核醫(yī)學(xué)-消化系統(tǒng)

Digestivesystem消化系統(tǒng)臨床醫(yī)學(xué)八年制核醫(yī)學(xué)教學(xué)課件1一、GastrointestinalbleedingimagingPrincipleAfterI.Venjecionof

99mTc-RBCor99mTc-Sc,abdominallargevesselsandorganswithabundant

bloodaredeveloped.Sincegastrointestinalwallwithlowerbloodsupply,itusuallycouldnotbeseen.Whenactivebleedinglesionsappearedingastrointestinalwallforvariousreasons,imagingagentscouldgetinto

gastrointestinaltractfromvascularrupture,formulatingabnormalradioactiveconcentrationimages,whichcouldlocatetheblutene

chloaide.299mTc-RBC99mTc-ScImagingagents3Indications

⑴Acuteactivegastrointestinalbleeding

⑵Chronic,intermittentgastrointestinalbleeding

⑶Angiorrhexisandtraumaticbleeding499mTc-RBCNormalImageInterpretation5NormalImageInterpretation6AbnormalImageInterpretation7AbnormalImageInterpretation8AbnormalImageInterpretation9二、Ectopicgastricmucosa

imagingBarrett’sesophagusMeckeldiverticulumentericduplicationEctopicgastricmucosa10MeckelDiverticulum99mTcO4-11EntericDuplication99mTcO4-12三、SalivaryglandimagingImagingagent:99mTcO4-。Indications:

⑴Functionalevaluationofsalivarygland,mainlyfordiagnosisofSjogrensyndrome,residualsalivaryglandafteroperation,andtransplantationofsalivarygland

⑵Diagnosisofspace-occupyinglesions,suchasWarthintumor13NormalImageInterpretation14ClinicalApplicationsA.normalB,C,D.Sjogrensyndrome

151617四、UreabreathtestIndications:⑴DiagnosisofHPinfectionandauxiliarydiagnosisforgastrointestinaldisease⑵Patientswithacuteandchronicgastritisandgastroduodenalulcer

⑶Post-therapyevaluationofHPinfectionandrecurrencedetection

⑷EpidemiologicsurveyandscreeningofHPinfection18五、HepatobiliaryimagingLiverimagingHepatobiliarydynamicimagingLiverperfusionandbloodpoolimagingLiverstaticimaging19HepatobiliarydynamicimagingPrinciple

uptakebylivercells,andsecretedtobilecapillaries,thendraingedthroughthebiliarytracttotheintestineImagingagents99mTc-IDAs99mTc-PAA20Imagingagents藥物名稱γ射線能量 吸收劑量（Gy）尿中排泄率（%）（KeV） 肝臟 全身（3h）

99mTc-HIDA 140 8.10X10-6 2.70X10-6 20 99mTc-EHIDA

140 8.10X10-6 2.70X10-6 5 99mTc-DISIDA 140 2.70X10-6 5.40X10-6 4.5 99mTc-PAPADA 140 2.43X10-6 4.50X10-6 10 99mTc-BIDA 140 1.35X10-6 5.40X10-6 2 99mTc-Mebrofenin 140 2 99mTc-PG 140 1.08X10-5 2.70X10-6 28 99mTc-PI 140 8.10X10-6 2.70X10-6 10 99mTc-PMT

140 1.35X10-5 5.40X10-6 2 21InterventionaltestCholecystokinintestMorphinetestPhenobarbitaltest22IndicationsDiagnosisofacutecholecystitisDifferentialdiagnosisofjaundicesDifferentialdiagnosisofbiliaryductdisordersofnewborninfantFollow-upandmornitoringoftherapeuticeffectofhepatobiliaryoperationDiagnosisofhepatocellularcarcinoma,hepaticadenomaandfocalnodularhyperplasiaDeterminationofcongetinalbileductdistensionandectopicgallbladderDiagnosisofduodenogastricbilerefluxAncillaryevaluationofhepatobiliaryfunction23NormalHepatobiliaryImagingBloodflowphaseLiverparenchymaphaseBileductexcretionphaseIntestineexcretionphase24NormalHepatobiliaryImaging5min15min30min45min10min2526acutecholecystitis27morphinetest（1）28morphinetest（2）29Biliaryobstruction5min45min24h30Incompletegeneralgallbladdertractobstruct31Congenitalbiliaryatresia

3233neonatalhepatitis5min24h1h4h34Postoperativebileleakage

35Delayed

Hepatobiliary

ImagingHCC(++)36Delayed

Hepatobiliary

Imaging2hours5hoursHCC(+)37HepaticperfusionandHepaticbloodpoolimaging

liverbloodsupply:portalvein75%,hepaticartery25%

hepaticperfusionimaging:arterysection,veinsection

hepaticbloodpoolimaging:balancesectionPrincipleImagingagent:99mTc-RBC38Normalhepaticperfusionimaging

39Normalhepaticbloodpoolimaging

40IndicationsDifferentialdiagnosisofhepaticspace-occupyinglesions,especiallyforhemangiomaEvaluationofbloodperfusionofhepaticspace-occupyinglesionsEvaluationofhepaticbloodperfusion41primaryhepaticcarcinoma42hepati