دانلود کتاب پزشکی هسته‌ای بالینی در مغز و اعصاب – اطلسی از موارد چالش‌برانگیز، جلد دوم

The applications of Nuclear Medicine in neurodegenerative disorders, epilepsy as well as in neuroimmunology and neuro-oncology have expanded in the last two decades. The main reason for such increase in the number of applications is the wide use of PET imaging with [18F]FDG, with tracers targeting pathological processes such as amyloid and tau aggregates, as well as with [18F]Fluorodopa, 68Ga-DOTATOC/DOTATATE, and [18F] Fluoroethyltyrosine, using hybrid imaging with CT and MRI. Dopamine transporters (DAT) SPECT has also become a diagnostic imaging modality widely used in clinical practice. Nowadays, challenges might derive from atypical or incomplete clinical presentations requiring combined interpretation of both functional and morphological images acquired with hybrid imaging as well as with stand-alone modalities. In particular, the expansion of hybrid imaging with the broad implementation of PET/MRI systems has contributed to a more integrated diagnostic approach in nuclear neurology, combining multimodal MR and PET imaging. Finally, the implementation of total-body PET/CT systems provides new opportunities for brain imaging, allowing for instance to derive quantitative parameters (i.e. cerebral blood flow) through measurement of image-derived arterial input function as well as the exploration of brain-body axes. These developments have improved the diagnostic work-up but have also contributed to more technical complexity. Similarly, nuclear medicine tools are increasingly integrated as biomarkers to improve the accuracy of clinical diagnosis and to identify disease trajectories that characterise the natural history of neurological diseases. There is therefore a need for continuous education in Clinical Nuclear Medicine, as well as for updates of the procedures and software development that are necessary to achieve more objective reading and diagnostic interpretations of the brain scans. The development in the area of theragnostic also opens up new opportunities in neurooncology, with the possibility to benefit from a targeted diagnostic and therapeutic approach. In this regard, while already available diagnostic and therapeutic companions are potentially already available for Meningiomas (e.g. 68Ga and 177Lu radiolabelled somatostatin analogues), innovative delivery approaches will likely be needed for other neuro-oncological indications to theragnostics. The purpose of this book is to present a collection of challenging cases, in which the use of nuclear medicine examinations, in combination with MRI and optimised user-independent methods of image processing and analysis, interpreted in association with the clinical presentation and context, has contributed to the final diagnosis. The chapters describe cases of patients with neurodegenerative disorders, epilepsy and brain tumours, as well as all less frequent clinical scenarios such as autoimmune encephalitis, Creutzfeldt- Jacob and Huntington’s disease. In all cases, clinical question, main findings and possible interpretations are highlighted. The added value of semiquantification and voxel-based analysis and the need to compare metrics with normal subjects’ database have been also discussed when appropriate. Finally, most relevant papers and guidelines are also provided as reference for the reader. In the second edition, we have included 14 new cases, covering different areas, including neurodegenerative disorders, epilepsy, theragnostic, and neurovascular disorders. Our intention with this book was to provide guidance on the correct interpretation of nuclear medicine procedures for the diagnosis of neurological disorders and exemplify more and less common variants that may render the interpretation of nuclear medicine images complex. A recurrent observation across cases is the importance of a thorough analysis of the clinical question, an in-depth knowledge of tracer behaviour and potential pitfalls, and a multidisciplinary synthesis of clinical, laboratory and imaging findings. The combination of all these elements is key for an accurate interpretation and required in order to fully exploit the great potential of nuclear medicine methods, reminding the importance of training that emphasises not only the technical expertise but also the clinical expertise of nuclear medicine specialists. We hope that these cases will support the clinical work of specialists and will serve as support for teaching new professionals. We thank all the contributing authors for their expertise and competence that made possible to realise this unique collection of challenging cases.