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5/26/2018 y Hoc Hat Nhan Chan Doan - Ths Chuong
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Y H HT NHNH OTHS. NGUYN THNH CHNG
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BA NHM CHNH:1. NGHIM PHP THM D CHC
NNG2. GHI HNH NHP NHY CC C
QUAN, T CHC HOC TON C
TH3. CC NGHIM PHP INVITRO
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I-THM D CHC NNG:
THM D CHC NNG TUYN GIP:
- otptrung I-131 tituyngip
1.Ch nh
2.Chun bbnhnhn
3.o tptrung I-131 tituyngip sau 2h v 24h.
4.nh gi ktqu.
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II- GHI HNH NHP NHY:1. X HNH TUYN GIP:2. X HNH THN HNH TH V CHC NNG3. GHI HNH NO4. CHN ON BNH TIM MCH5. X HNH XNG
6. X HNH PHI7. X HNH GAN
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1. X HNH TUYN GIP:1.1. Nguyn l ghi hnh tuyngip: khnngbtIot vi
nngcao v gilu di trong tuyn.
1.2. Chnh
- Xc nhvtr, hnh dng, kch thcv cutrc TG.
- nhgi cc nhn TG.
- nhgi tnh trngchcnngcanhn TG.
- nhgi trcv sau phuthutbnhnhn ung thTG
- Cc trnghpvim TG
- Chnonphn bitcc u vng cv trung tht, TGlcch.
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1.3. Dcchtphng x: I-131; Tc-99m, I-1231.4. Thitbghi hnh: gamma camera, my SPECT1.5.nhgi ktqu:- TG bnh thng
- Nhngbtthng:
+ TG ph i nhngbnhnhn cnggip trng+ TG nh bnhnhn suy gip+ Cc nhn nng hocnhn lnh
+ Nhn c+ TG lcch+ Cc di cncaung thTG
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2. * X HNH THN HNH TH2.1. Nguyn l ghi hnh: sdngcc DCPX pht tia
Gamma, hpthu nhanh thn, tham gia vo qutrnh lc cuthn, chtitv bi xut cc ng
thn.2.2. Chnh:- Xc nhkch thc, vtr v giiphucathn- Nghi chnthngthn, u v nang thn
-Xc nhthnlcch
- nhgi hnh nhv chcnngthnghp- ivibnhnhn mncmvithuccnquang.2.3. Dcchtphng x: DMSA-Tc-99m
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2.4. Thitbghi hnh: my gamma camera, my SPECT
2.5.nhgi ktqu:
- Thnbnh thng
- Nhngbtthng:
+ Vng mnhthoc khuytHPX khi thnbtnthng: u, nang, nhimu, p xe, vchnthng, lao thn, .
+ Thnlcch.
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2. * X HNH THN CHC NNG:
2.1. Nguyn l: sdngcc DCPX l chtm ngbi xutduynhtra khicthl qua thn. Tim tnh mchsau ghihnh HPX catngthntheo thigian snhgi cchcnngtngthn.
2.2. Chnh:
- nhgi hotngchcnnghai thnhocring rtngthn.
- nhgi v theo di sau ghp thn
- nhgi v theo di tcngtitniu.
2.3. Dcchtphng x:- DTPA-Tc-99m
- GHATc-99m
- MAG3-Tc-99m
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2.4. Thitbghi hnh: my Gamma camera hocmySPECT.
2.5. Phn tch thn:
- Thnbnh thngc 3 phn: phnmch, phn
titv phnbi tit.
- Cc thng scbn: Tmax, T1/2
- Thnbtthng
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3. CHN ON BNH NO:
* X HNH NO QUY C
3.1. Nguyn l gh i hnh : khi hng ro mu no tn
thng, mtschttrong mu c thxm nhpvo vng tnthng.
3.2. Dcchtphng x:
- Tc-99m- pertechnetate
-Tc-99m-DTPA
- Tc-99m-GHA,
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3.3. Thitbgh i hnh:my Gamma camera, my SPECT
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* X HNH TI MU NO:- Nhmpht hinsphn bmu v stimu
nhiuvng cano.
- Chnh: + ChnonbnhAlzheimer
+ Xc nh kch thch+ Chnonchtno
+ Chnonl lndo AIDS
+ Ghi hnh sphn bcatimu notrong can thip
+nhgi tnthngno.
