaging of ectopic gastric mucosa in experimental Meckel’s diverticulum. J Nucl Med 1981; 22:678-683.
Medline Google Scholar
13 Yeker D, Buyukunal C, Benli M, Buyukunal E, Urgancioglu I. Radionuclide imaging of Meckel’s diverticulum: cimetidine versus pentagastrin plus glucagon. Eur J Nucl Med 1984; 9:316-319.
Medline Google Scholar
14 Diamond RH, Rothstein RD, Alavi A. The role of cimetidine-enhanced technetium-99m-pertechnetate imaging for visualizing Meckel’s diverticulum. J Nucl Med 1991; 32:1422-1424.
Medline Google Scholar
15 Heyman S. Meckel’s diverticulum: possible detection by combining pentagastrin with histamine H2 receptor blocker. J Nucl Med 1994; 35:1656- 1658.
Medline Google Scholar
16 Treves S, Grand RJ, Eraklis AJ. Pentagastrin stimulation of technetium-99m uptake by ectopic gastric mucosa in a Meckel’s diverticulum. Radiology 1978; 128:711-712.
Medline Google Scholar
17 Krishnamurthy S, Krishnamurthy GT. Cholecystokinin and morphine pharmacological intervention during 99mTc-HIDA cholescintigraphy: a rational approach. Semin Nucl Med 1996; 26:16-24.
Medline Google Scholar
18 Fink-Bennett D, Balon H, Robbins T, Tsai D. Morphine-augmented cholescintigraphy: its efficacy in detecting acute cholecystitis. J Nucl Med 1991; 32:1231-1233.
Medline Google Scholar
19 Ziessman HA. Cholecystokinin cholescintigraphy: victim of its own success? J Nucl Med 1999; 40:2038-2042.
Medline Google Scholar
20 Chen CC, Holder LE, Maunoury C, Drachenberg CI. Morphine augmentation increases gallbladder visualization in patients pretreated with cholecystokinin. J Nucl Med 1997; 38:644-647.
Medline Google Scholar
21 Kim CK. Pharmacologic intervention for the diagnosis of acute cholecystitis: cholecystokinin pretreatment or morphine, or both? J Nucl Med 1997; 38:647-649.
Medline Google Scholar
22 Achong DM, Oates E. Normal gallbladder ejection fraction after morphine augmentation. Clin Nucl Med 1999; 24:837-841.
Medline Google Scholar
23 Nadel HR. Hepatobiliary scintigraphy in children. Semin Nucl Med 1996; 26:25-42.
Medline Google Scholar
24 Fine EJ. Interventions in renal scintigraphy. Semin Nucl Med 1999; 29:128-145.
Medline Google Scholar
25 Conway JJ, Maizels M. The “well tempered” diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis—a report from combined meetings of The Society for Fetal Urology and members of The Pediatric Nuclear Medicine Council–The Society of Nuclear Medicine. J Nucl Med 1992; 33:2047-2051.
Medline Google Scholar
26 O’Reilly PH, Testa HJ, Lawson RS, et al. Diuresis renography in equivocal urinary tract obstruction. Br J Urol 1978; 50:76-80.
Medline Google Scholar
27 Taylor AT, Jr, Fletcher JW, Nally JV, Jr, et al. Procedure guideline for diagnosis of renovascular hypertension: Society of Nuclear Medicine. J Nucl Med 1998; 39:1297-1302.
Medline Google Scholar
28 Taylor A, Nally J, Aurell M, et al. Consensus report on ACE inhibitor renography for detecting renovascular hypertension: Radionuclides in Nephrourology Group. Consensus Group on ACEI Renography. J Nucl Med 1996; 37:1876-1882.
Google Scholar
29 Nally JV, Jr, Chen C, Fine E, et al. Diagnostic criteria of renovascular hypertension with captopril renography: a consensus statement. Am J Hypertens 1991; 4:749S-752S.
Medline Google Scholar
30 Nally JV, Jr, Black HR. State-of-the-art review: captopril renography—pathophysiological considerations and clinical observations. Semin Nucl Med 1992; 22:85-97.
Medline Google Scholar
31 Imanishi M, Kawamura M, Akabane S, et al. Aspirin lowers blood pressure in patients with renovascular hypertension. Hypertension 1989; 14:461-468.
Medline Google Scholar
32 van de Ven PJ, de Klerk JM, Mertens IJ, et al. Aspirin renography and captopril renography in the diagnosis of renal artery stenosis. J Nucl Med 2000; 41:1337-1342.
Medline Google Scholar
33 Ladenson PW. Recombinant thyrotropin versus thyroid hormone withdrawal in evaluating patients with thyroid carcinoma. Semin Nucl Med 2000; 30:98-106.
Medline Google Scholar
