Radionuclide Diagnosis

RADIONUCLIDE DIAGNOSIS
OF DISEASES OF THE GASTROINTESTINAL TRACT.
RADIATION DIAGNOSTICS COMPLICATIONS OF

PEPTIC ULCERS.
BY DANIAL ASHOORI ZADEH.

GROUP 1
• Scintigraphic investigation of gastrointestinal bleeding.
• Meckel’s diverticulum.
• Radionuclide imaging of inflammatory bowel disease.
• Somatostatin receptor scintigraphy.

Scintigraphic investigation
of gastrointestinal bleeding.
80% of patients of GI bleeding

has source in esophagus, stomach or duodenum.
• Endoscopy has a high success rate in showing
the cause of upper GI bleeding.
• 20% has source in small bowel or colon is more
difficult to establish.
Indications
1.Patients with recurrent episodes of bleeding.

2.Endoscopy is negative or inconclusive.
3.Patients in whom surgical risks are high.
4.Patient with bleeding of severity to produce malena.
Techniques
Two approaches have been developed.
1.Radiolabelled colloid.
2.Radiolabelled red cells.
Radiolabelled colloid
• Colloid particles in size range from301000nm labeled with technetium.
• In patients who are actively bleeding at the time of injection ,leakage of tracer into
the lumen of gut will produce a focus of activity.
• Subsequent images are obtained at intervals up to 45 minutes.
• Extravagated blood from small bowel shows a central area which moves relatively
quickly around the centre of abdomen.
• Colonic activity moves fairly slowly around the periphery of the abdomen in a clock
wise direction.
Radiolabelled red cells
• The stability of the tracer with in the vascular

compartment allows sequential imaging for up
to 24 hours.
• Which gives the opportunity of detecting bleeding
which is episodic or continuing at a slower rate.
• A bolus injection of up to 400 mBq of Tc99-RBCs and followed by
abdominal images obtained at 5 min intervals for about 1 hr.
• Imaging can be continued at increasing intervals up to 24 hrs.
Meckel’s diverticulum
• It is a remnant of embryonic omphalomesenteric duct
persists into adult life in about 2% of population.
Few of them produce clinical problems like
1. Peptic ulceration causing abdominal pain or occult
bleeding.
2. Scarring following chronic inflammation leads to
small bowel obstruction.
Scintigraphic technique.
Intravenously injected pertechnetate cleared from

circulation by thyroid, salivary gland , choroid plexus of
brain and by stomach from gastric mucosa which then
moves along the lumen.
The procedure visualizes gastric mucosa in the

stomach and also in ectopic sites including barrett’s
esophagus and duplication cysts as well as Meckel’s
diverticulum.
Preparation.
• Adults should starve overnight to reduce gastric secretions.
• Infants and children should with hold one feed.
• H2 blockade is prescribed.
• After 200-400 mBq of sodium pertechnetate.
• Images of abdomen and pelvis are obtained with patient supine.
• Images are obtained at 5 min intervals up to 45 min.
Abdominal lesions with an increased blood pool or extracellular

fluid component for e.g. aneurysms, tumors, inflammatory masses
show maximum activity on early images.
Gastric mucosa activity increases in intensity over 20-30 min.
Interpretation.
- Abdominal lesions with an increased blood pool
or extracellular fluid component for e.g.
aneurysms, tumours, inflammatory masses show
maximum activity on early images. Gastric
mucosa activity increases in intensity over 20-30
min.
- Meckel’s diverticulum appears as a focal area of
uptake which is remote from but synchronous with
the normal gastric mucosa.
Radionuclide imaging
of inflammatory bowel disease.
• Autologous white cells are labeled either with

technetium 99 or with indium 111 and injected into the
patient.
• Images obtained over the next few hours demonstrate
the localization of white cells and in particular will show
abnormal foci of infection or inflammation.
• Bowel activity at 1 hr is taken as evidence of
inflammatory bowel disease.
Applications
1.Detecting inflammatory bowel disease. In the early stages

