雙核素心肌斷層顯像方法儀器

1、雙核素心肌斷層顯像方法,,儀器 ◆采用 elscint varicam 雙探頭SPECT (GE公司提供），配備超高能準(zhǔn)直器 (UHEC)。 ◆雙探頭采用90度垂直位(L-mode) 進(jìn)行分步采集。,,體位◆患者取仰臥位，雙手抱頭充分暴 露心前區(qū)?！籼筋^盡量貼近患者以最大限度增 加計(jì)數(shù)，減少噪聲。,,,采集條件采 集 程 序 為 系統(tǒng) 自 帶雙核素?cái)鄬硬?/p>

2、集程序 ( HEI/MIBI ECT Dual Isotope) ; 能峰為140kev 及 511kev、窗寬20%；矩陣64×64 ；采集時(shí)間為 30-35秒；探頭旋轉(zhuǎn)角度為90度(由左前至右后共180度）、每3度一幀分步采集。,,處理?xiàng)l件 采用濾波反投影法進(jìn)行重建，分別得到 水平長(zhǎng)軸、短軸及垂直長(zhǎng)軸三個(gè)斷面的 圖象；濾波函數(shù)采用butterworth,截止頻 率為0.45, 權(quán)重值為

3、4.5。,,血糖調(diào)節(jié),靜脈注射99Tcm-MIBI20mCi，45分鐘后測(cè)定患者的血糖濃度，將血糖濃度控制在7.9-8.8mmol/L之間。如果患者血糖濃度低于7.8mmol/L需要口服葡萄糖補(bǔ)充，如果血糖濃度高于8.9mmol/L則需要皮下注射胰島素降低血糖濃度。在血糖控制后10-15min，靜脈注射18F-FDG 6-8mCi，一小時(shí)后顯像。,,Case 1 LJZ,History : 67 – year - old m

4、ale, 2 years history of progressive typical exertional angina and inferior myocardial infarction.Cardiac risk factors included age, known history of CAD. The resting ECG revealed sinus bradycardia and evidence of

5、an old inferior myocardial infarction.,,Clinical course,Cardiac catheterization revealed a 100% LAD lesion and 90% narrowing of the right coronary artery.The patient underwent successful coronary bypass surgery .,,DI

6、SA imaging protocol,MIBI Plasma glucose FDG DISA 0′ 40′ 60′ 120′(min)Plasma glucose 140~160mg%.Plasma glucose level ? 140mg%, 50-75g glucose. Diabetes mellit

7、us, Insulin was subcutaneously injected according to the plasma glucose.,,,,,,,Case 2 WCD,A 62-year-old female with no past cardiac history presented with a 6 month history of exertional chest pain with both typica

8、l and atypical feature. Cardiac risk factors included hypercholesterolemia, family history of CAD.The resting ECG revealed normal.,,Hospital course,Cardiac catheterization : LAD 90% , LCX 80%, RCA 60%Cli

9、nical diagnosis: CAD Angina pectorisThe patient underwent CABG.,,Case 3 LJX,44-year-old male without known CAD presented with a 3 year history of atypical chest pain and dyspnea on

10、 exertion. Cardiac risk factors included cigarette smoking.No history of hypertension , diabetes mellitus .ECG revealed nonsepecific T wave abnormalities.Echocardiography revealed dilated left ventricle

11、 and atrium.Severe left ventricular hypokinesis.LVEF=25%,,Clinical course,Cardiac catheterization : Three coronary vessels.There was a 80% LAD lesion, 90% narrow of the left circumflex artery and 50% lesio

12、nin the right coronary artery . One month later the patient underwent CABG.,,Case 4 GTB,A 58-year-old man presented with mild congestive heart failure 1 year. He had often experienced a chest tig

13、htness, and shortness of breath. Cardiac risk factors included age and hypercholesterolemia.The resting ECG revealed LBBB.The resting MIBI - FDG SPECT(DISA) was performed.,,Clinical course,Cardiac catheteriz

14、ation: three coronary artery disease , LAD 80% LCX 60% RCA 95%The patient underwent PTCA of mid RCA lesion.,,Case 5,A man 52 - year - old presented

15、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

16、 resting ECG revealed evidence of an old anterior myocardial infarction.,,Clinical course,Cardiac Catheterization:100% LAD lesion ,100% proximal circumflex marginal lesion. Ventriculogram revealed an anteroapic

17、al aneurysm.The patient underwent CABG andneurysmectomy.,,Case 6 CBK,A 66-year -old without know CAD presented with recent onset of chest fullness on exertion, which was relieved with rest. Cardiac risk factor

18、s included diabetes mellitus and tobacco use . The resting ECG was normal.,,Clinical course,Cardiac catheterization: 90% stenosis of LAD.The patient underwent successful of PTCA and stent of the proximal LAD lesi

19、on.,,Case 7 Hsyi,A 67 – year - old male presented with atypical chest pain and shortness of breath . He had experienced an anterior myocardial infarction 8 year prior. He had stopped smo

20、king cigarettes,and his hyperlipidemia and hypertension were well controlled with medication. The resting ECG revealed an old anteriormyocardial infarction.,,Hospital course,Cardiac catheterization: LAD 100% ,LCX m

21、id 90% stenosis.The patient was treated with medicine.,,Case 8 Mzl,A 46 - year - old male with a history of myocardial infarction 2 years. Cardiac risk factors included cigarette smoking .The resting ECG reve

22、aled an old inferior myocardial infarction.,,Case 9 Slt,A 49- year-old male had had an anterior myocadial infarction 1 year previously.Recently he began to hypotension and mild congestive heart failure.Cardiac

23、risk factors: age, positive family of CAD.,,Hospital course,Cardiac catheterization: (1) LAD 100% occulsion; (2) anteroapical aneurysm. Cardiac death, one month later.,,Case 10,A 58-years-old male

24、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..,,Hospital

25、course,Coronary angiography showed three vesslesstenosis. LAD 70% LCX 60% RCA 95% The patient underwent PTCA of RCA.,,Cedars-Sinai法門控心肌斷層顯像,,,結(jié)果,左室局部功能比較 77例患者

26、的539段心肌節(jié)段中，門控MIBI顯像和LVG的符合率為82.9%；門控FDG顯像和LVG的符合率為78.9%。,,LVG和門控MIBI比較,門控MIBI LVG 0 1 2 3 0 249 19 10 0 1

27、 0 98 18 0 2 0 26 61 9 3 0 0 12 39兩者符合率達(dá)82.9%,,,,,,,LVAG和門控FDG比較,門控MIBI LVG

28、 0 1 2 3 0 231 23 14 8 1 0 98 18 0 2 0 21 66

29、 9 3 0 0 21 30兩者的符合率為78.9%,,,,,,造影結(jié)果,患者于2000年11月5日行冠狀動(dòng)脈+左心室造影，11月10日行門控雙核素顯像。造影發(fā)現(xiàn)LAD 狹窄30-40% ，RCA（-），LCX（-）；LVEF=38%，前側(cè)壁、心尖部室壁瘤形成。,,造影結(jié)果,2001年2月2日行冠狀動(dòng)脈+左心室造影：RCA全程斑塊