神经系统核医学

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1、,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编

2、辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五

3、级,2020/11/3,,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,单击此处编辑母版标

4、题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/11/3,,*,神经系统核医学,神经系统核医学神经系统核医学,2020/11/3,2,内 容,,神经核医学定义,,目前现状与热点问题,,主要检查的,原理,、方法及,临床应用,,神经核医学研究进展与发展方面,2020/11/3,3,概 述,,神经核医学定义,,核素示踪技术用于神经精神疾病诊治,及脑科学研究分支学科,目前现状与热点问题,,分子功能显像,神经核医学主要检查的方法,,Cerebral blood flow perfusion imaging,Cerebral metabolic imaging,,Neurore

5、ceptor imaging,Neurofunctional study and brain science,Cerebrospinal fluid imaging,,Brain imaging,,2020/11/3,4,第一节 脑血流灌注显像,,Cerebral blood flow perfusion tomography,,2020/11/3,5,一、原理与方法,1,．,SPECT,脑血流灌注显像,,,,99m,Tc-ECD,,99m,Tc-HMPAO,,123,I-IMP,,入脑显像剂与血流成正比,2,．氙,[,133,Xe],脑血流灌注显像,3,. PET,脑血流灌注显像,,13,

6、NH,3,·,H,2,O,、,15,O,·,H,2,O,,2020/11/3,6,Imaging agent and request,,Imaging agent,99m,Tc-HMPAO,99m,Tc-ECD,,133,Xe,,15,O-H,2,O,Request,Small molecule(<400),Zero charge,Lipid soluble,Cerebral imaging,2020/11/3,7,二、影像分析,对称分布，对比度好，轮廓清楚,,全脑平均血流量参考值,,44.2,,4.5,ml,/(100,g,.,min,),,2,断面、,,2cm,异常放射性分布,,2

7、020/11/3,8,,Cerebral blood flow perfusion tomography,Coronal,,Sagittal,Transverse,section,2020/11/3,9,,Normal cerebral blood flow tomogram,Normal right-left differences in cerebral cortical activity should be <8% to 10%,2020/11/3,10,,Normal Ischemia Infarct,13,N-NH,3,·H,2,O PET

8、,Cerebral blood flow perfusion tomography,99m,Tc-ECD SPECT,2020/11/3,11,负荷试验脑血流灌注显像,药物介入试验：乙酰唑胺试验（,Diamox test,）、美解眠药物诱发试验、抗胆碱药物介入试验、二氧化碳吸入试验等,人为干预介入试验：过度换气诱发试验、剥夺睡眠诱发试验、直立负荷试验、睡眠诱发试验、,Wadas,试验、颈动脉阻塞试验等,生理刺激介入试验：肢体运动、感觉刺激试验等,认知作业介入试验：记忆、计算、思索、听觉语言学习等,物理性干预试验：磁场干预、低能激光照射、中医针刺等,,通过增加脑负荷量了解脑血流和代谢的反应性变化

9、，以提高缺血性病变，特别是潜在的缺血性病变的阳性检出率。,2020/11/3,12,在影像上出现相对放射性减淡缺损区,,,CO,2,+H,2,O,,碳酸酐酶,H,2,CO,2,脑内,CO,2,,静脉推注乙酰唑胺,1g,碳酸脱氢氧化过程受抑，导致脑内,pH,,，脑血管扩张,,血供正常区域,rCBF,可增加,20,％～,30,％,潜在或缺血部位血管扩张反应弱,rCBF,增加不明显,乙酰唑胺试验（,Diamox test,）,2020/11/3,13,负荷介入试验的意义,提高对缺血性脑血管疾病的诊断的敏感性,脑血管储备能力的评价,脑血管疾病治疗疗效评价,脑血管病预后估计,痴呆的鉴别诊断,

10、,2020/11/3,14,,Ischemic cerebral vascular diseases,TIA: Transient ischemic attacks,Cerebral infarction,Epilepsy,Dementia,Brain tumor,Brain function ,etc,三、临床应用,2020/11/3,15,Ischemic cerebral vascular diseases,,,rCBF>23ml/,100g/min,asymptomatic ischemia,rCBF<23ml/100g/min,appear ischemic symptom,(fun

