The role of nuclear medicine in central nervous system evaluation

Anatomical imaging modalities such as CT and MRI are essential for evaluating central nervous system (CNS) disorders by providing detailed visualization of structural abnormalities. Molecular and functional imaging lack detailed anatomical delineation but offer complementary insight into pathologic processes involved in a disease that is not discernable in anatomical imaging. The design of molecular and functional imaging studies for CNS disorders is driven by their underlying pathophysiology. ¹⁸F-FDG is used to evaluate neuronal metabolism, ^99mTc-based radiotracers are employed to assess brain perfusion patterns, and CSF-binding tracers are used to detect cerebrospinal fluid abnormalities. Radiopharmaceuticals that target specific receptors or pathological biomarkers enable disease-specific imaging, such as amyloid and tau PET scans in dementia, somatostatin receptor imaging with DOTATATE PET in meningiomas, and dopamine transporter imaging with DaT scan in parkinsonian syndromes. This review provides a comprehensive overview of key nuclear imaging techniques and commonly utilized radiotracers for assessing CNS pathologies. It also briefly highlights emerging trends in the role of nuclear medicine within neuroimaging, including the expanding application of theranostics for specific brain tumors.