Nuclear Medicine

Cerebral perfusion nuclear imaging allows accurate and reproducible quantification of cerebral blood flow which can provide useful information in the evaluation of early dementia.

SPECT-CT imaging of Alzheimer’s Disease

Alzheimer’s disease is one of the most important neuro-degenerative conditions which usually presents with progressive memory loss. There is now general agreement that Alzheimer’s Disease is amenable to diagnosis.

In the early stages of disease, standard imaging with CT or MRI usually show normal findings, however, SPECT nuclear imaging of the brain can demonstrate abnormalities in the perfusion patterns of the brain (cerebral hemispheres) before the onset of structural changes.​

Multi-infarct dementia

This is another important cause of memory loss which is often difficult to separate from Alzheimer’s disease. SPECT imaging often allows accurate distinction between this cause of dementia and Alzheimer’s Disease.

Dacryoscintigraph (Tear duct/lacrimal)

Dacryoscintigraphy is widely known to be an effective modality in diagnosing abnormalities of the lacrimal system that cause epiphora (abnormal overflow of tears).

Nuclear imaging can provide a dynamic picture demonstrating the exact point of obstructed flow. 

The test is very easily performed with eye drops. We are then able to track the path and progress of the eye drops through the tear ducts (also known as the lacrimal system).

Nuclear Imaging is now a very well established technique used for the investigation of hyperparathyroidism. Sestamibi scintigraphy allows the detection of parathyroid adenomas and the position of any ectopic glands.

SPECT-CT parathyroid imaging

We routinely use high resolution hybrid SPECT-CT Imaging as part of our parathyroid scans. This enables more sensitive and accurate identification of any enlarged parathyroid glands.​

​SPECT-CT combined with ultrasound​

We are also able to offer a complete diagnostic package for the elvaluation of hyperparathyroidism to include both nuclear imaging (SPECT-CT) and specialist neck ultrasound.

This provides the referring clinician with the best possible information in order to accurately guide further therapy.

Thyroid scintigraphy facilitates the detection of focal and/or global abnormalities of thyroid anatomy, correlation of anatomy with function, and detection of aberrant or metastatic functioning thyroid tissue or residual normal tissue after therapy.

Clinical indications:​

Thyroid imaging is useful in, but not limited to: 

• Evaluation of the size and location of thyroid tissue.
• Differentiation of causes of hyperthyroidism e.g. Graves disease, Hashimoto’s thyroiditis
• Differentiation of suspected focal or diffuse thyroid disease.
• Evaluation of clinical laboratory tests suggestive of abnormal thyroid function.
• Assessment of the function of thyroid nodules identified on clinical examination or ultrasound or by other diagnostic imaging.
• Evaluation of congenital thyroid abnormalities. 

Added value of correlative ultrasound in the assessment of thyroid disease.

​We are also able to perform correlative ultrasound on the same day as a patients thyroid scinitscan. This often provides additional valuable information allowing optimal imaging assessment of both function and anatomy.

Gastrointestinal scintigraphy is generally indicated when more anatomic based studies have not been able to diagnose a cause for the patient’s medical history, signs, and symptoms.

The clinical indications are broad and particularly include (but are not limited to):​

• Quantification of the rate of emptying of liquid and/or solid meals from the stomach.
• Demonstration of transit through the small and large intestine.
• Evaluation and quantification of transit through and reflux into the esophagus.
• Demonstration of salivary gland function and tumors.
• Detection of ectopic functioning gastric mucosa (Meckel’s Diverticulum).
• Verification of suspected aspiration.

Dynamic hepatobiliary scintigraphy with gallbladder contractile stimulation is a valuable imaging technique that is often underutilised.

Also known as a ‘HIDA’ scan, a hepatobiliary scan evaluates hepatocellular function and the biliary system by tracing the production and flow of bile from the formative phase in the liver, and its passage through the biliary system into the small bowel.

Dynamic images of the liver, biliary tree, and gut are obtained, providing unique functional information which is not available by any other means. 

​Persistent Right Upper Quadrant Pain with Normal Ultrasound / MRCP.

One of the more common clinical scenarios in which hepatobiliary nuclear imaging is useful relates to patients who experience intermittent right upper quadrant pain but have no evidence of gallstones or biliary on standard anatomical imaging. 

There is growing evidence that hepatobiliary scanning allows accurate selection of patients who may benefit from cholecystectomy.

Our SPECT-CT scans are fully funded by ACC.

​Clinical indications​

There are a number of clinical indications for hepatobiliary including:

• Functional biliary pain syndromes (biliary dyskinesia).
• Post cholecystectomy pain syndrome.
• Sphincter of Oddi dysfunction.
• Biliary system patency.
• Assessment of biliary enteric bypass procedures (e.g. Kasai procedure).
• Assessment of choledochal cysts.
• Acute cholecystitis.
• Bile leakage.
• Functional assessment of the liver before partial hepatectomy.
• Assessment of liver transplant.
• Afferent loop syndrome.
• Evaluation of abnormal gallbladder contraction (e.g. chronic cholecystitis).
• Enterogastric (duodenogastric) reflux assessment.
• Esophageal bile reflux after gastrectomy.

