Brain scintigraphy

What is brain scintigraphy?

Brain scintigraphy is a nuclear medicine procedure in which a small amount of radioactive particles is injected into a vein, usually in the arm, and their distribution in the brain is made visible through images taken with a gamma camera. Various brain disorders, such as tumors, epilepsy foci, as well as Parkinson's disease and types of dementia, can be diagnosed using different variations of this procedure. Brain scintigraphy is also useful for monitoring the progression of already known conditions.

The procedure is covered by statutory and private health insurance when medically indicated and is easy to perform, with minimal pain and risk for the patient.

What can brain scintigraphy reveal?

Brain scintigraphy makes the metabolic activity of the brain visible. It can show areas with particularly high or low metabolic activity, or detect a disturbance of the blood-brain barrier. These conditions occur in various diseases, such as:

• Brain tumors (benign or malignant)
• TIA (Transient Ischemic Attack)
• Delayed Ischemic Neurological Deficit (DIND)
• Dementia-related diseases, especially Alzheimer's disease
• Brain hemorrhages
• Brain injuries
• Epileptic foci

Furthermore, the perfusion reserve can be determined in the case of carotid stenosis (narrowing of the carotid arteries due to arteriosclerosis).

A special variant of brain scintigraphy called DaTscan or Dopamine Transporter Scan, examines the dopamine-releasing nerve cells of the brain. It is used to differentiate essential tremor, a very common movement disorder whose prevalence increases with age, from other conditions like Parkinson’s disease or multiple system atrophy (MSA), as tremor often serves as a leading symptom in all of these conditions. Unlike Parkinson’s disease or MSA, essential tremor does not involve damage to dopamine-releasing cells. An abnormal DaTscan can rule out Parkinson’s disease with 97% certainty.

Other diseases such as Lewy body dementia or Huntington's chorea, which also affect the dopamine system, can be assessed using the DaTscan.

What preparations are required for brain scintigraphy?

Patients do not need to fast for a brain scintigraphy and can eat and drink normally. However, some medications that could potentially interact with the injection given during the procedure need to be stopped beforehand. These include:

• Antidepressants
• Neuroleptics
• Dopamine agonists and L-Dopa
• Anticholinergics
• Psychostimulants

Before a DaTscan, the patient takes medication which reduces the uptake of iodine into the thyroid gland in the form of drops or a tablet. This prevents the radioactive iodine molecules from accumulating in the thyroid gland.

It is important to note that the examination cannot be performed if the patient is pregnant. An iodine allergy is also an absolute contraindication for DaTscan. Perfusion scintigraphy, however, which assesses metabolism, does not use iodine but instead uses technetium or gallium, making it safe to perform even for patients with an iodine allergy.

If a brain scintigraphy has already been carried out in the last three months, a new examination should be avoided where possible because of the radiation exposure. If a brain scintigraphy is urgently needed for a breastfeeding woman, breastfeeding must be interrupted for 48 hours afterward to avoid exposing the child to the radioactive radiation. For this reason, close contact with children and pregnant women should also be avoided for the rest of the day. A distance of one meter is sufficient for radiation protection. To minimize radiation exposure to the body, it can be helpful to drink plenty of fluids after the brain scintigraphy. Additionally, urinating, when possible, can help speed up the elimination of the radioactive particles.

How does brain scintigraphy work?

First, a radioactively labeled substance is injected into a vein. In a DaTscan, radioactive iodine is used to label a dopamine receptor ligand. For perfusion scintigraphy, technetium or gallium is used.

The radioactive particles take several hours to cross the blood-brain barrier and spread throughout the brain.

After the waiting period, images are taken with a gamma camera for about half an hour in a lying position. This special camera makes radioactive radiation visible, showing the exact distribution of the injected substance in the brain. The images are then analyzed and interpreted using a computer program.

Apart from the venous injection which is mandatory, this is a completely painless procedure.

Are there risks or side effects with brain scintigraphy?

Brain scintigraphy is a very safe procedure overall with very few risks and side effects. However, complications may rarely occur.

There is a possibility of an allergic reaction to iodine during a DaTscan examination. An allergic reaction to technetium or gallium is significantly rarer. Furthermore, the DaTscan may rarely cause headaches, skin tingling, dizziness or an increased appetite.

The radiation exposure from brain scintigraphy is roughly comparable to that of a CT scan of the chest, or two to three times the average natural radiation exposure per year in Germany. Statistically speaking, any exposure to radiation increases the risk of cancer.

Which doctors & clinics specialize in brain scintigraphy?

Given that the presumed diagnoses that require brain scintigraphy are neurological conditions, the indication for this procedure is mainly given by neurologists to confirm or rule out such diagnoses.

However, the planning, execution and evaluation of the examination is carried out by nuclear medicine specialists and can be performed either in the nuclear medicine department of a clinic or in a nuclear medicine practice.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of brain scintigraphy. They are looking forward to and are ready to address your questions and treatment requests.