消化系统核医学.ppt

1、Digestive System ImagingXiaohua（Eva） ZhuDept. of Nucl. Med.& PET,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTvLiver-spleen scanning；liver perfusion and blood pool imaging；hepatobiliary dynamic imaging vNoninvasive detection of portal vein shunting vGastrointestinal bleeding imagingvEctopic Gastric Muc

2、osa Imagingvesophageal transit；gastric emptying；small intestines transitvgastroesophageal reflux；duodenum-gastric refluxvsalivary glands imagingv14C-urea breath testv14C-aminopyrine breath testvTumor imagingDep. Nucl. Med.,TJ Hosp.,HUSTKupfferS cells-liver-spleen scanningHepatic artery/portal vein-p

3、erfusion imagingsinusoid-blood pool imaginghepatocyte-hepatobiliary dynamic imagingDep. Nucl. Med.,TJ Hosp.,HUSTLiver-Spleen ScanningvKupffers cells-line liver sinusoids. Remove cellular debris, bacteria, and other particulate matter, including radioactive colloids. Dep. Nucl. Med.,TJ Hosp.,HUSTANTP

4、OSTLLARLAnormal imagescold defectDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTLiver Perfusion and Blood Pool ImagingvBlood supply portal vein: formed by confluence of splenic and superior mesenteric vein, accounts for 75 of liver blood flow; hepatic artery a

5、ccounts for remaining 25 of flow. vDynamic imaging and static imaging at 30min: 99mTc-RBCvThe local radioactivity is related to the blood capacityDep. Nucl. Med.,TJ Hosp.,HUSTNormal images: flowvArtery phase vVein phaseDep. Nucl. Med.,TJ Hosp.,HUSTNormal images：blood poolDep. Nucl. Med.,TJ Hosp.,HUS

6、TAbnormal images（1）: increased flow at artery phaseDep. Nucl. Med.,TJ Hosp.,HUSTAbnormal images (2) : blood pool vexcessive radioactivity-hemangiomavradioactivity as same as the surrounding normal liver tissue-hepatoma, adenomavno radioactivity：cyst, abscessDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Me

7、d.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTHemangioma: a. liver images using colloids; b. blood pool imagesDep. Nucl. Med.,TJ Hosp.,HUSTCyst: a. liver images using colloids; b. blood pool imagesDep. Nucl. Med.,TJ Hosp.,HUSTClinical applicationvHemangioma (肝血管瘤)：the first choicevDiagnosis standard:

8、 excessive radioactivityvSpecificity almost 100, sensitivity 90（false negative if tumors diameter1.5cm or there is fibrosis, calcification and thrombosis in tumor）Dep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Ho

9、sp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTHepatobiliary Dynamic ImagingDe

10、p. Nucl. Med.,TJ Hosp.,HUST胆红素(bilirubin)的代谢Dep. Nucl. Med.,TJ Hosp.,HUSTHepatocyteIDA/PAABilisBile ductBowelSPECT dynamic imagingMechanismDep. Nucl. Med.,TJ Hosp.,HUST药物名称 射线能量 吸收剂量（Gy） 尿中排泄率（%） （KeV） 肝脏 全身 （3h）99mTc-HIDA1408.10 X10-62.70 X10-62099mTc-EHIDA1408.10 X10-62.70 X10-655 10mCi 99mTc-DISI

11、DA1402.70 X10-65.40 X10-64.599mTc-PAPADA1402.43 X10-64.50 X10-61099mTc-BIDA1401.35 X10-65.40 X10-6299mTc-Mebrofenin 140299mTc-PG1401.08 X10-52.70 X10-62899mTc-PI1408.10 X10-62.70 X10-61099mTc-PMT1401.35 X10-55.40 X10-62方 法：显像剂（清除快、肝摄取高、迅速分泌、浓度高、肠道不 重吸收、尿中排泌率低、受胆红素增高影响小、易于制备）Dep. Nucl. Med.,TJ Hosp.,

12、HUSTMethods: preparationvFasting 68hvSincalide injected 3060min before imaging to for patients prolonged fasting or maintained through veinsvNot using narcotic cause sphincter of Oddi dilation 612h before imaging vAtaracticDep. Nucl. Med.,TJ Hosp.,HUSTMethods: imagingvAnterior view, right/left later

13、als and posterior view if necessaryvDynamic imaging: images each every 1 or 5 minutes for 60 minutesvDelay imaging: 2,4,12h even 24h imaging should be performed if gallbladder or bowel not visualizedDep. Nucl. Med.,TJ Hosp.,HUSTMethods: interventionvCCK：测定胆囊收缩功能；禁食超过2024h的病人在检查前排空胆囊vPhenobarbital：增加

14、显像剂的肝胆排泄和诊断先天性胆道闭锁的特异性。5mg/kg/d，连续710dvFatty-meal test：测定胆囊收缩功能vMorphine：to cause sphincter of Oddi spasm forcing IDA into gallbladder if cystic duct patent, if gallbladder not visualized by 40 minutes. Dep. Nucl. Med.,TJ Hosp.,HUSTLiver parenchymaPhaseBile duct excretionPhaseIntestine excretionphas

15、eNormal imagesDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTAbnormal imagesvCardiac activity fades slowly: liver dysfunctionvCold defect or hot spotvDelayed gallbladder visualization or nonvisualization at 4 hours: chronic or acute cholecystitisvDelayed bowel

