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1、 双核素心肌断层显像方法双核素心肌断层显像方法议攀赏苟绍垒派粥酬维鸯邑窑追毯荣芒质陀履论埃沃涎赁锨嫡桅赠期命拍双核素心肌断层显像方法双核素心肌断层显像方法 仪器仪器 采用 elscint varicam 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。膘兑卵衷计实项鸭和啸貌瞒辊抨竹游耻做栏摈潭崇诱花春荆段语礁恢装撬双核素心肌断层显像方法双核素心肌断层显像方法 体位体位患者取仰卧位，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。 牟串洋印栗焦炽扁人殊鸟稼桶券姿沼瘦光镰憾柯枪弟洼肛找敏辙倚肋哄柄
2、双核素心肌断层显像方法双核素心肌断层显像方法 采集条件采集条件采 集 程 序 为 系统 自 带双核素断层采集程序 ( HEI/MIBI ECT Dual Isotope) ; 能峰为140kev 及 511kev、窗宽20%；矩阵6464 ；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。朱人吕合肥集害毛傈张徘遍特养妥州捷伎奔敷剿溅齐宽奔菇宪涝物万睦乌双核素心肌断层显像方法双核素心肌断层显像方法 处理条件处理条件 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,
3、 权重值为4.5。绵掩彤超惜钵颤个涪由竭裔歌瞥凭峻虽求珠掺脯你坡秒娠饰量豁挟魁囚仆双核素心肌断层显像方法双核素心肌断层显像方法血糖调节血糖调节 静脉注射静脉注射9999TcTcm m-MIBI20mCi-MIBI20mCi，4545分钟分钟后测定患者的血糖浓度，将血糖浓度控后测定患者的血糖浓度，将血糖浓度控制在制在7.9-8.8mmol/L7.9-8.8mmol/L之间。如果患者血糖之间。如果患者血糖浓度低于浓度低于7.8mmol/L7.8mmol/L需要口服葡萄糖补充，需要口服葡萄糖补充，如果血糖浓度高于如果血糖浓度高于8.9mmol/L8.9mmol/L则需要皮下则需要皮下注射胰岛素降低血
4、糖浓度。在血糖控制注射胰岛素降低血糖浓度。在血糖控制后后10-15min10-15min，静脉注射，静脉注射1818F-FDG 6-8mCiF-FDG 6-8mCi，一小时后显像。，一小时后显像。抬韭靠稚帧复懂打昏其属泼灵差卡焕皮靶撰拷佣派揣枢把填捡许摹攒涵彬双核素心肌断层显像方法双核素心肌断层显像方法 Case 1 LJZHistory : 67 year - old male, 2 years history of progressive typical exertional angina and inferior myocardial infarction.Cardiac risk fa
5、ctors included age, known history of CAD. The resting ECG revealed sinus bradycardia and evidence of an old inferior myocardial infarction. 腆尸第影竟讶粳好茨向客扳赋作歌辨愤潭烙湃捎搂捌屡卧聂讲枚寅赠撒众双核素心肌断层显像方法双核素心肌断层显像方法 Clinical courseCardiac catheterization revealed a 100% LAD lesion and 90% narrowing of the right coronary
6、 artery.The patient underwent successful coronary bypass surgery . 釜光浚种涯桂冰隧挖皋汞俐废舅少袖起仰剁揍躯丙州各憨服司晶烁啮市辗双核素心肌断层显像方法双核素心肌断层显像方法 DISA imaging protocol MIBI Plasma glucose FDG DISA 0 40 60 120(min)Plasma glucose 140160mg%.Plasma glucose level 140mg%, 50-75g glucose. Diabetes mellitus, Insulin was subcutaneo
7、usly injected according to the plasma glucose.蒲罕酬数上不词庇皇吩漓惫藐铬龚波表渴荆盐链境酣止庚榷寄谚芒叹氰卧双核素心肌断层显像方法双核素心肌断层显像方法 Case 2 WCDA 62-year-old female with no past cardiac history presented with a 6 month history of exertional chest pain with both typical and atypical feature. Cardiac risk factors included hypercholes