34 Ladenson PW, Braverman LE, Mazzaferri EL, et al. Comparison of administration of recombinant human thyrotropin with withdrawal of thyroid hormone for radioactive iodine scanning in patients with thyroid carcinoma. N Engl J Med 1997; 337:888-896.
Medline Google Scholar
35 Weintraub BD, Szkudlinski MW. Development and in vitro characterization of human recombinant thyrotropin. Thyroid 1999; 9:447-450.
Medline Google Scholar
36 Meier CA, Braverman LE, Ebner SA, et al. Diagnostic use of recombinant human thyrotropin in patients with thyroid carcinoma (phase I/II study). J Clin Endocrinol Metab 1994; 78:188-196.
Medline Google Scholar
37 Haugen BR, Pacini F, Reiners C, et al. A comparison of recombinant thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab 1999; 84:3877-3885.
Medline Google Scholar
38 Travin MI, Wexler JP. Pharmacological stress testing. Semin Nucl Med 1999; 29:298-318.
Medline Google Scholar
39 Cohen MC. A snapshot of nuclear cardiology in the United States. Am Soc Nucl Cardiol Newsletter 1998; 5:13.
Google Scholar
40 Santos-Ocampo CD, Herman SD, Travin MI, et al. Comparison of exercise, dipyridamole, and adenosine by use of technetium-99m sestamibi tomographic imaging. J Nucl Cardiol 1994; 1:57-64.
Medline Google Scholar
41 Miller DD, Younis LT, Chaitman BR, et al. Diagnostic accuracy of dipyridamole technetium 99m-labeled sestamibi myocardial tomography for detection of coronary artery disease. J Nucl Cardiol 1997; 4:18-24.
Medline Google Scholar
42 Lette J, Tatum JL, Fraser S, et al. Safety of dipyridamole testing in 73,806 patients: the Multicenter Dipyridamole Safety. J Nucl Cardiol 1995; 2:3-17.
Medline Google Scholar
43 Taillefer R, Amyot R, Turpin S, et al. Comparison between dipyridamole and adenosine as pharmacologic coronary vasodilators in detection of coronary artery disease with thallium 201 imaging. J Nucl Cardiol 1996; 3:204-211.
Medline Google Scholar
44 Pearlman JD, Boucher CA. Diagnostic value for coronary artery disease of chest pain during dipyridamole-thallium stress testing. Am J Cardiol 1988; 61:43-45.
Medline Google Scholar
45 Iskandrian AS, Heo J, Nguyen T, et al. Assessment of coronary artery disease using single-photon emission computed tomography with thallium-201 during adenosine-induced coronary hyperemia. Am J Cardiol 1991; 67:1190-1194.
Medline Google Scholar
46 Pennell DJ, Underwood SR, Swanton RH, et al. Dobutamine thallium myocardial perfusion tomography. J Am Coll Cardiol 1991; 18:1471- 1479.
Medline Google Scholar
47 Young M, Pan W, Wiesner J, et al. Characterization of arbutamine: a novel catecholamine stress agent for diagnosis of coronary artery disease. Drug Dev Res 1994; 32:19-28.
Google Scholar
48 Marwick TH. Arbutamine stress testing with closed loop drug delivery: toward the ideal or just another pharmacologic stress technique? J Am Coll Cardiol 1995; 26:1176-1179.
Medline Google Scholar
49 Webster MW, Makaroun MS, Steed DL, et al. Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J Vasc Surg 1995; 21:338-345.
Medline Google Scholar
50 Yonas H, Smith HA, Durham SR, et al. Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg 1993; 79:483-489.
Medline Google Scholar
51 Detre JA, Samuels OB, Alsop DC, et al. Noninvasive magnetic resonance imaging evaluation of cerebral blood flow with acetazolamide challenge in patients with cerebrovascular stenosis. J Magn Reson Imaging 1999; 110:870-875.
Google Scholar
52 Cikrit DF, Dalsing MC, Lalka SG, et al. The value of acetazolamide single photon emission computed tomography scans in the preoperative evaluation of asymptomatic critical carotid stenosis. J Vasc Surg 1999; 30:599-605.
Medline Google Scholar
53 Ohnishi T, Yano T, Nakano S, et al. Acetazolamide challenge and technetium-99m-ECD versus iodine 123-IMP SPECT in chronic occlusive cerebrovascular disease. J Nucl Med 1997; 38:1463-1467.
Medline Google Scholar
54 Burt RW, Witt RM, Cikrit D, Reddy RV. Carotid artery disease: evaluation with acetazolamide-enhanced Tc-99m HMPAO SPECT. Radiology 1992; 182:461-466.
Medline Google Scholar

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Published in print: May 2002

Vol. 22, No. 3

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