of disease WBC scintigraphy may be the only positive test
with normal barium or colonoscopy.
2. Assessing the extent and location of abnormal bowel.
3.Follow up.
4.Assessing the complications.
Somatostatin receptor scintigraphy
• Octreotide is a synthetic analogue with 8 amino acids which
binds to somatostatin membrane receptors which occurs in cells
of neuroendocrine origin.
• Octreotide is labelled with indium 111DTPA and is used to
localize tumors of endocrine origin both primary and secondary.
• Major applications for SRS are in the localization of pancreatic
islet cell tumors and their metastases and in the investigation of
GIT carcinoids, and related tumors and their metastases.
Technique
• Treatment with un labeled octreotide reduce tracer uptake
by tumor so it is desirable to stop such treatment 2 to 3
days before the test.
• 110MBq of indium 111chelated with DTPA bound to 10-
20microgram of carrier octreotide is given intravenously.
Whole body images are taken at 4 and 24 hr.
Interpretation
In normal subject 90% of injected activity is excreted

in urine by 24 hr.
A high level uptake is typical in spleen and rather low

grade activity in liver.
A small proportion is excreted via biliary tract.

Results
SRS is highly accurate in detecting primary bowel
carcinoids and their mets in mesenteric lymph nodes.
Useful in patient presenting with liver met when the
primary site is not known.
Staging of carcinoid tumors particularly detecting
extrahepatic and extra abdominal disease.
What is PEPTIC ULCER?????
Breaks in mucosal surface>5mm in size

Depth till submucosa
In any part of GI tract exposed to aggressive action of
acid pepsin juices.
Can be acute or chronic
Both can penetrate muscularis
mucosae..
Pathomorphology
•Round
•Punched out craters
•2 to 4 cm diameter
Mild edema of immediate adj. mucosa
Margins – Perpendicular - No Elevant or Beading
Surrounding Mucosal folds Radiate like Wheel Spokes
Base Remarkably Clean
Clinical features
• Abdominal pain
• Epigastric
• Burning or gnawing discomfort
• 90 min to 3 h after meal
• Frequently relieved by antacids or food in DU.
• Awakes the pt from sleep b/w midnight & 3 am.
• Nausea
• Weight loss
• Dyspepsia if not relieved by food antacids , if not relieved by
food antacids , radiates to back—penetrating ulcer
Complications
1) Symptoms : Pain worsening with meals, nausea and

vomiting of undigested food
Examin : succusion splash
2)Symptoms : Tarry stools or coffee ground emesis
Acute hematemesis
Anemia
Examn : tachycardia and orthostasis
suggesting dehydration
Surgical complications
•Recurrent ulceration
•Afferent loop syndromes
•Dumping syndromes
•Post vagotomy diarrhea
•Bile reflux gastropathy
•Maldigestion & malabsorption
•Gastric adenocarcinoma
Thank you !

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RADIONUCLIDE DIAGNOSIS

OF DISEASES OF THE GASTROINTESTINAL TRACT.

RADIATION DIAGNOSTICS COMPLICATIONS OF

BY DANIAL ASHOORI ZADEH.

• Radionuclide imaging of inflammatory bowel disease.

• Somatostatin receptor scintigraphy.

80% of patients of GI bleeding

1.Patients with recurrent episodes of bleeding.

• Colloid particles in size range from301000nm labeled with technetium.

the lumen of gut will produce a focus of activity.

• Subsequent images are obtained at intervals up to 45 minutes.

quickly around the centre of abdomen.

• The stability of the tracer with in the vascular

Intravenously injected pertechnetate cleared from

The procedure visualizes gastric mucosa in the

Abdominal lesions with an increased blood pool or extracellular

• Autologous white cells are labeled either with

1.Detecting inflammatory bowel disease. In the early stages

In normal subject 90% of injected activity is excreted

A high level uptake is typical in spleen and rather low

A small proportion is excreted via biliary tract.

Breaks in mucosal surface>5mm in size

1) Symptoms : Pain worsening with meals, nausea and

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