- Dcchtphng x: Tc-99m HMPAO, Tc-99m-ECD.
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NH GI KT QU:
- ivicc DCPX bnh thngkhng iqua hng
ro mu no: nubnh thngstrngHPX, nuc tnthngscho mtimnng trn nnlnh
- iviDCPX bnh thngvniqua hng romu no: bnh thngth chtphng xphn b
ngu, nuc tnthngsxuthinvnggimhoctrngHPX.
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Xhnh no bnh thng: ghi hnh bngmyGamma Camera viTc-99m-O4: khng c HPX trong tchcno.
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Khiu nguyn bo xp:
( Gliomablastoma)
Ghi hnh vimy Gamma
Camera: khiu tng
ngvivng tngHPX
btthngtrong t
chcno.
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Hnh nhxhnh no bnhnhn bchtno(brain death): khng cn HPX tptrung hai bncuino (DCPX: HMPAO: l chtqua chngro mu no)
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4. CHN ON BNH TIM MCH:(Tim hchtnhn)
Gmc ba nhm:
-Nhm 1: nhgi timu ctim v sinh lccatbo ctim
- Nhm 2: Dng cc htnhn phng xchphnhdatrn hottnh sinh hccachng nhchp
hnh dng chtngtrong vng nhimu ctim- Nhm 3: cc kthutnhgi hiuquchcnng
cahotngtim mch.
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Cc kthuty hchtnhn
dng trong chnonbnhtim mch- Kthutpha sm(first pass)
- Xtm thtk
- Timu ctim
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LU TRNH U TIN
(PHA TI MU U TIN, PHA SM)- Tim DCPX vo tnhmchvitcnhanh
dngmc, quan st sdchchuyncaDCPXny c thxc nhv nhgi ctctun
hon ttay phi(hoctay tri) ntim, cc lungthng trong tim, cc thng schcnngtim vvnngthnh ctim.
- Chnh: nhgi chcnngthtphi, thttri;
pht hincc lungthng trong tim, bnhl ccvan tim, pht hinrilonvnngthnh ctim,chnonbinchngnhimu ctim cp, chnoncnauthtngc,
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Phngphp xk tm tht
- SdngDCPX ha utrong mu, cho php
ghi lihnh nhtm tht; sthay ibmu trongtm thtqua cc giai oncachu chuyntim scho ta bitchcnngtm thu, tm trngv cc
hotngcathnh tim.- Chnh:
+ sau nhimu ctim
+ Suy tim bmsinh
+ Phnh thnh tht+nhgi chnh xc chcnngtm tht
+ theo di tc dngcathuciutrv sau PT tim.
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GHI HNH TI MU C TIM- Nguyn l: Cc DCPX pht tia gamma theo dng
mu nui dngctim v cphn btrong ;nhngvng ctimu bnh thngsth
hintrn hnh ghi l nhngvng c tptrungHPX; ngclinhngvng timu km sgimhocmtHPX.
- GHi hnh hai trngthi: ngh(rest) v gngsc(stress).
- DCPX: Thalium 201; Tc-99m-Sestamibi; Tc-99m-Teboroxime;
- Trong PET: N13H3; H2-O-15; F-18-FDG,
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- Thitb: my gamma camera, my SPECT, myPET
- Phn tch ktqu:
+ Vng gimHPX tngngvitimu km
+ Vng mtHPX tngngvivng t ctimu hocvng bnhimu hocsoctim.
+ trngthi ngh: HPX phn bngu, trngthi gngscthygimhot: vng ctim gimhotnghockhng hotng(ngmin:hibernation)
+ trngthi nghv gngscuthymtHPX:soctim hocc nhimu.
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5. X HNH XNG:5.1. Nguyn l ghi hnh: vng xngbtnthng
thngikm viti toxng, tnghotng
chuynha calci, v thdng cc DCPX c chuynha tngngvicalci th chng stptrung ticc vng ti toxngvinngcao.
5.2. DCPX: Tc-99m-MDP, Tc-99m-HMDP, Tc-99m-
EHDP,5.3. Thitbghi hnh: my gamma camera, my SPECT,
my PET.
