成功大學醫學院核子醫學科部

李碧芳 (Bi-Fang Lee)

Nuclear Medicine (NM)

Instrumentaion in NM

In Vivo: Scintigraphy– 閃爍造影機 (gamma camera)

– 正子造影機 (PET scanner)

In Vitro: Radioimmunoassay (RIA)– 放射免疫分析伽瑪計數器 (gamma counter)

Imaging of Nuclear Medicine

Planar scintigraphy

SPECT (Single Photon Emission Computed Tomography)– 單光子射出電腦斷層 , 即核醫電腦斷層掃描

PET (Positron Emission Tomography)

Planar scintigraphy SPECT-projection imaging

SPECT

Gamma Camera

PET-CT

                                      

Myocardial perfusion scintigraphy

Provide information concerning the regional distribution of myocardial perfusion

Myocardial perfusion scintigraphy

Radiopharmaceuticals Thallium (Tl-201) Tc-99m isonitriles

– Tc-99m sestamibi, Tc-99m tetrofosmin– Better physical characteristics: higher

photon flux, lower attenuation, lower radiation exposure

Myocardial perfusion scintigraphy

Thallium (Tl-201): Kinetics– Incorporation: 4% myocardium

Coronary flow: Linear relationship between incorporation of Tl-201 into myocardium and coronary flow

Myocyte capacity for extraction

– Redistribution: After peak Tl-201 conc. is achieved

Washout: an equilibration process Difference in Tl-201 conc. between intracellular and

intravascular space Coronary flow

Myocardial perfusion scintigraphy:

Thallium (Tl-201): Kinetics

Well perfused areas: take up a greater amount of Tl-201, reaches its highest conc. rapidly

Ischemic areas: not achieve high conc., delayed peak value

Myocardial perfusion scintigraphy:Study Protocols

Myocardial perfusion scintigraphy:Study Protocols

Myocardial perfusion imaging

83 歲男性病人，主訴胸悶，有高血壓史。 persantine 藥物負荷下之掃描影像（ A 列影像）。間隔 3 小時休息狀態下再度掃描（ B 列影像）。可見左心室前 壁、間壁、下壁及心尖部位運動狀態下出現灌流缺損，休息狀態下呈現再分佈。

Myocardial perfusion imaging

70 歲男性，有三條血管病變之冠狀動脈疾病， 8 年前曾接受血管繞道手術。 persantine 藥物負荷下之掃描影像（ A 列）可見嚴重之灌流缺損分佈在左心室前壁、間壁、下壁及心 尖，在休息狀態下影像（ B 列）不見再分佈現象。