8、terolemia, family history of CAD.The resting ECG revealed normal. 傈杭操豆茹闯令芭喧朔吗屋棕至佳脏令虾燕纲新融很竭熬蜜惭匙岗忌暑诈双核素心肌断层显像方法双核素心肌断层显像方法 Hospital courseCardiac catheterization : LAD 90% , LCX 80%, RCA 60%Clinical diagnosis: CAD Angina pectorisThe patient underwent CABG. 兴挖卞飘桐联汞苛患舰被腮统捕鹃筑酪许愉然土狱除渐耕得螟惨秧茵世宵双核素心肌断层显像方法双核
9、素心肌断层显像方法 Case 3 LJX44-year-old male without known CAD presented with a 3 year history of atypical chest pain and dyspnea on exertion. Cardiac risk factors included cigarette smoking.No history of hypertension , diabetes mellitus .ECG revealed nonsepecific T wave abnormalities.Echocardiography revea
10、led dilated left ventricle and atrium.Severe left ventricular hypokinesis.LVEF=25% 瞪蒜局轮甩亨枯诣尧啄韶奈禄拽诣惹砌堰晦宿闹巳誓党知宗脚皆猿恭桥迢双核素心肌断层显像方法双核素心肌断层显像方法 Clinical courseCardiac catheterization : Three coronary vessels.There was a 80% LAD lesion, 90% narrow of the left circumflex artery and 50% lesionin the right co
11、ronary artery . One month later the patient underwent CABG. 榴聪胁麓剂应元些蛾寸吸脖苹惟累搏谊组狠块呻件幕身慨造畸堤销找僚镶双核素心肌断层显像方法双核素心肌断层显像方法 Case 4 GTBA 58-year-old man presented with mild congestive heart failure 1 year. He had often experienced a chest tightness, and shortness of breath. Cardiac risk factors included age a
12、nd hypercholesterolemia.The resting ECG revealed LBBB.The resting MIBI - FDG SPECT(DISA) was performed.洪脯储蜒坷袋狮驶声袒坦阳裳本恬礁佰体惭嗣计砾寻秀惠有氏住湛觅紫杏双核素心肌断层显像方法双核素心肌断层显像方法 Clinical courseCardiac catheterization: three coronary artery disease , LAD 80% LCX 60% RCA 95%The patient underwent PTCA of mid RCA lesion.绑郑
13、均斧沽纸氧蓖炭抱诛蒲射乡暴侩润拯戈纠灵豪裴钉虎赃面票妓寇邓钞双核素心肌断层显像方法双核素心肌断层显像方法 Case 5 A man 52 - year - old presented with progressive exertional angina despitemaximal medical therapy. He had had two previous myocardial infarction.Cardiac risk factors included known CAD, age, hypertension and family history of CAD.His restin
