雙核素心肌斷層顯像方法雙核素心肌斷層顯像方法1

儀器

◆采用elscintvaricam雙探頭SPECT(GE公司提供），配備超高能準直器(UHEC)。

◆雙探頭采用90度垂直位(L-mode)進行分步采集。儀器2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數(shù)，減少噪聲。

體位3

采集條件采集程序為系統(tǒng)自帶雙核素斷層采集程序(HEI/MIBIECTDualIsotope);能峰為140kev及511kev、窗寬20%；矩陣64×64；采集時間為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。采集條件4

處理條件采用濾波反投影法進行重建，分別得到水平長軸、短軸及垂直長軸三個斷面的圖象；濾波函數(shù)采用butterworth,截止頻率為0.45,權(quán)重值為4.5。處理條件5血糖調(diào)節(jié)

靜脈注射99Tcm-MIBI20mCi，45分鐘后測定患者的血糖濃度，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-FDG6-8mCi，一小時后顯像。血糖調(diào)節(jié)靜脈注射99Tcm-MIBI20mC6

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

Case1LJZH7

ClinicalcourseCardiaccatheterizationrevealeda100%LADlesionand90%narrowingoftherightcoronaryartery.Thepatientunderwentsuccessfulcoronarybypasssurgery.

ClinicalcourseC8DISAimagingprotocol

MIBIPlasmaglucoseFDGDISA0′40′60′120′(min)Plasmaglucose140~160mg%.Plasmaglucoselevel

140mg%,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法門控

心肌斷層顯像Cedars-Sinai法門控

心肌斷層顯像27結(jié)果左室局部功能比較77例患者的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%。結(jié)果左室局部功能比較28LVG和門控MIBI比較

門控MIBILVG0123024919100109818020266193001239兩者符合率達82.9%LVG和門控MIBI比較29LVAG和門控FDG比較