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5.4. Chnh:
- nhkhu cc tnthngxng
- Pht hincc di cnvo xngcabnhnhn
ung thv, TLT, - Xc nhvtr sinh thitv mclan rngca
cc tnthngph hyxng
- Sng lcpht hindi cncaung thv, phi,
-Pht hincc di cnxngticc cowquan khc.
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5.5.nhgi ktqu:
Hinh nhung thphid i cnvo xng,Gh i hnh viTc-99m-MDPbngmy SPECT 2 u.
Xhnh xngviTc-99m -MDP
Tnthngung thd i cn
xnga.
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Ung thitrng di cnxng: CT(-); SPECT (+)
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6. THM D CHC NNG PHI:6.1. Nguyn l chung:
- Xhnh timu phi: Cc htnhduphng xsau khi tim tnhmchgy tcnghntmthicc
mao mch phi, v vyc thghi hnh phi. Nudng mu bnghnth skhng c HPX tivngbtnthng.
- Xhnh thng kh phi: Bnhnhn ht DCPX sau
ghi hnh. Nhngvng phic thng kh km sngliHPX, nhngvng thng kh phittsschHPX.
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6.2. DCPX:
- Ghi hnh timu phi: Tc-99m-MAA
- Ghi hnh thng kh phi: Tc-99m-DTPA
6.3. Chnh:- Xhnh timu phi: chnonnghnmch
phi, chnonluhuytphitngvng trc
phuthutctbmtphnphi.
- Xhnh thng kh phi: Chnonhuytkhi
phi, nhgi thng kh phitngvng.
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6.4. My ghi hnh: Gamma camera, SPECT6.5.nhgi ktqu:
- Xhnh timu phi: vng gimhockhng ctimu ngmchphithhinl vng lnh.
- Xhnh thng kh phi: Vng phithng kh km
th kh phng xtnngnn l vng tptrungHPX.
- Phihpghi hnh timu phiv thng kh
phi: trong chnonvng tcmchphi(pulmonary embolism): l vng tnthngtrn xhnh timu phiv l vng c thng kh phibnh thng.
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7. X HNH GAN7.1. Nguyn l: tchcgan bao gmtbo nhu m
gan v tbo lin vng nim. Sau khi tim keophng xvo tnhmch, ty loiDCPX sxm
nhpvo tbo lin vng nim hocnhdunhu m gan v cho ta ghi hnh gan.
7.2. Chnh:
* Ghi hnh gan:nhgi hnh dng, vtr, kch thc
cagan; Pht hinv nhvcc tnthngkhutr nhung thgan, p xe gan, nang gan,..
* Ghi hnh gan mt: nhgi chcnngtbo nhu mgan, ngmtv ti mt,
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7.3. Dcchtphng x: nhduhlin vng nim: keo vng, keo
Sulfua-Tc-99m, Phyton-Tc-99m
nhdutbo nhu m gan: Rose Bengal-I-131,
BSP-I-131.7.4. Thitbghi hnh: my gamma camera, spect/-ct,pet/-ct.
7.5.nhgi ktqu:
- Xhnh gan: tnthngl vng gimhockhuytHPX, thay ikch thc,
- Xhnh gan mt: khng thyhocmunHPXvng rut,
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Xhnh gan bnh thngviTc-99m-SC
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Xhnh gan viTc-99m-SC: khuytgan tri
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Xhnh gan viTc-99m-SC: lch to, xuthinhottnhtyxng(tngp lctnhmchca)
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Xhnh gan mtviTc-99m-HIDA
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Xhnh u mu gan viTc-99m-RBC
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Xhnh u mu gan viTc-99m-RBC
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III. GHI HNH KHI U:
Gm3 nhm chnh:
1. Ghi hnh khiu khng chiu:
- Xhnh bngtngphnm tnh
- Xhnh bngtngphndngtnh
2. Ghi hnh khiu chiu(ghi hnh mindchphngx- RIS)
3. Ghi hnh khiu theo nguyn tcchuynha (bngkthutPET)
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1. GHI HNH KHI U KHNG C HIU
1.1. Theo nguyn tctngphnm tnh: nic khiu l vng khuythocgimHPX.
- Ung thtuyngip: l nhn lnh(cold nodule)- U gan: trong xhnh gan l vng lnh
-Ung thphi: l vng lnh1.2. Theo nguyn tctngphndngtnh: nickhiu l vng tptrung hotphng xcao hntchcxung quanh
- U no: trn xhnh viTc-O4: khiu l vng nng
trn Scintigram- U xng.- Cc khi u nng: ung thda, ung thv, u nhn
cu.
