Miscellaneous applications of radionuclide imaging

The procedures discussed in this chapter are either developmental, in limited clinical use, or frankly moribund. A number of radionuclide imaging techniques have proved disappointing when approached from a purely anatomic point of view. This is particularly evident to our colleagues with the explosive growth of the noninvasive imaging procedures, magnetic resonance imaging (NMR), CT, and ultrasound, and the introduction of the less invasive digital radiographic approach to vascular opacification, all of which are capable of providing exquisite anatomic or tissue detail beyond the reach of current or reasonably priced nuclear medicine imaging systems. Yet, most nuclear medicine procedures possess the unique advantage of portraying a physiologic function without interfering with that function. Moreover, the procedures can be employed under conditions of stress, which are likely to bring out pathophysiologic abnormalities that remain masked when unchallenged. Information concerning form without functional data has less meaning than both together. The physiologic information inherent in nuclear medicine imaging may often provide not only key diagnostic information but also illuminate a therapeutic trail. Yet, it is often slighted in favor of the anatomic quest. While mastery of the nuances of imaging details remains critical, radionuclide image interpretation must rest upon a firm physiologic foundation. For this reason, this chapter emphasizes the physiologic approach