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)

SPECT-projection imaging 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。