16、 visualization or nonvisualization at 24 hours：biliary obstruction, congenital biliary atresia, biliary malformation, et alvRadioactivity at abnormal site: bilis leakage; duodenum-gastric refluxDep. Nucl. Med.,TJ Hosp.,HUSTvDifferentiated diagnosis of jaundice (differentiation of congenital biliary

17、atresia from neonatal hepatitis)vDiagnosis of acute cholecystitisvMonitoring response to hepatobiliary surgeryvLiver transplantation monitoringvHCC, Hepatic adenoma, Focal nodular hyperplasiavOthers: choledochal cyst, ectopic gladderball, et alDep. Nucl. Med.,TJ Hosp.,HUSTDifferentiation of congenit

18、al biliary atresia from neonatal hepatitisvCause 7080 neonatal jaundicevDifficult to differentiate by symptom and laboratory testvTreatment and prognosis are different, surgery is necessary in 3 month for congenital biliary atresiavCongenital biliary atresia: accuracy 91, sensitivity 97, specificity

19、 82, nonvisualization of bowel at 24h; otherwise, neonatal hepatitisv 3 days examination project of National Taiwan University（1982）, 7 days examination project of Tongji hospital（1987）, accuracy 96.8%, 98.8% respectivelyDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Ho

20、sp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTAcute cholecystitisvBackground: vast majority of cases due to cystic duct obstruction, us

21、ually caused by stonevAccuracy: 95; specificity: 99(adult)vFindings: nonvisualization of the gallblader with normal hepatic uptake and visualization of common duct and bowel. (sincalide, morphine, 4h delayed imaging） Dep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,

22、HUST Monitoring the response to hepatobiliary surgeryvpostoperative complications: biliary stenosis/obstructionvbilis leakagevduodenum-gastric reflux, 1.4Dep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTD

23、ep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTLiver Transplantation MonitoringvSimultaneously display the liver blood flow, function and morphologyvIdentify complications such as extrahepatic biliary obstruction, intra-biliary cholestatic and liver cell damage after transplantationvReject

24、ion vFunctionDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUST99mTc-EHIDA显像及ROI分析Dep. Nucl. Med.,TJ Hosp.,HUST99mTc-EHIDA显像及ROI分析Dep. Nucl. Med.,TJ Hosp.,HUSTHepatic cell carcinomaRLARLADep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTCommon duct cystDe

25、p. Nucl. Med.,TJ Hosp.,HUSTIncomplete common bile duct obstructionDep. Nucl. Med.,TJ Hosp.,HUSTReverse visceraTumor Imaging-PETDep. Nucl. Med.,TJ Hosp.,HUST vA-C：1级HCC（Edmondson and Steiner分级）。A：CT low density；B：18F-FDG no uptake；C：11C-acetate high uptake (pancreas metastasis）。vD-F：3级HCC（Edmondson a

26、nd Steiner分级）。D：CT low density；E：18F-FDG high uptake；F：11C-acetate no uptake。Dep. Nucl. Med.,TJ Hosp.,HUST 11C-acetate, HCC with brain, lung and vertebrae metastasisDep. Nucl. Med.,TJ Hosp.,HUST Metastatic hepatic carcinoma using 18F-FDG Dep. Nucl. Med.,TJ Hosp.,HUSTGastrointestinal Bleeding Imaging

27、vTheory: extravasated image agents show up as focal hot spot v99mTc-red blood cell: intermittent bleeding episodes 99mTc-sulfur colloid: acute bleeding episodesvSensitivity for hemorrhages of 0.1ml/minvNoninvasiveDep. Nucl. Med.,TJ Hosp.,HUST适 应 证用胃镜或结肠镜无法达到出血部位用胃镜或结肠镜无法达到出血部位临床上有持续出血症状，而其他常规临床上有持续出

28、血症状，而其他常规检查结果为阴性检查结果为阴性血管造影结果可疑或为阴性血管造影结果可疑或为阴性急性大量出血使内窥镜视野模糊急性大量出血使内窥镜视野模糊患者拒绝有创性或有痛苦的检查方法患者拒绝有创性或有痛苦的检查方法小儿消化道出血小儿消化道出血优优 势势Dep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDep. Nucl. Med.,TJ Hosp.,HUSTDifferentiationvVascular acti

29、vity: doesnt movevHyperaemia of intestinal mucosavAfflux of gastric juice to bowelvUreter activity 5min10minDep. Nucl. Med.,TJ Hosp.,HUSTFalse negative vLittle hemorrhages， =100dpm/mmolCO2Dep. Nucl. Med.,TJ Hosp.,HUSTvHP: Chinese infected rate 60%, 90% duodenum ulcer , 70% stomach ulcer, the first k

30、ind of carcinogen by WHOvSensitivity 9097, specificity 89100v14C-UBT - easy, fast, noninvasive, sensitive, credibleDep. Nucl. Med.,TJ Hosp.,HUSTSummaryvThe major clinical application of liver flow ang blood pool imagingvThe mechanism and clinical application of hepatobiliary imagingvThe clinical application of Gastrointestinal Bleeding Imaging and Ectopic Gastric Mucosa ImagingThank you！Dept.of Nucl. Med.,TJ Hosp.,HUST