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ngdnglm sng caphngphpghi hnh khng chiu:
1. Cc khiu hthnkinh trung ngKhiu nguyn bo xp:
( Gliomablastoma)Ghi hnh vimy Gamma
Camera: khiu tng
ngvivng tngHPX
btthngtrong t
chcno.
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ngdnglm sng caphngphp
ghi hnh khng chiu:2. Khiu tuynnitit: Ung thtuyngip thbitha
(thnh, thnang): xhnh viTc-99m hocI-131.
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ngdnglm sng caphngphpghi hnh khng chiu:
3. Ung thphi: xhnh viGa-67, Tl-201
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ngdnglm sng caphngphp
ghi hnh khng chiu:4. Ung thgan v ung thdi cnvo gan: xhnh vi
cc chtkeo nhduTc-99m hocGa-67.
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ngdnglm sng caphngphp
ghi hnh khng chiu:
5. Ung thv: Xhnh viTc99m-Seta MIBI
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ngdnglm sng caphngphp
ghi hnh khng chiu:6. Ung thxngv ung thdi cnvo xng: x
hnh xngton thn viTc-99m MDP
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2. GHI HNH MIN DCH PHNG X(Radioimmunoscintigraphy: RIS)
Nguyn l: mikhiu c mtloitbo ung th,nhngtbo ny tora nhngkhng nguyn c
hiu, khng nguyn skthpvikhng thchiucan. Sdngkhng thchiunhduVPX pht tia gamma, khng thny skthpvikhng nguyn tngngcatchcung thv tothnh phchp: khng nguynkhng th
nhduphng x; nhvykhiu trthnh ngunpht tia gamma, ktqul ta sc mthnh ghidngtnh l hnh nhcakhiu ung thchiu.
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2. GHI HNH MIN DCH PHNG X- Khng nguyn:
+ CEA (carcinoembryonic antigen),
+ HCF (human choriogonadotropin),
+ AFP (alpha-fetoprotein),- Khng th(antibody) v DCPX nhdukhng
th:
+ Khng thndng (monoclonal antibody) kt
hpchiuvikhng nguyn ung thcntm.+ DCPX nhdukhng th: ccVPX pht tia gamma
c mcnnglngthch hpv c isngngnnhTc-99m, I-123,..
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3. GHI HNH KHI U THEO NGUYN TC CHUYN HA(PET- Positron Emision Tomography)
L phngphp ghi hnh khiu c nhyv chiucao hnnhiuso vicc phngphp chnonhnh nhkhc.
Nguyn l cbncaghi hnh khiu bngPET l cstptrung chiuDCPX lachndatrnnhngkhc bitvsinh l hchocchuynhagiakhiu v tchcbnh thng.
V d: khiu thngtngtctnghpprotein sovitchclnh, do n cnnhiuacid aminhn; khiu tngphn hyglucose hndo nhucusdngglucose cao hntchclnh.
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Nhvynuta dng cc chttinthn caAND hayglucose gnviccVPX thch hp(C-11, F-18,O-15,..) cc DCPX ny sthm nhpvo trong tbo khiu theo cchchuynha. V vyta sghi hnh ckhiu mtcch kh chiuvic
thng tin vchuynha v hnh nhgiiphucakhiu.
Kthphai phngphp ghi hnh PET v CT trncng mtmy, bnhnhn sngthivachp
CT vacchpPET, ta thu chnh nhCT(hnh nhcutrc) v hnh nhcaPET (hnh nhchcnngv chuynha); hai hnh ctrnvolm mt.
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MY PET/CT
M HNH MY PET/CT
MY PET/CT TI TT YHHN&UB
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HNH CT HNH PET HNH PET/CT+
+ =
=Hnh nhcu trcgii phu
Hnh nhchuyn hachc nng
Hnh nhcu trc vchc nng
HNH PET/CT
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DCPX
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UNG TH VM DI CNXNG
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UNG TH D DY
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UNG TH TY
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UNG TH GAN
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UNG TH PHIDI CN XNG
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XIN TRN TRNG CM N
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