11、ctional threshold),SPECT,abnormal,rCBF<8ml/,100g/min,Occur cerebral structural change,（,Structure threshold,）,CT,、,SPECT,abnormal,Normal,50ml,Chronic low perfusion state,Cerebral infarction,25~40% in 5 yrs,2020/11/3,16,TIA (Transient ischemic attacks),,Diagnostic positive rate was related with per

12、iod of disease,,,,,早期,CT,和,MRI,（,-,）,,SPECT rCBF,阳性率大多＞,50,％,<24 h 60~87%,<2 w 40~50%,>3 m 25%,2020/11/3,17,Right cerebral median artery infarction,Cerebral Infarction,2020/11/3,18,Characteristic of brain infarction in rCBF,Distribution defect or decrease, more than CT,右侧大脑皮质血流灌注降低,左则小脑血流灌注减低,过度灌

13、注,（,Luxury perfusion,）,交叉性小脑失联络（,Crossed cerebellar diaschisis,）,2020/11/3,19,Left temporal lobe epilepsy,stage of attack,CT,：,30%,,50%,，,MRI,：,50%,,70%,rCBF,：,70%,,80%,Epilepsy,2020/11/3,20,Right front lobe epilepsy (,interictal,),2020/11/3,21,AD,,逐渐出现记忆力减退、认知功能障碍、,行为异常和社交障碍,诊断,临床表现,,早期无特征性,影像学

14、,,常规影像的局限性,,典型为,双侧顶叶和颞叶为,主,对称性放射性减淡缺损区,Dementia,2020/11/3,22,—,鉴别诊断,—,疗效预测,—,预后判断,Brain Tumor,2020/11/3,23,Recurrence of glioma after surgery.,Accumulation is related to malignancy,IV: Accumulation is obvious,I-II: Accumulation is unobvious,2020/11/3,24,病变处可见,明显异常放,射性分布减,低或缺损区,Brain Trauma,2020/11/3

15、,25,第二节 脑代谢显像,,Cerebral metabolic imaging,一、原理与方法,射线与物质相互作用,湮灭辐射,脑葡萄糖代谢显像,氟,[,18,F]-FDG,：,LCMRGlu,，,CMRGlu,,脑氧代谢显像,：氧,[,15,O]-H,2,O,,：,CMRO,2,，,OEF,脑蛋白质代谢显像,,：碳,[,11,C]-MET,,PET,、,PET/CT,符合线路,SPECT,2020/11/3,26,正常脑代谢,18,F-FDG PET/CT,显像,二、影像分析,2020/11/3,27,三、临床应用,Epilepsy (EP),Dementia,Brain tumor,

16、Parkinson disease(PD),Cerebral vascular disease,Research cerebral function,2020/11/3,28,EP ictal,EP interictal,FDG uptake,,FDG uptake,,Epilepsy,2020/11/3,29,Where is lesion?,Dementia,2020/11/3,30,AD,PET,、,PET/CT,是当前唯一早期诊断,Alzheimer’s,,病的技术手段,,,,,,,PET/MRI,技术,Alzheimer’s Dementia,2020/11/3,31,Alzheim

17、er,’,s,病,FDG PET,显像特点,特征性表现：新皮质相关区域（,颞顶叶皮层,）代谢降低，偶尔也累及前额部，而主要感觉运动皮层和视皮层，纹状体、丘脑、小脑、基底节均少受累及,早期：双侧颞顶叶、后扣带回和额叶一些区域代谢显著降低,晚期：双侧颞叶包括海马回沟代谢降低,FDG PET,对于轻度,AD,敏感性（,87%,）不如中重度病例（,96%,），特异性尚不满意（,70%,）,2020/11/3,32,Alzheimer,’,s,Disease,2020/11/3,33,18F-FDG PET images of vascular dementia. Hypometabolism affe

18、cting,cortical, subcortical, and cerebellar areas,is often seen in vascular dementia. Arrows indicate hypometabolism of the right frontal cortex (far left, middle right), right parietal cortex (far left, middle left), right basal ganglia and thalamus (middle right), and right temporal cortex (far ri

