chapter  39
36 Pages

Nuclear Medicine as an Aid to Minimally Invasive Surgery, with Emphasis on Hybrid SPECT/CT Imaging

The increase in detection of occult lesions has led to the development of new methods to identify foci or tissues that have been preoperatively labelled with a radioactive tracer. The identication of occult lesions for radioguided surgery can be carried out in two ways. The rst approach consists of systemic administration of a specic radiopharmaceutical that exhibits tropism for a tumour or tissue, such as 99mTc-sestamibi for the identication of parathyroid adenomas or hyperplasia (Mariani et al. 2003) or 111In-DTPA-octreotide for the identication of neuroendocrine tumours (Gulec and Baum 2007). In the second approach, the tissue to be excised is labelled by intratumoural injection of 99mTc-albumin macro-aggregate or 99mTc-colloid guided by ultrasound (US), CT, or another imaging methods. This technique, known as radioguided occult lesion localisation (ROLL), was rst described in 1998 for the preoperative localisation of occult lesions of the breast (Paganelli et al. 1997). Both techniques require preoperative imaging of radioactivity accumulation in the target tissue. Preoperative imaging may be performed by planar or SPECT/CT images depending of complexity of the anatomical site of lesion (head and neck, abdomen). Often, presurgical imaging should be preferably carried out with SPECT/CT, which enables simultaneous detection

39.1 Sentinel Lymph Node Mapping in Early Breast Cancer ...................................................... 674 39.2 Radioguided Occult Lesion Localisation ............................................................................. 679

39.2.1 ROLL Technique ......................................................................................................680 39.3 Other Applications of Sentinel Node Mapping under Clinical Validation...........................680 39.4 SPECT/CT in Oncology ....................................................................................................... 689

39.4.1 Hybrid SPECT/CT Imaging in Endocrine and Neuroendocrine Tumours ............... 689 39.4.1.1 Differentiated Thyroid Carcinoma ............................................................ 689 39.4.1.2 Parathyroid Disease ...................................................................................692 39.4.1.3 Adrenocortical Tumours ............................................................................ 693

39.4.2 Neuroendocrine Tumours .........................................................................................694 39.4.2.1 Sympathetic Nervous System Tumours .....................................................696