内容发布更新时间 : 2024/5/4 6:33:54星期一 下面是文章的全部内容请认真阅读。

上海交通大学医学院仁济临床医学院

理论课教案

第 次课 教学方式 学时 专业 班级 年 月 日 题 Neurological Nuclear Medicine（2学时） 目 本 课 目 的 要 求 1. Master the principle and radiopharmaceutical of brain perfusion and metabolism imaging 2. Master the abnormal patterns of Neurological perfusion and metabolism imaging 3. Master the indications of brain perfusion imaging 4. Master the clinical application of perfusion imaging 5. Master the clinical application of metabolism imaging 6. Master the principle of intervene perfusion imaging and its clinical application 1. Dopamine transporter imaging principle and clinical value 2. Current situation of brain receptor imaging 3. Cerebrospinal fluid imaging 本 课 的 重 点 、 难 点 本材 课及 使参 用考 教书 本具 次及 课电 应化 用器 教材 1、黄 钢主编：《核医学》，高等教育出版社，2003年12月，北京，第1版。 2、黄 钢主编：《核医学概要——Outline of Nuclear Medicine》（英中文对照），高等教育出版社，2006年1月，北京，第1版。 3、李少林主编：《核医学》，人民卫生出版社，2004年10月，北京，第6版。 4、潘中允主编：《临床核医学》，原子能出版社，1994年10月，北京，第1版。 Multimedia 教学程序、时间分配及主要内容 一．Brain anatomy and physical review 二． SPECT Brain perfusion imaging 备 注 一） Principle of Brain Perfusion Imaging Radiotracer was uptaken into nerve cells after injecting intravenously, its distribution in is proportional to the focal brain blood flow and its function. 二）Radiopharmaceutical and characteristics for perfusion imaging 99mTc-ECD is a neutral, lipophilic complex that rapidly enters the brain via passive diffusion.After intravenous injection (20~30mCi), brain uptake of 99mTc-ECD is rapid, reaching its peak at 5 minutes postinjection 99mTc-HMPAO brain uptake is rapid, reaching a maximum within 10 minutes. 123I-IMP can abtain obsulte rCBF 三）Normal image interpretation gray matter imaging clear white matter unclear well-distributed symmetria anatomic landmark clear 四）Abnormal image interpretation Focal decreased uptake Focal increased uptake Crossed cerebellar diaschisis Enlargement of white matter or midline shift Structure disorder Abnormal distribution of the tracer cerebral atrophy Dissymmetric distribution 五）Brain perfusion imaging indications Cerebral ischemia Dementia Seizures Alzheimer diseases psychiatric diseases Brain death Parkinson's Disease 六）Clinical application １.Acute CNS Ischemia/Infarction Infarct lesions are easily identified and typically appear as areas of decreased or absent perfusion .SPECT imaging could provide information of infarct volume ,location and pneumbra area even at early stage (3-4 hours). crossed cerebellar diaschisis reduction in blood flow in the contralateral cerebellum when larger cerebral infarction occurs or in the cerebral hemisphere also occur after contralateral cerebellar infarction. Luxury perfusion increased perfusion around infarction at subacute stage. 2.Transient Ischemic Attacks It is a reversible ischemic episode. Rest flow perfusion imaging may be unremarkable. SPECT imaging with the use of a vasodilator such as ACZ has been shown to increase the likelihood of detection of residual blood flow changes after TIA or to show the vascular effects of cerebral or carotid vascular disease. 3.Dementia Alzhermer’ disease is a neurological degradation disease and MD is outcome of multiple infarction of brain. Typical appearance of AD is symmetrically decreased or absent perfusion AD on temperal-parietal lobe. However, multiple decreased or absent perfusion are shown on MD iamge. 4.Epilepsy Seizure foci appear as dramatically increased areas of blood flow when the tracers are administered during the seizure. Interictal studies show focal or global blood flow decreases, 70% of patients are in the temporal lobe. 5.Parkinson disease SPECT may find decreased perfusion in basal ganglia region , and diffused perfusion decrease may be shown in entire cortical in severe patients. 6.Psychiatric Disorders schizophrenia: reduction of flow to the frontal cortex, changes in basal ganglia perfusion, and changes in temporal lobe. Depression: either increases or decreases in the frontal lobes. 7.brain death No brain perfusion demonstrates brain death. 8.brain trauma 9.brain tumor Uptake of tracers in tumors has been variable. 三．Brain intervene imaging 一）Principal of brain intervene perfusion imaging Brain perfusion or function state will be changed transiently through various modalities including medicine, physical or other methods. It can be documented by SPECT perfusion imaging right after intervention. 二）Intervene methods 1. medicine intervention 2. hyperventilation test 3. physical stimulation test 4. cognitive performance test 三）Clinical application 1.silent brain ischemia detection detect slight ischemia of brain 2.cerebrovascular reserve assessment 3.cerebrovascular reaction in CCD 4.Prognosis prediction of cerebrovascular disease 四．Brain FDG metabolism imaging 一）Principle of FDG metabolism imaging Glucose is the main energy resource in brain. It can be transported into brain cell mediated by glucose transporter on cell surfaces and participate in glycolysis promoted by