Physiological Measurements With Radionuclides in Clinical Practice

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ISBN: 9780192619945 | 0192619942
Cover: Hardcover
Copyright: 4/23/1998

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As functional imaging continues to inform everyday clinical practice, clinicians need to know more about the quantitative aspects of physiology and pathophysiology. Presented in accessible language, this book integrates the principles and mathematics of measurement with physiological systems to which the quantitative problems are applied. The book discusses the related basic mathematics, the measurement of blood flow, peripheral circulation and microvascular solute transfer, pharmacokinetics routinely used in nuclear medicine, as well as scinitillion detectors, data-processing and quantification. Measurement in the heart, lung, gastro-intestinal tract, liver, spleen, genitourinary tract and brain are discussed.

Foreword

(2)

Preface

vii

(1)

Abbreviations

viii

1 Basic mathematics

(27)

Introduction

(1)

1.1 Equations, variables and graphs

(2)

1.2 Simple calculus

(6)

1.2.1 Differentiation

(2)

1.2.2 Integration

(1)

1.2.3 Exponential decay and growth

(3)

1.2.4 The area under an exponential graph

(1)

1.3 Curve fitting, plotting and stripping

(4)

1.3.1 Curve fitting

(2)

1.3.1.1 Least squares fitting

(2)

1.3.1.2 Exponential fits

(1)

1.3.2 Plotting data on semi-logarithmic graph paper

(1)

1.3.3 Curve stripping

(1)

1.4 Compartmental analysis

(6)

1.5 Deconvolution analysis

(1)

1.6 Statistical techniques relevant to nuclear medicine

(8)

1.6.1 The statistics of conventional experiments--population statistics

(2)

1.6.2 The statistics of counting

(2)

1.6.3 The statistics of imaging

(1)

1.6.4 Comparing counts

(1)

1.6.5 Comparing sets of measurements from two different experiements

(2)

2 Transit time, clearance, distribution volume and extraction fraction

(17)

Introduction

(1)

2.1 Transit and residence time

(6)

2.1.1 Measurement of transit and residence time

(3)

2.1.2 Correction for non-ideal conditions

(2)

2.1.2.1 Correction for recirculation

(1)

2.1.2.2 Correction for bolus dispersion (instaneous input)

(1)

2.2 Clearance

(6)

2.2.1 Measurement of clearance

(5)

2.2.1.1 Steady state

(1)

2.2.1.2 Blood clearance following bolus injection

(2)

2.2.1.3 Organ clearance from uptake measurement

(2)

2.2.1.4 Measurement of urinary clearance

(1)

2.2.1.5 Measurement of organ clearance by positron emission tomography

(1)

2.3 Distribution volume

(1)

2.4 Extraction fraction

(3)

2.4.1 Relationships between extraction fraction, clearance and blood flow -- PS product

(2)

2.5 Expressing variables as quotients

(1)

References

(1)

3 Measurement of blood flow

(23)

Introduction

(1)

3.1 Fick principle

(17)

3.1.1 Inert gas washout

(5)

3.1.1.1 Bolus injection

(4)

3.1.1.2 Steady state

(1)

3.1.2 Measurement of blood flow from clearance

(3)

3.1.2.1 Blood flow from blood disappearance of tracer following bolus injection

(2)

3.1.2.2 Blood flow from organ uptake

(1)

3.1.3 Measurement of blood flow by PET

(8)

3.1.3.1 Positron labelled water

(2)

3.1.3.1.1 Continuous infusion

(1)

3.1.3.1.2 Bolus injection

(1)

3.1.3.2 Non-linear regression analysis

(1)

3.1.3.3 Significance of PS product

(1)

3.1.3.4 Blood flow measurement by PET based on the three-compartment model

(2)

3.1.3.5 Correction of organ blood volume in PET

(1)

3.2 Indicator dilution

(2)

3.3 Fractionation of cardiac output

(2)

3.4 Plethysmography

(1)

3.5 Blood flow measurement based on transit time

(1)

References

(1)

4 Pharmacokines of agents routinely used in nuclear medicine

(20)

Introduction

(1)

4.1 Renal agents

(3)

4.1.1 DTPA

(2)

