双核素心肌断层显像方法课件

双核素心肌断层显像方法双核素心肌断层显像方法1

仪器

◆采用elscintvaricam双探头SPECT(GE公司提供），配备超高能准直器(UHEC)。

◆双探头采用90度垂直位(L-mode)进行分步采集。仪器2体位◆患者取仰卧位，双手抱头充分暴露心前区。◆探头尽量贴近患者以最大限度增加计数，减少噪声。

体位3

采集条件采集程序为系统自带双核素断层采集程序(HEI/MIBIECTDualIsotope);能峰为140kev及511kev、窗宽20%；矩阵64×64；采集时间为30-35秒；探头旋转角度为90度(由左前至右后共180度）、每3度一帧分步采集。采集条件4

处理条件采用滤波反投影法进行重建，分别得到水平长轴、短轴及垂直长轴三个断面的图象；滤波函数采用butterworth,截止频率为0.45,权重值为4.5。处理条件5血糖调节

静脉注射99Tcm-MIBI20mCi，45分钟后测定患者的血糖浓度，将血糖浓度控制在7.9-8.8mmol/L之间。如果患者血糖浓度低于7.8mmol/L需要口服葡萄糖补充，如果血糖浓度高于8.9mmol/L则需要皮下注射胰岛素降低血糖浓度。在血糖控制后10-15min，静脉注射18F-FDG6-8mCi，一小时后显像。血糖调节静脉注射99Tcm-MIBI20mC6

Case1LJZHistory:67–year-oldmale,2yearshistoryofprogressivetypicalexertionalanginaandinferiormyocardialinfarction.Cardiacriskfactorsincludedage,knownhistoryofCAD.TherestingECGrevealedsinusbradycardiaandevidenceofanoldinferiormyocardialinfarction.

Case1LJZH7

ClinicalcourseCardiaccatheterizationrevealeda100%LADlesionand90%narrowingoftherightcoronaryartery.Thepatientunderwentsuccessfulcoronarybypasssurgery.

ClinicalcourseC8DISAimagingprotocol

MIBIPlasmaglucoseFDGDISA0′40′60′120′(min)Plasmaglucose140~160mg%.Plasmaglucoselevel140mg%,50-75gglucose.Diabetesmellitus,Insulinwassubcutaneouslyinjectedaccordingtotheplasmaglucose.DISAimagingprotocol9

Case2WCDA62-year-oldfemalewithnopastcardiachistorypresentedwitha6monthhistoryofexertionalchestpainwithbothtypicalandatypicalfeature.Cardiacriskfactorsincludedhypercholesterolemia,familyhistoryofCAD.TherestingECGrevealednormal.

Case2WC10HospitalcourseCardiaccatheterization:LAD90%,LCX80%,RCA60%Clinicaldiagnosis:CADAnginapectorisThepatientunderwentCABG.

HospitalcourseC11Case3LJX44-year-oldmalewithoutknownCADpresentedwitha3yearhistoryofatypicalchestpainanddyspneaonexertion.Cardiacriskfactorsincludedcigarettesmoking.Nohistoryofhypertension,diabetesmellitus.ECGrevealednonsepecificTwaveabnormalities.Echocardiographyrevealeddilatedleftventricleandatrium.Severeleftventricularhypokinesis.LVEF=25%

Case3LJX412ClinicalcourseCardiaccatheterization:Threecoronaryvessels.Therewasa80%LADlesion,90%narrowoftheleftcircumflexarteryand50%lesionintherightcoronaryartery.OnemonthlaterthepatientunderwentCABG.

Clinicalcourse13Case4GTBA58-year-oldmanpresentedwithmildcongestiveheartfailure1year.Hehadoftenexperiencedachesttightness,andshortnessofbreath.Cardiacriskfactorsincludedageandhypercholesterolemia.TherestingECGrevealedLBBB.TherestingMIBI-FDGSPECT(DISA)wasperformed.Case4GTBA14ClinicalcourseCardiaccatheterization:threecoronaryarterydisease,LAD80%LCX60%RCA95%ThepatientunderwentPTCAofmidRCAlesion.Clinicalcourse15Case5