There is growing evidence that hepatobiliary scanning allows accurate selection of patients who may benefit from cholecystectomy.

SPECT-CT - Superior Sentinel Node Localisation:​

SPECT-CT has been show to offer significant advantages to patients undergoing sentinel node biopsy, including:​

• More accurate anatomical localization, potentially reducing the time taken to find nodes during surgery.
• Identification of false positives (due to contamination or spillover from the injection site).
• Increased sensitivity - visualisation of nodes not seen on standard ‘planar’ imaging.
• Informing the surgeon of the need for an alternative surgical approach when necessary.

Dynamic mapping

Our scans are also performed using a dynamic imaging technique which provides excellent detail regarding the path of drainage for a particular node. This helps to more accurately identify which node is the true first ‘sentinel’ node amongst a group of adjacent nodes.

​Stress-free referral

We have worked very closely with our referrers to develop an efficient, stress-free referral system. We recognise the upset and stress felt by patients when they are given a diagnosis of melanoma or breast cancer. When faced with this diagnosis in the clinic setting, patients often experience ‘information overload’ at the thought of organising a separate scan for a sentinel node biopsy. We have therefore created a simple two-step process which assists patients through their subsequent journey.

Step 1

When the decision is made to perform a sentinel biopsy, staff at the surgical clinic are able to request an appointment for the patient over the phone, either before the patients appointment or while they are attending their appointment with the surgeon.

Step 2

​Once an appointment time has been confirmed, staff at the surgical clinic can enter the patients details and appointment time on a printable electronic (.pdf) form to hand to the patient. Alternatively, we can provide printed copies if required.

The form provides the following information:

• The purpose of a sentinel node scan.
• An explanation of the procedure.
• Details of how to prepare for the scan.
• Travel directions to Accuron Radiology.
• An explanation of the procedure following the scan.

Once an appointment time has been confirmed, staff at the surgical clinic can enter the patients details and appointment time on a printable electronic (.pdf) form to hand to the patient. Alternatively, we can provide printed copies if required.

​Fast delivery of results

Immediately after the scan, a report is issued and patients are provided with a printed copy with accompanying images, including dynamic sequences.

Online digital access to the report and scans is also available on the clinicians computer via our Inteleviewer PACS.

Bone scanning continues to be one of the most sensitive techniques for detecting bone pathology and often augments other modalities such as MRI in arriving at a definite diagnosis. Hybrid nuclear imaging (SPECT-CT) is increasingly recognised as a useful tool in the imaging of musculoskeletal disorders, particularly in the subspecialist fields of orthopaedic and sports medicine. We have the most advanced SPECT-CT scanners in New Zealand and are able to offer this modality 5 days a week. Musculoskeletal SPECT-CT is also fully funded by ACC. Our images are also available to view online.

Clinical uses of Bone Scintigraphy include:​

• Detecting occult fractures, in particular:
  ◦ Tibial stress fractures vs shin splints.
  ◦ Scaphoid fractures.
  ◦ Tarsal / metatarsal stress fractures.
• Determining a cause for undiagnosed bone pain.
• Evaluation of back pain:
  ◦ Pars fractures.
  ◦ Determination of active facet arthropathy.
  ◦ Determination of active disc related arthrosis.
  ◦ Investigation of potential instability.
  ◦ Evaluation of post operative fusion.
• Determination of active arthropathy related to lumbosacral pseudoarthrosis.
• Detection of active entheseopathy, in particular:
  ◦ Hamstring origins.
  ◦ Quadriceps / Patellar tendon insertions.
  ◦ Calcaneal.
  ◦ Plantar.
• Evaluation of joint prostheses – Hip, knee and shoulder.
• Detection of systemic musculoskeletal disease eg metabolic and metastatic.
• Evaluation of Paget’s disease (active vs inactive).
• Detection of early AVN.
• Early detection of osteomyelitis (vs soft tissue cellulitis).

The gamma camera detects the radiation released from the radioactive tracer that has been absorbed in your body. This is what creates the image.

You will receive specific instructions based on the type of scan you are having (for example food and drink restrictions, medicine restrictions, or instructions about whether you need to have a full or empty bladder). Please let the doctor or technologist know if you are pregnant or could be pregnant, or if you are breastfeeding.

The radioactive tracers will be given to you in one of three ways: as an injection in your skin or a vein, breathing in a gas, or by mouth. The technologist will decide the method based on the type of test you are having. Imaging may start immediately after administration of the tracer or you may have to wait for a period of time before imaging can begin. This will be explained to you during booking and again at your appointment. Once imaging begins, the gamma camera may move down your body, rotate around you, or stay in one place.

The Nuclear Medicine bone scan is a safe and routine procedure. Millions of bone scans have been done around the world without complication. The radiation dose used for a bone scan is kept very low, and will not cause harm to the body. The tracer is gone completely from your system in 36 hours. Please notify the technologist before the scan if you are pregnant or breastfeeding.