4.1.2 DMSA

(1)

4.1.3 Hippuran and mercaptoacetyltriglycine (MAG-3)

(1)

4.1.4 Glucoheptonate

(1)

4.2 Hepatic agents

(1)

4.2.1 IDA analogues

(1)

4.2.2 Colloids

(1)

4.3 Bone agents

(1)

4.4 Lung agents

(3)

4.4.1 Perfusion agents

(1)

4.4.1.1 Microparticles

(1)

4.4.1.2 Inert gases

(1)

4.4.2 Ventilation agents

(2)

4.4.2.1 Inert gases

(1)

4.4.2.1.1 Xenon

(1)

4.4.2.1.2 Krypton-81m

(1)

4.4.2.2. Aerosols

(1)

4.5 Blood cells

(1)

4.5.1 Erythrocytes

(1)

4.5.2 Platelets

(1)

4.5.3 Granulocytes

(1)

4.6 Myocardial agents

(3)

4.6.1 Potassium analogues

(1)

4.6.2 Isonitriles

(1)

4.6.3 Teboroxime

(1)

4.6.4 Ammonia

(1)

4.6.5 Fatty acids and glucose

(1)

4.7 Brain agents

(1)

4.7.1 Diffusible solutes

(1)

4.7.2 Technetium-99m HMPAO and iodine-123 iodoamphetamine

(1)

4.8 Gallium-67 and indium-111

(1)

4.8.1 Gallium-67

(1)

4.8.2 Indium-111

(1)

4.9 Agents localizing in endocrine glands

(1)

4.9.1 Adrenal gland

(1)

4.9.1.1 Adrenal medulla

(1)

4.9.1.2 Adrenal cortex

(1)

4.9.2 Parathyroid glands

(1)

4.9.3 Thyroid gland

(1)

4.9.4 Somatostatin receptor imaging

(1)

4.10 Pertechnetate

(1)

4.11 Proteins

(5)

4.11.1 Albumin

(1)

4.11.2 Transferrin

(1)

4.11.3 Proteins of the coagulation pathways

(1)

4.11.4 Immunglobulins

(1)

4.11.4.1 Monoclonal antibodies

(1)

4.11.4.2 Human polyclonal immunoglobulin

(1)

4.11.5 Acute phase proteins

(2)

5 Scintillation detectors, data processing and quantification

(22)

Introduction

(1)

5.1 Scintillation detectors

(6)

5.1.1 Scintillation well counter

(1)

5.1.2 Scintillation probe

(1)

5.1.3 Gamma camera

(2)

5.1.4 Positron camera

(1)

5.2 Data

(2)

5.2.1 Sources of errors in data

(1)

5.3 Data acquisition

(3)

5.3.1 Static acquisition

(1)

5.3.2 Dynamic acquisition

(1)

5.3.3 List mode acquisition

(1)

5.3.4 Gated acquisition

(1)

5.3.5 Single photon emission computerized tomography

(1)

5.3.6 Positron emission tomography

(1)

5.4 Quantification

(6)

5.4.1 Time

100

(1)

5.4.1.1 Measurement of rate constants

101

(1)

5.4.2 Volume

101

(1)

5.4.3 Quantity or mass

101

(4)

5.4.3.1 Simple depth correction

102

(1)

5.4.3.2 Geometric mean

103

(1)

5.4.3.3 Comparison with a phantom

103

(1)

5.4.3.4 Comparison with another radiopharmaceutical

103

(1)

5.4.3.5 Correction for attenuation in SPECT imaging

104

(1)

5.5 Image analysis

105

(3)

5.5.1 Parametric analysis

106

(1)

5.5.2 Phase and amplitude analysis

106

(1)

5.5.3 Principal components and factor analysis

107

(1)

5.6 Measurement of affinity and dissociation constants

108

(2)

6 The peripheral circulation and microvascular solute transfer

110

(21)

6.1 Peripheral circulation

110

(4)

6.1.1 Skin blood flow

110

(1)

6.1.2 Muscle blood flow

110

(1)

6.1.3 Limb blood flow

110

(2)

6.1.3.1 Plethysmography

110

(2)

6.1.3.2 Inert gas washout

112

(1)