Aman52-year-oldpresentedwithprogressiveexertionalanginadespitemaximalmedicaltherapy.Hehadhadtwopreviousmyocardialinfarction.CardiacriskfactorsincludedknownCAD,age,hypertensionandfamilyhistoryofCAD.HisrestingECGrevealedevidenceofanoldanteriormyocardialinfarction.Case5A16ClinicalcourseCardiacCatheterization:100%LADlesion,100%proximalcircumflexmarginallesion.Ventriculogramrevealedananteroapicalaneurysm.ThepatientunderwentCABGandneurysmectomy.Clinicalcours17Case6CBKA66-year-oldwithoutknowCADpresentedwithrecentonsetofchestfullnessonexertion,whichwasrelievedwithrest.Cardiacriskfactorsincludeddiabetesmellitusandtobaccouse.TherestingECGwasnormal.Case6C18ClinicalcourseCardiaccatheterization:90%stenosisofLAD.ThepatientunderwentsuccessfulofPTCAandstentoftheproximalLADlesion.Clinicalcour19Case7HsyiA67–year-oldmalepresentedwithatypicalchestpainandshortnessofbreath.Hehadexperiencedananteriormyocardialinfarction8yearprior.Hehadstoppedsmokingcigarettes,andhishyperlipidemiaandhypertensionwerewellcontrolledwithmedication.TherestingECGrevealedanoldanteriormyocardialinfarction.Case7HsyiA20HospitalcourseCardiaccatheterization:LAD100%,LCXmid90%stenosis.Thepatientwastreatedwithmedicine.HospitalcourseCa21Case8MzlA46-year-oldmalewithahistoryofmyocardialinfarction2years.Cardiacriskfactorsincludedcigarettesmoking.TherestingECGrevealedanoldinferiormyocardialinfarction.Case8MzlA422Case9SltA49-year-oldmalehadhadananteriormyocadialinfarction1yearpreviously.Recentlyhebegantohypotensionandmildcongestiveheartfailure.Cardiacriskfactors:age,positivefamilyofCAD.Case9SltA23HospitalcourseCardiaccatheterization:(1)LAD100%occulsion;(2)anteroapicalaneurysm.Cardiacdeath,onemonthlater.HospitalcourseCardiaccathete24Case10A58-years-oldmalewithhypertensionof8yearsdurationhadaninferiormyocardialinfarction2yearsbefore.Cardiacriskfactorsincludedageandhypertension.TherestingECGrevealedanoldinferiormyocardialinfarction..Case10A58-years-oldmalewit25HospitalcourseCoronaryangiographyshowedthreevesslesstenosis.LAD70%LCX60%RCA95%ThepatientunderwentPTCAofRCA.HospitalcourseCoronaryangiog26Cedars-Sinai法门控

心肌断层显像Cedars-Sinai法门控

心肌断层显像27结果左室局部功能比较77例患者的539段心肌节段中，门控MIBI显像和LVG的符合率为82.9%；门控FDG显像和LVG的符合率为78.9%。结果左室局部功能比较28LVG和门控MIBI比较

门控MIBILVG0123024919100109818020266193001239两者符合率达82.9%LVG和门控MIBI比较29LVAG和门控FDG比较

门控MIBILVG0123023123148109818020216693002130两者的符合率为78.9%LVAG和门控FDG比较30造影结果

患者于2000年11月5日行冠状动脉+左心室造影，11月10日行门控双核素显像。造影发现LAD狭窄30-40%，RCA（-），LCX（-）；LVEF=38%，前侧壁、心尖部室壁瘤形成。造影结果患者于2000年11月5日行冠状动脉31造影结果

2001年2月2日行冠状动脉+左心室造影：RCA全程斑块；LAD起始至中段扩张狭窄交替，最窄70-80%；LCX全程斑块。LVEF=32%，前侧壁、间隔、膈面运动减弱，心尖运动消失。2001年2月6日行门控双核素显像。造影结果2001年2月2日行冠状动脉+左心室造影：R32结论

应用99mTc-MIBI/18F-FDG双核素门控心肌显像，可以在了解左心室心肌的血流灌注和代谢情况的同时，提供左心室功能的重要信息，所得到的LVEF和局部功能有较高的准确性。结论应用99mTc-MIBI/18F-FD33双核素心肌断层显像方法课件34双核素心肌断层显像方法课件35双核素心肌断层显像方法课件36

双核素心肌断层显像方法双核素心肌断层显像方法37

仪器

◆采用elscintvaricam双探头SPECT(GE公司提供），配备超高能准直器(UHEC)。

◆双探头采用90度垂直位(L-mode)进行分步采集。仪器38体位◆患者取仰卧位，双手抱头充分暴露心前区。◆探头尽量贴近患者以最大限度增加计数，减少噪声。

体位39

采集条件采集程序为系统自带双核素断层采集程序(HEI/MIBIECTDualIsotope);能峰为140kev及511kev、窗宽20%；矩阵64×64；采集时间为30-35秒；探头旋转角度为90度(由左前至右后共180度）、每3度一帧分步采集。采集条件40

处理条件采用滤波反投影法进行重建，分别得到水平长轴、短轴及垂直长轴三个断面的图象；滤波函数采用butterworth,截止频率为0.45,权重值为4.5。处理条件41血糖调节

静脉注射99Tcm-MIBI20mCi，45分钟后测定患者的血糖浓度，将血糖浓度控制在7.9-8.8mmol/L之间。如果患者血糖浓度低于7.8mmol/L需要口服葡萄糖补充，如果血糖浓度高于8.9mmol/L则需要皮下注射胰岛素降低血糖浓度。在血糖控制后10-15min，静脉注射18F-FDG6-8mCi，一小时后显像。血糖调节静脉注射99Tcm-MIBI20mC42

Case1LJZHistory:67–year-oldmale,2yearshistoryofprogressivetypicalexertionalanginaandinferiormyocardialinfarction.Cardiacriskfactorsincludedage,knownhistoryofCAD.TherestingECGrevealedsinusbradycardiaandevidenceofanoldinferiormyocardialinfarction.

