Tabulka č. 7
Diagnostické referenční úrovně pro vyšetření v nukleární medicíně
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| Orgán, systém, | Druh vyšetření, skupina | Radionuklid | Látka, chemická | Aktivita |
| onemocnění | | | forma | aplikovaná při |
| | | | | jednom |
| | | | | vyšetření |
| | | | | [MBq] |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| kosti | scintigrafie | Tc-99m | fosfáty, fosfonáty | 800 |
| | (celotělová, třífázová, SPECT) | | | |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| kostní dřeň | scintigrafie | Tc-99m | nanokoloidy | 550 |
| | (celotělová, SPECT) | | | |
+------------------------+-----------------+--------------------+-------------+------------------------+------------------+
| mozek | scintigrafie | dynamická | Tc-99m | TcO DTPA | 600 |
| | | | | 4, | |
| | +--------------------+-------------+------------------------+------------------+
| | | statická, planární | Tc-99m | TcO DTPA | 600 |
| | | | | 4, | |
| | +--------------------+-------------+------------------------+------------------+
| | | SPECT | Tc-99m | TcO DTPA, HMPAO, ECD | 800 |
| | | | | 4, | |
| | +--------------------+-------------+------------------------+------------------+
| | | receptory | 1-123 | Ioflupan, IBZM | 200 |
| | +--------------------+-------------+------------------------+------------------+
| | | akumulace glukózy | F-18 | FDG | 400 |
| +-----------------+--------------------+-------------+------------------------+------------------+
| | cisternografie | In-111 | DTPA | 40 |
| | +-------------+------------------------+------------------+
| | | Yb-169 | EDTA | 40 |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| štítná žláza | akumulační test | I-131 | jodid | 0,5 |
| +----------------+---------------------+-------------+------------------------+------------------+
| | scintigrafie | planární | Tc-99m | TcO | 200 |
| | | | | 4 | |
| | | +-------------+------------------------+------------------+
| | | | Tc-99m | MIBI, DMSA (V) | 400 |
| | | +-------------+------------------------+------------------+
| | | | I-123 | jodid | 20 |
| | | +-------------+------------------------+------------------+
| | | | I-131 | jodid | 7 *) |
| | | +-------------+------------------------+------------------+
| | | | TI-201 | chlorid | 80 |
| | +---------------------+-------------+------------------------+------------------+
| | | celotělová při | Tc-99m | MIBI, DMSA (V) | 800 |
| | | karcinomu štítné +-------------+------------------------+------------------+
| | | žlázy | I-131 | jodid | 185 |
| | | +-------------+------------------------+------------------+
| | | | TI-201 | chlorid | 100 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| příštítná tělíska | scintigrafie | planární | Tc-99m | TcO | 200 |
| | | | | 4 | |
| | | +-------------+------------------------+------------------+
| | | | Tc-99m | MIBI | 800 |
| | | +-------------+------------------------+------------------+
| | | | TI-201 | chlorid | 80 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| plíce | scintigrafie | planární | Tc-99m | aerosol, technegas | 1000 **) |
| | ventilační | +-------------+------------------------+------------------+
| | | | Kr-81m | plyn | 6000 ***) |
| +----------------+---------------------+-------------+------------------------+------------------+
| | scintigrafie | planární | Tc-99m | MAA, mikrosféry | 200 |
| | perfuzní +---------------------+-------------+------------------------+------------------+
| | | SPECT | Tc-99m | MAA, mikrosféry | 3000 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| srdce | perfuze | SPECT | Tc-99m | MIBI, tetrofosmin | 900 ****) |
| | myokardu | | | | 1400 *****) |
| | +---------------------+-------------+------------------------+------------------+
| | | SPECT | TI-201 | chlorid | 110 |
| | +---------------------+-------------+------------------------+------------------+
| | | SPECT (reinjekce) | TI-201 | chlorid | 40 |
| +----------------+---------------------+-------------+------------------------+------------------+
| | metabol. zobrazování PET | F-18 | FDG | 500 |
| | (viabilita) | | | |
| +--------------------------------------+-------------+------------------------+------------------+
| | radionuklidová ventrikulografie | Tc-99m | erytrocyty | 800 |
| +--------------------------------------+-------------+------------------------+------------------+
| | scintigrafie prvního průtoku | Tc-99m | TcO Tc-99m DTPA | 900 |
| | | | 4, | |
| +--------------------------------------+-------------+------------------------+------------------+
| | adrenergní inervace | I-123 | MIBG | 400 |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| lymfatický systém | radionuklidová lymfografie | Tc-99m | nanokoloid | 150 |
| +--------------------------------------+-------------+------------------------+------------------+
| | detekce sentinel. uzlin | Tc-99m | nanokoloid | 150 |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| cévy | radionuklidová venografie | Tc-99m | MAA | 200 |
| | (jedna končetina) +-------------+------------------------+------------------+
| | | TC-99m | DTPA | 300 |
| +--------------------------------------+-------------+------------------------+------------------+
| | radionuklidová angiografie | Tc-99m | erytrocyty, TcO , | 800 |
| | | | 4 | |
| | | | DTPA, HSA | |
| +--------------------------------------+-------------+------------------------+------------------+
| | scintigrafická detekce trombu | Tc-99m | trombocyty | 500 |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| krev | objem krve a složek | Tc-99m | HSA | 80 |
| | +-------------+------------------------+------------------+
| | | I-131 | HSA | 6 |
| | +-------------+------------------------+------------------+
| | | Cr-51 | erytrocyty | 6 |