6.1.4 Peripheral arterio-venous shunting

112

(2)

6.2 Microvascular water and solute transfer

114

(15)

6.2.1 Water

114

(1)

6.2.1.1 Filtration

114

(1)

6.2.1.2 Diffusion

114

(1)

6.2.2 Solutes

114

(14)

6.2.2.1 Permeability surface area (PS) product for solutes

115

(2)

6.2.2.2 Diffusion restriction

117

(1)

6.2.2.3 Relation between PS and clearance

118

(1)

6.2.2.4 Measurement of PS product

118

(10)

6.2.2.4.1 Indicator dilution

118

(1)

6.2.2.4.2 Tissue uptake measurements

119

(3)

6.2.2.4.3 Residue detection

122

(2)

6.2.2.4.4 Measurement of solute disappearance from plasma -- the whole body PS product

124

(4)

6.2.2 Microvascular protein transfer

128

(1)

References

129

(2)

7 The heart

131

(20)

7.1 Myocardial haemodynamics

131

(7)

7.1.1 Myocardial blood flow

131

(5)

7.1.1.1 Xenon-133

132

(1)

7.1.1.2 Cardiac output fractionation -- radiolabelled microspheres

132

(3)

7.1.1.3 Rubidium-82 continuous infusion

135

(1)

7.1.1.4 Oxygen-15 labelled water

135

(1)

7.1.2 Distribution of myocardial perfusion

136

(2)

7.2 Extrinsic parameters of cardiac performance

138

(3)

7.2.1 Cardiac output

139

(2)

7.2.2 Mean circulation time

141

(1)

7.3 Intrinsic parameters of cardiac performance

141

(6)

7.3.1 Ejection fraction

142

(1)

7.3.1.1 Multiple gated cardiac imaging

142

(1)

7.3.1.2 First pass

142

(1)

7.3.1.3 Inert gases

143

(1)

7.3.2 End-systolic, end-diastolic and stroke volumes

143

(1)

7.3.3 Rates of ventricular filling and emptying

144

(1)

7.3.4 Intracardiac shunting

144

(3)

7.3.4.1 Left to right shunting

145

(1)

7.3.4.2 Right to left shunting

146

(1)

7.4 Myocardial substrate utilization

147

(2)

7.4.1 Imaging fatty acid utilization

147

(1)

7.4.2 Glucose utilization

148

(1)

References

149

(2)

8 The lung

151

(28)

8.1 Mechanics of breathing

151

(4)

8.1.1 Regional ventilation

152

(1)

8.1.2 Ventilatory turnover and the lung time constant

153

(1)

8.1.3 Lung gas volumes

154

(1)

8.1.3.1 Functional residual capacity (FRC) and residual volume

154

(1)

8.1.3.2 Regional lung volume

155

(1)

8.2 Pulmonary haemodynamics

155

(9)

8.2.1 Pulmonary blood flow

157

(1)

8.2.2 Distribution of pulmonary blood flow

157

(1)

8.2.3 Lung blood volume and pulmonary intravascular transit time

158

(2)

8.2.3.1 Pulmonary blood volume and haematocrit

158

(2)

8.2.3.2 Pulmonary intravascular transit time

160

(1)

8.2.4 Lung water

160

(3)

8.2.5 Intrapulmonary vascular shunting

163

(1)

8.3 Pulmonary granulocyte kinetics

164

(2)

8.3.1 Pulmonary granulocyte pooling

165

(1)

8.3.2 Pulmonary granulocyte migration

166

(1)

8.4 Capillary alveolar transfer

166

(9)

8.4.1 Ventilation/perfusion ratio

166

(3)

8.4.2 Alveolar epithelial permeability

169

(4)

8.4.2.1 Measurement of alveolar epithelial permeability

170

(3)

8.4.3 Pulmonary endothelial permeability

173

(2)

8.5 The metabolic functions of the lung

175

(2)

8.5.1 Pulmonary amine extraction

176

(1)

8.5.2 Lung clearance of receptor-bound amine

176

(1)

References

177

(2)

9 The gastro-intestinal tract and liver

179

(17)

9.1 Salivary glands

179

(1)

