Medullary thyroid cancer is a rare tumor driven from neuroendocrine cells. In the last decade there has been important discoveries regarding its genetics and relationship between genotype and phenotype on familial cases. However remains unknown the best approach for patient with maintained high levels of tumor markers such as calcitonin. Most available imaging techniques are able to accurately find metastatic lesions only in advanced disease. Traditionaly, nuclear medicine images are able to find metastatic suspicious lesions before they reach the size to be considered suspicious in conventional studies such as computed tomography scans or magnetic resonance imaging. However in patients with medullary thyroid cancer the ideal radiopharmaceutical for this purpose is yet to be found. Based on the biology of the tumor, some radiopharmaceuticals have been studied for diagnosis and also for therapy in those patients. The aim of this review is to describe the radiopharmaceuticals used for diagnosis and treatment until today and the role of each of them in medical care. In conclusion, the medullary thyroid cancer is a rare tumor and the review shows that despite all studies there is still no consensus on the importance of nuclear medicine in the diagnosis and treatment of these patients. Further studies are still needed.

This study was performed to evaluate the usefulness of bone tracer 99mTC-MDP in detecting renal disorders by imaging of renal cortex for patients with cortical defect and estimation of split renal function (SRF) as compared with renal cortical imaging agent 99mTC-DMSA. In this study 23 patients (6 males, 17 females) with range age of 16y -75y (mean 45.6y ± 17.4y), and a total of 46 studies (using both 99mTC-DMSA and 99mTC-MDP per patient for left and right kidneys) were performed for detecting renal disorders. Both studies were performed within 48 hours between each other. SRF was calculated in all cases from renal uptake of the tracers into the region of interest by using computer acquired data of gamma camera. For detecting renal cortex abnormalities, all cortical scars and defects scars seen on 99mTc-DMSA scan were also detected by 99mTc-MDP.

The results showed that the non visualized kidney on 99mTC-DMSA scan was also non visualized on 99mTC-MDP. Also, there was a high correlation between SRF values obtained from 99mTC-MDP and 99mTC-DMSA, where (p>0.01, r= 0.93 for left kidney and r=0.0.92 for right kidney).

The similar SRF values of 99mTC-MDP and 99mTC-DMSA allow to use of 99mTC-MDP tracers for detecting both of bone and renal abnormalities.

In this study tagging of 99mTc with PZN was examined with regards to different concentration of PZN, stannous chloride, 99mTc and pH ranges from 5.00-6.00. The suitability of the 99mTc labeled PZN was assessed in terms of percent radiochemical purity (%RCP) yield in normal saline at concentration value of the stannous chloride as 120 mg, stability in serum (in vitro) at 37°C at different intervals, in vitro up take by live and heat killed E. coli, biodistribution behavior in artificially E. coli (live and heat killed) infected animal model rat and scintigraphic accuracy in artificially E. coli infected animal model rabbit. Maximum %RCP yields of 98.25 ± 0.26% was observed after 30 m of labeling using 2 mg of PZN, 125 μg stannous chloride, 2.5 m Ci sodium pertechnetate and pH 5.3. The labeled PZN showed stable profile in serum at 37°C with a total decay of 16.40 ± 0.18%.

The labeled PZN showed 72.55 ± 0.90% maximum bacterial uptake after 90 min in live and in case of heat killed E. coli, no significant uptake was seen. The labeled PZN showed 14.75 ± 0.40% absorption and accumulation in the infected muscle of the rat infected with live E. coli and infected to normal muscle ratio was 6:1. Scintigraphically, it was observed that after few minutes, the activity accumulated in the infected muscle was more than the others sites. The instant investigation substantiated that labeling PZN through this technique as compared to 99mTcV:N~ and 99mTc(CO)3~ showed almost analogous %RCP yield, stability in serum at 37°C, in vitro binding with E. coli, biodistribution profile in animal modal rats and scintigraphic accuracy in animal model rabbit.

A 32-year-old female patient admitted with right hip pain that was diagnosed of diffuse PVNS in right hip joint with magnetic resonance imaging. She went arthoscopic synovectomy for this lesion. Six weeks after the surgery, RS was applied. Before RS three phase bone scintigraphy was taken and minimal increased perfusion, minimal hyperemias were detected in right hip joint. On the late phase images relatively increased activity accumulation in right hip joint was seen. 3 mCi (111 MBq) yttrium-90 colloid was administered to the hip joint under fluoroscopy guidance. The Bremsstrahlung imaging was performed using a gamma camera equiped four hours after RS. In the six and nine months control after RS patient did not have any complaints. In nine months control, MRI and three phase bone scintigraphy were taken and no pathologic radioactivity accumulation on bone scan, any residual lesion or recurrence on MRI was present. To our best knowledge, this is the first case with arthroscopic surgery and adjuvant RS with Y-90 colloid which rarely applied in routine practice for treatment of diffuse PVNS of the hip.