| +--------------------------------------+-------------+------------------------+------------------+
| | přežívání a lokalizace destrukce | Cr-51 | erytrocyty, trombocyty | 6 |
| | krevních elementů | | | |
| | +-------------+------------------------+------------------+
| | | In-111 | trombocyty | 10 |
| +--------------------------------------+-------------+------------------------+------------------+
| | ferokinetika | Fe-59m | Fe(III) citrát | 3 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| slezina | scintigrafie | planární | Tc-99m | alterované erytrocyty | 100 |
| | +---------------------+-------------+------------------------+------------------+
| | | SPECT | Tc-99m | alterované erytrocyty | 200 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| hepatobilární | scintigrafie | planární | Tc-99m | koloidy | 150 |
| systém | +---------------------+-------------+------------------------+------------------+
| | | SPECT | Tc-99m | koloidy | 300 |
| | +---------------------+-------------+------------------------+------------------+
| | | dynamická | Tc-99m | IDA deriváty | 250 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| gastrointestinální | scintigrafie slinných žláz | Tc-99m | TcO | 100 |
| trakt | | | 4 | |
| +--------------------------------------+-------------+------------------------+------------------+
| | motilita jícnu | Tc-99m | koloidy | 70 |
| +--------------------------------------+-------------+------------------------+------------------+
| | gastroesofageální reflux | Tc-99m | koloidy | 50 |
| +--------------------------------------+-------------+------------------------+------------------+
| | evakuace žaludku | Tc-99m | koloidy | 60 |
| +--------------------------------------+-------------+------------------------+------------------+
| | scintigrafie div. Meckeli | Tc-99m | TcO | 500 |
| | | | 4 | |
| +--------------------------------------+-------------+------------------------+------------------+
| | scintigrafie krvácení do GIT | Tc-99m | erytrocyty | 700 |
| +--------------------------------------+-------------+------------------------+------------------+
| | stanovení ztrát krve a bílkovin | Cr-51 | erytrocyty | 4 |
| | v GIT +-------------+------------------------+------------------+
| | | I-125 | HSA | 6 |
| | +-------------+------------------------+------------------+
| | | I-131 | HSA | 6 |
| +--------------------------------------+-------------+------------------------+------------------+
| | Schillingův test | Co-57 | monocyanocobalamin | 1 |
| | +-------------+------------------------+------------------+
| | | Co-58 | monocyanocobalamin | 1 |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| ledviny | renografie prostá | I-131 | hippuran | 1 |
| +----------------+---------------------+-------------+------------------------+------------------+
| | scintigrafie | planární | Tc-99m | DMSA(III), glukonát | 150 |
| | +---------------------+-------------+------------------------+------------------+
| | | SPECT | Tc-99m | DMSA(III), glukonát | 250 |
| | +---------------------+-------------+------------------------+------------------+
| | | dynamická | Tc-99m | DTPA, MAG3, EC | 250 |
| | +---------------------+-------------+------------------------+------------------+
| | | s hodnocením | Tc-99m | DTPA, MAG3, EC | 500 |
| | | perfuze | | | |
| |----------------+---------------------+-------------+------------------------+------------------+
| | stanovení EPPL, GFR | Tc-99m | MAG3, DTPA | 20 |
| | +-------------+------------------------+------------------+
| | | I-131 | hippuran | 0,5 |
| | +-------------+------------------------+------------------+
| | | Cr-51 | EDTA | 3 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| močový | radionuklidová | přímá | Tc-99m | DTPA, TcO | 50 |
| měchýř | cystografie | | | 4 | |
| | +---------------------+-------------+------------------------+------------------+
| | | nepřímá | Tc-99m | MAG3 | 200 |
+------------------------+----------------+---------------------+-------------+------------------------+------------------+
| varlata, šourek | scintigrafie | Tc-99m | TcO | 600 |
| | | | 4 | |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| nádory | scintigrafie | Tc-99m | MIBI, depreotid, | 800 |
| | (planární, SPECT) | | protilátky | |
| | +-------------+------------------------+------------------+
| | | In-111 | protilátky, | 190 |
| | | | pentetreotid | |
| | +-------------+------------------------+------------------+
| | | Ga-67 | citrát | 300 |
| | +-------------+------------------------+------------------+
| | | TI-201 | chlorid | 100 |
| | +-------------+------------------------+------------------+
| | | I-123 | MIBG | 400 |
| | +-------------+------------------------+------------------+
| | | F-18 | FDG | 750 |
| +--------------------------------------+-------------+------------------------+------------------+
| | scintimamografie | Tc-99m | MIBI, tetrofosmin, | 800 |
| | (planární, SPECT) | | fosfonáty | |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
| záněty | scintigrafie | Tc-99m | leukocyty, HIG | 600 |
| | (planární, SPECT) +-------------+------------------------+------------------+
| | | Tc-99m | protilátky | 800 |
| | +-------------+------------------------+------------------+
| | | In-111 | leukocyty | 30 |
| | +-------------+------------------------+------------------+
| | | Ga-67 | citrát | 150 |
+------------------------+--------------------------------------+-------------+------------------------+------------------+
*) jen před terapií 1-131
**) aktivita v nebulizátoru; předpokládá se, že méně než 1/10 se deponuje v plicích
***) pro jednu aplikaci
****) aktivita pro jednu aplikaci v rámci dvoudenního protokolu
*****) sumární aktivita pro jednodenní protokol.
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