19、ght). The hypometabolism of the left cerebellum (far right) is characteristic of cross-cerebellar diaschisis, caused by diminished afferent input from the contralateral cortex.,Vascular Dementia,2020/11/3,34,,Schizophrenia,Parkinson’disease,Pick’s Disease,双侧额叶和颞叶,纹状体,双侧额叶,2020/11/3,35,18F-FDG PET im

20、ages of Huntington’s disease. This patient (43-y-old man) has an 8-y history of progressive Huntington’s disease. Arrows highlight the typical metabolic pattern of hypometabolism severely affecting the,basal ganglia,(right) at a time that cortical metabolism is still relatively intact (left and midd

21、le). As the disease progresses, diffuse cortical involvement gradually develops.,,Huntington’s Disease,2020/11/3,36,Imaging of gliomas by means of MRI and PET,：,biologically active tumour tissue,grade of gliomas,recurrence and radiation necrosis,distinguish functionally areas,Brain Tumor,2020/11/3,3

22、7,肺癌伴脑转移,2020/11/3,38,患者女性，,40,岁，左肾透明细胞癌术后一年，发现左额叶脑转移，行,,-,刀治疗后,3,月,PET,18,F-FDG,MRI,2020/11/3,39,右额脑梗死,Cerebral vascular disease,2020/11/3,40,PET CBF and OEF images in a 40-year-old female with moyamoya disease examined before (Pre) and after (Post) a right-side bypass surgery. Before treatment, C

23、BF and OEF are decreased and increased, respectively, in the right frontal region (white arrows), hallmarking poor CVR. CBF and OEF were significantly improved by bypass surgery (yellow arrows),.,,脑代谢显像评估脑血管疾病预后,2020/11/3,41,Brain Function Research,2020/11/3,42,脑功能研究,脑科学热点,,,揭示大脑的,神奇与奥秘,,认知功能评定,2020

24、/11/3,43,单侧手指运动,对侧中央前回、辅助运动皮质区代谢增高,单耳听故事,对侧颞叶代谢活跃,单纯语言刺激,右侧颞叶代谢增高,单纯音乐刺激,左侧颞叶代谢增高,语言和音乐混合刺激,双侧颞叶代谢增高,增高,20%,～,25,％,2020/11/3,44,受体显像为研究人体神经受体的分布、数量（密度）和功能（亲和力）提供了唯一的、无创伤性手段,第三节 神经受体显像,,Neuroreceptor imaging,PET,18,F-DOPA,多巴胺,D,2,受体显像,DAT,显像,,一、原理与方法,2020/11/3,45,脑受体的分布与功能,多巴胺,D,2,:,,尾状核、豆状核（,parkins

25、on,,肌张力降低，精神分裂症等）,乙酰胆碱,：,大脑皮质和海马（,AD,,重症肌无力）,阿片,：丘脑中部、尾状核、豆状核（麻醉药成瘾、疼痛综合征、介毒药物研究）,5-HT,：杏仁核、丘脑中部、尾状核、颞叶等（睡眠障碍、精神疾病等）,肾上腺素能,：抑郁症等,2020/11/3,46,,神经递质和受体显像的主要放射性配体,,,受体,,单光子配体,,正电子配体,,,多巴胺,,123,I-ILIS,,123,I-IBZM,,123,I-,,-CIT,,99m,Tc-TRODAT1,,18,F-dopa,,11,C-NMSP,,11,C-raclopride,,11,C-,d,-threo-MP,,

26、11,C-,,-CIT,,,乙酰胆碱,,123,I-IQNB,，,123,I-IBVM,,11,C-Nicotine,,11,C-QNB,,,苯二氮杂,,123,I-Iomazenil,,11,C-Flumazenil,,,5-,羟色胺,,123,I-2-Ketanserin,,123,I-,,-CIT,,76,Br-2-Ketanserin,,11,C-,,-CIT,,,阿片,,123,I-Morphine,,123,I-,O,-IA-DPN,,131,I-DPN,,11,C-DPN,,11,C-CFN,,,,2020/11/3,47,SPECT,99m,Tc-TRADOT-1,影像,