9.2 Motility in the gastro-intestinal (GI) tract

179

(2)

9.2.1 Oesophageal transit time

179

(1)

9.2.2 Gastric emptying

180

(1)

9.2.3 Gastro-oesophageal reflux

180

(1)

9.2.4 Duodeno-gastric reflux

181

(1)

9.2.5 Intestinal transit time

181

(1)

9.3 Hepatic organic anion transport

181

(2)

9.4 Hepatic haemodynamics

183

(9)

9.4.1 Measurement of total liver blood flow

183

(5)

9.4.1.1 Organic anion clearance

183

(2)

9.4.1.2 Liver blood flow and IDA extraction efficiency by deconvolution analysis

185

(1)

9.4.1.3 Hepatic clearance of gastro-intestinally absorbable agents

186

(1)

9.4.1.4 Colloid clearance

187

(1)

9.4.1.5 Inert-gas washout

188

(1)

9.4.2 Arterio-portal flow ratio

188

(3)

9.4.2.1 Measurement of the arterio-portal ratio by first-pass kinetics

188

(1)

9.4.2.2 Inert gas

189

(1)

9.4.2.3 Measurement of hepatic arterial blood flow by PET

190

(1)

9.4.3 Porto-systemic shunting

191

(1)

9.5 Tests of gastro-intestinal permeability and absorption

192

(2)

9.5.1 Gastro-intestinal protein loss

192

(1)

9.5.2 Bile-acid absorption

193

(1)

9.5.3 Gastro-intestinal handling of sugars

194

(1)

References

194

(2)

10 Haematology and the spleen

196

(21)

10.1 Platelet kinetics

196

(10)

10.1.1 Platelet production

196

(1)

10.1.2 Platelet distribution and the splenic platelet pool

196

(6)

10.1.2.1 Splenic blood flow

197

(4)

10.1.2.1.1 Splenic blood flow by measurement of platelet input

197

(2)

10.1.2.1.2 Splenic blood flow measured by xenon washout

199

(1)

10.1.2.1.3 Splenic blood flow measured by fractionation of cardiac output

199

(1)

10.1.2.1.4 Splenic blood flow measured from heat damaged red cell clearance

200

(1)

10.1.2.2 Intrasplenic platelet transit time

201

(1)

10.1.2.3 Splenic platelet pool

202

(1)

10.1.3 Mean platelet life-span

202

(3)

10.1.3.1 Weighted mean of linear and exponential fits

203

(1)

10.1.3.2 Mills and Dornhorst equation

203

(1)

10.1.3.3 Multiple hit model

204

(1)

10.1.4 Platelet destruction

205

(1)

10.1.4.1 Measurement of intrasplenic platelet destruction

205

(1)

10.1.4.2 Measurement of extrasplenic platelet destruction

206

(1)

10.2 Erythrokinetics

206

(4)

10.2.1 Erthrocyte production -- ferrokinetics

206

(1)

10.2.1.1 Gastro-intestinal iron absorption

207

(1)

10.2.1.2 Plasma iron clearance

207

(1)

10.2.1.3 Plasma iron turnover

207

(1)

10.2.1.4 Red cell iron utilization

207

(1)

10.2.1.5 Whole body iron utilization

207

(1)

10.2.2 Red cell distribution -- intrasplenic kinetics

207

(3)

10.2.2.1 Unmodified red cells

208

(1)

10.2.2.2 Modified red cells

209

(1)

10.2.2.2.1 Heat damaged red cells

209

(1)

10.2.2.2.2 Immune coated red cells

209

(1)

10.3 Granulocyte kinetics

210

(4)

10.3.1 Granulocyte production

210

(1)

10.3.2 Granulocyte distribution -- intravascular margination

210

(3)

10.3.2.1 Measurement of regional marginating granulocyte pooling from transit time

211

(1)

10.3.2.2 Measurement of regional MGP from comparison with red cells

212

(1)

10.3.3 Mean granulocyte life span in blood

213

(1)

10.3.4 Granulocyte destruction and whole body losses

214

(1)

10.4 Blood volume

214

(1)

10.4.1 Red cell volume

214

(1)

10.4.2 Plasma volume

215

(1)