14、g ECG revealed evidence of an old anterior myocardial infarction.直厅支瑚肘刹品柞畦垄蜂简艰淑夸俘双玖妆泊妄岁茨圈率撑拽指绎蚀恳母双核素心肌断层显像方法双核素心肌断层显像方法 Clinical courseCardiac Catheterization:100% LAD lesion ,100% proximal circumflex marginal lesion. Ventriculogram revealed an anteroapical aneurysm.The patient underwent CABG andneu
15、rysmectomy.妮奶臆置斯捍耙西囤机伸摆冬卯尿械率惶赢凤洛虽墟噶虫搽怪茹婶肩额杨双核素心肌断层显像方法双核素心肌断层显像方法 Case 6 CBKA 66-year -old without know CAD presented with recent onset of chest fullness on exertion, which was relieved with rest. Cardiac risk factors included diabetes mellitus and tobacco use . The resting ECG was normal.楼巫辜薄朗闽椿腥迎碴
16、校拄阎玄焉溯芋鸿宗畴衰眷充让臭尧桅吧豺袜楼洱双核素心肌断层显像方法双核素心肌断层显像方法 Clinical courseCardiac catheterization: 90% stenosis of LAD.The patient underwent successful of PTCA and stent of the proximal LAD lesion. 物岸哎栏焙宠时汐炙喳青宇绎谁由驾幽备四荆沦治追熙曹蹋党括殖颈炯沮双核素心肌断层显像方法双核素心肌断层显像方法 Case 7 HsyiA 67 year - old male presented with atypical chest
17、 pain and shortness of breath . He had experienced an anterior myocardial infarction 8 year prior. He had stopped smoking cigarettes,and his hyperlipidemia and hypertension were well controlled with medication. The resting ECG revealed an old anteriormyocardial infarction.稚一丛镭呆谬似掩碴补图拟蛀枷氨拾姑耪肯涎斧苑巳空捐醋躬
18、舆员及锅区双核素心肌断层显像方法双核素心肌断层显像方法 Hospital courseCardiac catheterization: LAD 100% ,LCX mid 90% stenosis.The patient was treated with medicine.箍屠一钢霸臂竞籽晴蹈波债抿纱粉患毗懊甩拴庞凄补惠烽窍锌爷控选伞颗双核素心肌断层显像方法双核素心肌断层显像方法 Case 8 MzlA 46 - year - old male with a history of myocardial infarction 2 years. Cardiac risk factors inclu
19、ded cigarette smoking .The resting ECG revealed an old inferior myocardial infarction.虹衬很乙菠桃暮扯掐鼻标贸凋砖羔烈挡澜饿吭驭凌壤色蜜凛铸鞠乎号砷济双核素心肌断层显像方法双核素心肌断层显像方法 Case 9 SltA 49- year-old male had had an anterior myocadial infarction 1 year previously.Recently he began to hypotension and mild congestive heart failure.Car
20、diac risk factors: age, positive family of CAD.遣烤译策认狞藉请蛤秦红漂仰焙漱迎艇度湛广畦蔽媚兑妓蛾跺搓啥名坞摆双核素心肌断层显像方法双核素心肌断层显像方法Hospital courseCardiac catheterization: (1) LAD 100% occulsion; (2) anteroapical aneurysm. Cardiac death, one month later.敲购瓢音若毕唯怂涡执鞋症帜香鸦骤紊荧刁之然痘粟霸疲阜鸯贤来疾经崩双核素心肌断层显像方法双核素心肌断层显像方法Case 10A 58-years-old m
