The Brain, Salivary and Lacrimal Glands

Abstract

Brain imaging ismost often carried outwithX-ray computed tomography (CT) or magnetic resonance imaging (MRI). CT is fast, widely available, andhasmade conventional nuclearmedicine 99mTc pertechnetate brain imaging obsolete. MRI has the advantages of lack of ionizing radiation and superior soft tissue resolution. However, in an expanding number of clinical situations, brain single photon emission computed tomography (SPECT) or occasionally positron emission tomography (PET) may be the investigation of choice or provide complementary information to structural imaging. Virtually all nuclear medicine applications in the brain involve SPECT and there is rarely a role for planar imaging. It is important to understand the strengths and limitations of brain imaging in nuclear medicine so that these techniques are used appropriately alongside other methods of brain imaging. Newmethods of imaging neurotransmitter receptors and transporters have been developed and offer expanded roles for brainSPECT.Nuclearmedicine canmakevaluable contributions to the diagnosis and follow-up of patients with dementia, cerebrovascular disease, movement disorders, brain tumors, and other neurological diseases. This chapter will be divided into sections covering normal anatomy and physiology, technical aspects of brain SPECT, clinical applications of regional cerebral blood flow SPECT (rCBF SPECT), dopamine transporter and receptor imaging in movement disorders, and applications in brain tumor imaging. Where appropriate, the role of positron emission tomography (PET) will be indicated in the relevant sections. The only nuclear medicine application in the spine is bone scintigraphy, which is dealt with in Chapter 8.