27、Control,PD,,二、影像分析,2020/11/3,48,神经递质和受体显像主要临床研究与应用,,受体,,受体亚,型,,应用,,多巴胺,,D,1,，,D,2,DAT(,多巴胺转运蛋白,),,PD,，,HD,PD,，成瘾,,乙酰胆碱,,M(,毒蕈碱,),N(,烟碱,),,早老性痴呆,PD,，酗酒,,苯二氮杂,,GABA,PBZ,NMDA,,EP(,癫癎,),胶质瘤,EP,,5-,羟色胺,,5-HT,1 A, B, C,,,,5-HT,2, 3,5-HTT,(5-,羟色胺转运蛋白,),,焦虑，狂躁,/,抑郁精神病,PD,,阿片,,,，,,，,,,EP,，,精神病，抗痛作用，药物成瘾性和

28、依赖性研究以及戒毒作用,,,,三、临床应用研究,2020/11/3,49,配体,与,受体,特异结合,,—,受体空间分布、密度和亲和力,,—,在分子水平诊治受体相关性疾病,,2020/11/3,50,第四节 神经功能研究与脑科学,,Neurofunctional study and brain science,,,概述,神经系统进化是人类,生存竞争中进化的结果,,研究的方法学比较,,SPECT/CT,、,PET/CT,、,PET/MR,，,,fMRI,，其他技术,,临床应用研究,,2020/11/3,51,Positron emission tomography, PET,,,Molecular

29、 imaging,Positron emission tomography gets much objective,Information for the patients with brain disorders,2020/11/3,52,2020/11/3,53,2020/11/3,54,脑池显像,脑室,脑池,侧脑室脉络丛,侧脑室室间孔,第三脑室,大脑导水管,第四脑室,出正中孔和侧孔,小脑延髓池,大脑凸面,24h,颅底脑池,矢状窦旁蛛网,膜颗粒吸收,血液循环,蛛网膜下腔,注射显像剂,脑室显像,注射显像剂,正常脑脊液循环及显像原理,,第五节,,脑脊液间隙显像,,Cerebrospinal

30、fluid imaging,1h,3~6h,2020/11/3,55,正常蛛网膜下腔,-,脑池显像,(,前位,),1h 1.5h 3h 24h,基底池,四叠体池,外侧裂池,胼胝体池,侧脑室,2020/11/3,56,交通性脑积水,3h,6h,24h,2020/11/3,57,颅内高压手术分流后,患者自述鼻腔流出无,色液体,脑脊液间隙显像,可见脑池外异常放,射性分布,（,鼻漏,）,2020/11/3,58,第六章 脑显像,Brain imaging,弹丸

31、式注射,99m,TcO,4,-,后行脑血管动态显像,Normal image analysis,动脉相,:,呈两侧对称五叉型,脑实质相：弥漫性分布,(,3,),静脉相：脑实质放射性减少,一、放射性脑血管显像,,Radionuclide cerebral angiography,脑梗死,脑肿瘤,脑血管畸形,脑死亡,Normal image,2020/11/3,59,CCA,,CCA,脑死亡影像,2020/11/3,60,二、,血脑屏障功能静态显像,,1.,原理与方法,病变时,BBB,破坏而使显像剂入脑,,,,出现放射性聚集,,,2. Normal image analysis,,,头颅影像的左右

32、两侧基本对称,3.,Clinical application,-,Cephalitis(cephalitis of AIDS),-Subdural hematoma,-Meningioma,2020/11/3,61,1,,,2,,3,4,多摸态、多学科合作,神经核医学,第七节 研究进展与发展方向,,State-in art of nuclear neurology,,,,研发具有特异性脑显像剂,SPECT/CT,，,PET/CT,，,PET/MR,,,Translation of these basic studies into,address clinical problems,,202

33、0/11/3,62,PET/MR in,,vivo,PET/MR PET/MR,brain imaging fusion,(normal),2020/11/3,63,血管性老年痴呆的,PET/MR,图像,2020/11/3,64,Development of,,2020/11/3,65,,思考题,局部脑血流显像、脑代谢显像的原理是什么？,掌握几种主要疾病的影像特征和临床价值。,神经受体显像的原理及临床意义。,了解脑脊液显像的原理及主要临床意义。,神经系统核医学面临的挑战及应用前景。,2020/11/3,66,谢谢观赏！,2020/11/5,67,