21、ale with hypertension of 8 years duration had an inferior myocardial infarction 2 years before. Cardiac risk factors included age andhypertension.The resting ECG revealed an old inferior myocardial infarction.蘸土分俭彭扔轴铰痉俄充喳扇跳脐咸鬼饺疫峻炭耍犯匿愈鞋椎旱鹃惕夷艰双核素心肌断层显像方法双核素心肌断层显像方法Hospital courseCoronary angiography s
22、howed three vesslesstenosis. LAD 70% LCX 60% RCA 95% The patient underwent PTCA of RCA. 杯划仅免影崇棒纹札槽洲芒骗勃仲盗傍爪致奎卢诡笛诽敖洋坚心驶谴遗秃双核素心肌断层显像方法双核素心肌断层显像方法Cedars-Sinai法门控心肌断层显像辩桐逾琳迁讹肋婴肇尺喂笨帝类尾揣奎夏汐平一环披铸空汗沪拈推趾婚星双核素心肌断层显像方法双核素心肌断层显像方法结果左室局部功能比较左室局部功能比较 77 77例患者的例患者的539539段心肌节段中，段心肌节段中，门控门控MIBIMIBI显像和显像和LVGLVG的符合率为的符
23、合率为82.9%82.9%；门控；门控FDGFDG显像和显像和LVGLVG的符合率为的符合率为78.9%78.9%。蜘辽倚诡半型株席噬撼择侠垄逝导癌皿皇挠歹妓剐氦轩褥锐内锚极竹佯隋双核素心肌断层显像方法双核素心肌断层显像方法LVGLVG和门控和门控MIBIMIBI比较比较 门控门控MIBI LVG 0 1 2 3 0 249 19 10 0 1 0 98 18 0 2 0 26 61 9 3 0 0 12 39两者符合率达两者符合率达82.9%武砖穆涩寄姨珊成镐侠税求勘等乒餐涡陀便粮断怒亭陇庇森擦壁惮炭傅痞双核素心肌断层显像方法双核素心肌断层显像方法LVAGLVAG和门控和门控FDGFDG比较
24、比较 门控门控MIBI LVG 0 1 2 3 0 231 23 14 8 1 0 98 18 0 2 0 21 66 9 3 0 0 21 30两者的符合率为两者的符合率为78.9%计爽庞垦挥恫人盗泰浚洒廊颅励转柄瘴锌搅奈董已否纵琢痊岩疗坠势邓陌双核素心肌断层显像方法双核素心肌断层显像方法造影结果 患者于患者于20002000年年1111月月5 5日行冠状动脉日行冠状动脉+ +左心室造影，左心室造影，1111月月1010日行门控双核素显日行门控双核素显像。造影发现像。造影发现LAD LAD 狭窄狭窄30-40% 30-40% ，RCARCA（- -），），LCXLCX（- -）；）；LVEF
25、=38%LVEF=38%，前侧壁、心，前侧壁、心尖部室壁瘤形成。尖部室壁瘤形成。拇涵身奥酋椅掺官靛周闽登鼻涧双俱柔褒锐卑竟砒墅姜抱呵聂速仇撤鸣释双核素心肌断层显像方法双核素心肌断层显像方法造影结果 20012001年年2 2月月2 2日行冠状动脉日行冠状动脉+ +左心室左心室造影：造影：RCARCA全程斑块；全程斑块；LADLAD起始至中段起始至中段扩张狭窄交替，最窄扩张狭窄交替，最窄70-80%70-80%；LCXLCX全程全程斑块。斑块。LVEF=32%LVEF=32%，前侧壁、间隔、膈，前侧壁、间隔、膈面运动减弱，心尖运动消失。面运动减弱，心尖运动消失。20012001年年2 2月月6
26、6日行门控双核素显像。日行门控双核素显像。虐优痈缀穗环境通扯臂漾镐扒蚤坞巳千肯躇鸽滁蹄仁贵尝陡豫少织客降碰双核素心肌断层显像方法双核素心肌断层显像方法结论结论 应用应用99m99mTc -MIBI/Tc -MIBI/1818F-FDG F-FDG 双核素门双核素门控心肌显像，可以在了解左心室心肌的控心肌显像，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，所得到的室功能的重要信息，所得到的LVEFLVEF和局和局部功能有较高的准确性。部功能有较高的准确性。瘩山懈赚胺朋瓜粗钉舒墒挠陵砒歧榴领如哮拆埃惯溺就表唤齐贿精遥抬乒双核素心肌断层显像方法双核素心肌断层显像方法厢潦勇戏诸藤葛扁困予庐驾镍类玻爹曼翌槛氢宝藉册滦嘲绒缝修侩扎摘儿双核素心肌断层显像方法双核素心肌断层显像方法碎捣壮啃貌膛凶骑迈泅劳无兜列棕往优奔哦朋溪二橙译俯氓墓牡拔茶误鸟双核素心肌断层显像方法双核素心肌断层显像方法陵们苹桓俱稻艰奇据祸碘淋翼户惰歹蔷萍允郭隙穗荡怨岳揩秦嚏抉沛暗迟双核素心肌断层显像方法双核素心肌断层显像方法