10.5 Turnover of serum amyloid P component

215

(1)

References

215

(2)

11 The genitourinary system

217

(30)

Introduction

217

(1)

11.1 Renal haemodynamics

217

(19)

11.1.1 Renal blood flow

217

(5)

11.1.1.1 Hippuran clearance

218

(1)

11.1.1.2 Xenon-133 washout

219

(1)

11.1.1.3 Fractionation of cardiac output

219

(2)

11.1.1.4 Measurement of absolute renal blood flow by indicator dilution

221

(1)

11.1.1.5 Quantification of intra-renal blood flow distribution

221

(1)

11.1.2 Glomerular filtration

222

(13)

11.1.2.1 Measurement of GFR from plasma clearance

226

(4)

11.1.2.2 Differential renal function

230

(1)

11.1.2.3 Differential GFR and single kidney GFR

231

(4)

11.1.3 Filtration fraction

235

(1)

11.2 Tubular function

236

(6)

11.2.1 Parenchymal and whole kidney transit time

239

(2)

11.2.2 Quantifying pelvic drainage

241

(1)

11.3 Ureteric function

242

(1)

11.3.1 Ureteric motility

242

(1)

11.3.2 Vesico-ureteric reflux

242

(1)

11.4 Genital system

243

(1)

11.4.1 Penile blood flow

243

(1)

11.4.1.1 Penile plethysmography

244

(1)

11.4.1.2 Penile xenon-133 washout

244

(1)

11.4.2 Fallopian tube transit time

244

(1)

References

244

(3)

12 The brain

247

(15)

12.1 Cerebral blood flow

247

(9)

12.1.1 Measurement of cerebral perfusion using inert gases

247

(4)

12.1.1.1 Measurement by desaturation

247

(2)

12.1.1.2 Measurement by saturation

249

(2)

12.1.2 Measurement of cerebral blood flow at steady state

251

(1)

12.1.3 Cerebral blood volume

251

(1)

12.1.4 Cerebral intravascular transit time

251

(1)

12.1.5 Cerebral blood flow from the transit time equation

252

(1)

12.1.6 Quantification of the regional distribution of cerebral blood flow

252

(4)

12.1.6.1 Xenon-133 SPECT

252

(2)

12.1.6.2 Regional intravascular transit time

254

(2)

12.2 Cerebral oxygen consumption

256

(2)

12.2.1 Steady-state method

257

(1)

12.2.2 Non-steady-state method

258

(1)

12.3 Cerebral glucose utilization

258

(1)

12.4 Radio-ligand uptake by cerebral receptors

259

(1)

References

260

(2)

13 Body fluids, electrolytes and bone

262

(16)

13.1 Fluid distribution

262

(5)

13.1.1 Extracellular fluid volumes

262

(5)

13.1.1.1 Measurement of extracellular fluid volume

262

(2)

13.1.1.2 Distribution of fluid between plasma and interstitial fluid

264

(3)

13.1.1.3 Total body and intracellular fluid volumes

267

(1)

13.2 Electrolytes

267

(3)

13.2.1 The sodium space and exchangeable sodium

267

(1)

13.2.2 The potassium space and exchangeable potassium

268

(1)

13.2.3 Calcium turnover and gastro-intestinal calcium absorption

268

(2)

13.3 Bone

270

(7)

13.3.1 Skeletal haemodynamics and blood flow

270

(4)

13.3.1.1 Radiolabelled microspheres

272

(1)

13.3.1.2 Inert gas clearance

272

(1)

13.3.1.3 Plasma clearance

272

(1)

13.3.1.4 Regional bone tracer uptake measured by PET

273

(1)

13.3.2 Bone turnover

274

(1)

13.3.3 Bone mineral density

275

(2)

13.3.3.1 Composition of soft tissue

275

(1)

13.3.3.2 Bone mineral density

276

(1)

References

277

(1)

14 Exercises

278

(15)

14.1 Questions

278

(6)

14.2 Answers

284

(9)

Index

293

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Physiological Measurements With Radionuclides in Clinical Practice

Summary

Table of Contents

Supplemental Materials

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Physiological Measurements With Radionuclides in Clinical Practice

Summary

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