Case1LJZH43

ClinicalcourseCardiaccatheterizationrevealeda100%LADlesionand90%narrowingoftherightcoronaryartery.Thepatientunderwentsuccessfulcoronarybypasssurgery.

ClinicalcourseC44DISAimagingprotocol

MIBIPlasmaglucoseFDGDISA0′40′60′120′(min)Plasmaglucose140~160mg%.Plasmaglucoselevel140mg%,50-75gglucose.Diabetesmellitus,Insulinwassubcutaneouslyinjectedaccordingtotheplasmaglucose.DISAimagingprotocol45

Case2WCDA62-year-oldfemalewithnopastcardiachistorypresentedwitha6monthhistoryofexertionalchestpainwithbothtypicalandatypicalfeature.Cardiacriskfactorsincludedhypercholesterolemia,familyhistoryofCAD.TherestingECGrevealednormal.

Case2WC46HospitalcourseCardiaccatheterization:LAD90%,LCX80%,RCA60%Clinicaldiagnosis:CADAnginapectorisThepatientunderwentCABG.

HospitalcourseC47Case3LJX44-year-oldmalewithoutknownCADpresentedwitha3yearhistoryofatypicalchestpainanddyspneaonexertion.Cardiacriskfactorsincludedcigarettesmoking.Nohistoryofhypertension,diabetesmellitus.ECGrevealednonsepecificTwaveabnormalities.Echocardiographyrevealeddilatedleftventricleandatrium.Severeleftventricularhypokinesis.LVEF=25%

Case3LJX448ClinicalcourseCardiaccatheterization:Threecoronaryvessels.Therewasa80%LADlesion,90%narrowoftheleftcircumflexarteryand50%lesionintherightcoronaryartery.OnemonthlaterthepatientunderwentCABG.

Clinicalcourse49Case4GTBA58-year-oldmanpresentedwithmildcongestiveheartfailure1year.Hehadoftenexperiencedachesttightness,andshortnessofbreath.Cardiacriskfactorsincludedageandhypercholesterolemia.TherestingECGrevealedLBBB.TherestingMIBI-FDGSPECT(DISA)wasperformed.Case4GTBA50ClinicalcourseCardiaccatheterization:threecoronaryarterydisease,LAD80%LCX60%RCA95%ThepatientunderwentPTCAofmidRCAlesion.Clinicalcourse51Case5

Aman52-year-oldpresentedwithprogressiveexertionalanginadespitemaximalmedicaltherapy.Hehadhadtwopreviousmyocardialinfarction.CardiacriskfactorsincludedknownCAD,age,hypertensionandfamilyhistoryofCAD.HisrestingECGrevealedevidenceofanoldanteriormyocardialinfarction.Case5A52ClinicalcourseCardiacCatheterization:100%LADlesion,100%proximalcircumflexmarginallesion.Ventriculogramrevealedananteroapicalaneurysm.ThepatientunderwentCABGandneurysmectomy.Clinicalcours53Case6CBKA66-year-oldwithoutknowCADpresentedwithrecentonsetofchestfullnessonexertion,whichwasrelievedwithrest.Cardiacriskfactorsincludeddiabetesmellitusandtobaccouse.TherestingECGwasnormal.Case6C54ClinicalcourseCardiaccatheterization:90%stenosisofLAD.ThepatientunderwentsuccessfulofPTCAandstentoftheproximalLADlesion.Clinicalcour55Case7HsyiA67–year-oldmalepresentedwithatypicalchestpainandshortnessofbreath.Hehadexperiencedananteriormyocardialinfarction8yearprior.Hehadstoppedsmokingcigarettes,andhishyperlipidemiaandhypertensionwerewellcontrolledwithmedication.TherestingECGrevealedanoldanteriormyocardialinfarction.Case7HsyiA56HospitalcourseCardiaccatheterization:LAD100%,LCXmid90%stenosis.Thepatientwastreatedwithmedicine.HospitalcourseCa57Case8MzlA46-year-oldmalewithahistoryofmyocardialinfarction2years.Cardiacriskfactorsincludedcigarettesmoking.TherestingECGrevealedanoldinferiormyocardialinfarction.Case8MzlA458Case9SltA49-year-oldmalehadhadananteriormyocadialinfarction1yearpreviously.Recentlyhebegantohypotensionandmildcongestiveheartfailure.Cardiacriskfactors:age,positivefamilyofCAD.Case9SltA59HospitalcourseCardiaccatheterization:(1)LAD100%occulsion;(2)anteroapicalaneurysm.Cardiacdeath,onemonthlater.HospitalcourseCardiaccathete60Case10A58-years-oldmalewithhypertensionof8yearsdurationhadaninferiormyocardialinfarction2yearsbefore.Cardiacriskfactorsincludedageandhypertension.TherestingECGrevealedanoldinferiormyocardialinfarction..