Nuklearno medicinske preiskave možganov
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1 Nuklearno medicinske preiskovalne metode Nuklearno medicinske preiskave možganov Marko Grmek
2 Nuklearno medicinske preiskave možganov PET/CT možganov z 18 F-FDG Perfuzijska scintigrafija možganov (SPECT možganov) z 99m Tc-ECD ali 99m Tc- HMPAO Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane)
3 PET/CT možganov z 18 F-FDG (PET-CT brain imaging using 18 F-FDG) In the brain, glucose metabolism provides approximately 95% of the ATP required for brain function. Under physiological conditions, as well as in several diseases affecting the brain, glucose metabolism is tightly connected to neuronal activity. Therefore, changes in neuronal activity induced by disease are reflected in an alteration in glucose metabolism.
4 PET/CT možganov z 18 F-FDG PET/CT naprava
5 PET-CT možganov z 18 F-FDG EANM procedure guidelines for PET brain imaging using 18 F-FDG. Radiofarmak: 18 F-FDG Odrasli aktivnost 250 MBq Otroci EANM dosage card npr: otrok 20 Kg = 4,86 x 14 = 68 MBq Akvizicija - 30 min. po iniciranju radiofarmaka Low dose CT (čas nekaj sekund) Zaradi lokalizacije sprememb in korekcije atenuacije PET slikanje (10 minut) Ena posteljna lega (bed position)
6 PET-CT možganov z 18 F-FDG Rekonstrukcija: Iterativna iterations 6 subsets 21 Debelina rezine = 3 mm Postrekonstrukcijski programi: True D Scenium Efektivna doza: 7mSv
7 PET-CT možganov z 18 F-FDG Indikacije: Odkrivanje in opredelitev vrste demence (zgodnje odkrivanje in razlikovanje med različnimi vrstami demenc) Določitev mesta epileptogenega žarišča (interictal study) Opredelitev bolezni, ki se izražajo z motnjami gibanja (razlikovanje med Parkinsonovo boleznijo in atipičnimi parkinsonizmi) Nevro-onkološke bolezni (opredeljevanje narave možganskih tumorjev)
8 PET/CT možganov z 18 F-FDG 14 letno dekle Napotna diagnoza: Temporalna epilepsija
9 PET/CT možganov z 18 F-FDG 14 letno dekle Napotna diagnoza: Temporalna epilepsija
10 PET/CT možganov z 18 F-FDG 14 letno dekle Napotna diagnoza: Temporalna epilepsija
11 PET/CT možganov z 18 F-FDG Mesto epileptogenega žarišča
12 PET/CT možganov z 18 F-FDG Scenium Analysis Mesto epileptogenega žarišča
13 PET/CT možganov z 18 F-FDG PET/CT možganov pri bolnikih s Parkinsonovo boleznijo in različnimi atipičnimi parkinsonizmi
14 Perfuzijska scintigrafija možganov (SPECT) z 99m Tc-ECD ali 99m Tc-HMPAO Perfuzijska scintigrafija možganov prikaže regionalno prekrvitev možganov. SPECT/CT naprava
15 Brain perfusion SPECT using 99m Tc-labelled radiopharmaceuticals Physiological properties that radiopharmaceuticals must have to be useful for the measurement of brain perfusion by SPECT are: They must cross the blood brain barrier, Their extraction must be proportional to regional cerebral blood flow (rcbf), They must be retained within the brain in their initial distribution long enough for diagnostic tomographic images to be obtained.
16 Perfuzijska scintigrafija možganov Radiofarmak: 99mTc-HMPAO ali 99mTc-ECD aktivnost 600 MBq (ustrezno manj pri otrocih) Dvoglava gama kamera Z akvizicijo pričnemo min. po aplikaciji radiofarmaka Čas slikanja (skeniranja) ~30 min. (60 x 25 sec.)
17 Perfuzijska scintigrafija možganov Slikanje na gama kameri Dvoglava gama kamera. Visoko ločljivi nizko energijski kolimator (LEHR). Fotovrh pri 141 kev. 15 % okno. 2 x 60 posnetkov (180 stopinj) po 25 sekund. Matrika 128 x 128. Povečava 1,23. Oddaljenost detektorjev od centra rotacije 13,5 cm.
18 Perfuzijska scintigrafija možganov Indikacije: Iste kot za PET/CT možganov z 18 F-FDG (vendar ima SPECT možganov nižjo senzitivnost) Epilepsija - perfuzijska scintigrafija možganov v času epileptičnega napada (iktična) Možganska smrt
19 Perfuzijska scintigrafija možganov Standardne ravnine pri perfuzijski scintigrafiji možganov
20 Perfuzijska scintigrafija možganov Standardne ravnine pri perfuzijski scintigrafiji možganov
21 Perfuzijska scintigrafija možganov ictal interictal ictal interictal
22 Perfuzijska scintigrafija možganov možganska smrt Obvezna kontrola kvalitete radiofarmaka nad 90 % vezava
23 Perfuzijska scintigrafija možganov možganska smrt Aktivnosti v možganih ni možgani niso prekrvljeni
24 Perfuzijska scintigrafija možganov - možganska smrt Prva preiskava Ponovitev preiskave čez 3 dni Vidna je aktivnost v malih možganih Aktivnosti v možganih ni več videti
25 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN Brain neurotransmission SPECT using 123 I-labelled dopamine transporter ligands
26 Dopaminski prenašalec (DAT) Presinaptični dopaminski nevron kaudatus putamen Postsinaptični dopaminski nevron Enofotonska emisijska tomografija (SPECT) z 123 I-ioflupanom ( 123 I FP-CIT) se uporablja za prikaz nigrostriatalne nevronske integritete. Drugi možni radiofarmaki: 123 I β-cit, 99m Tc TRODAT-1, 18 F DOPA.
27 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN Bolniku razložimo potek preiskave, povprašamo ga katera zdravila jemlje (amfetamini, kokain, antidepresivi) in o morebitnih alergijah. Eno uro pred preiskavo zaužije bolnik 3 ml 3% KI (blokiramo ščitnico). Počasi intravensko apliciramo MBq 123 I ioflupana ( 123 I FP-CIT, komercialno DaTSCAN). S slikanjem pričnemo 3-4 ure po aplikaciji 123 I ioflupana (Bolnika namestimo v udoben položaj in mu fiksiramo glavo).
28 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN Slikanje na gama kameri Dvoglava gama kamera. Visoko ločljivi nizko energijski kolimator (LEHR). Fotovrh pri 159 kev. 15 % okno. 2 x 60 posnetkov (180 stopinj) po 25 sekund. Matrika 128 x 128. Povečava 1,23. Oddaljenost detektorjev od centra rotacije 13,5 cm.
29 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN Rekonstrukcija in ocenjevanje scintigramov Metoda vzvratne projekcije (FBP) ali iterativna metoda. Buterworth filter frekvence 0,45, order 7. Vizualno ocenjujemo niz scintigramov, reorientiranih v AC-PC ravnino, ki prikazujejo aktivnost v rezini možganov. Semikvantitativna ocena: primerjamo aktivnost, ki se je nakopičila v bazalnih ganglijih z nespecifično aktivnostjo v okcipitalnem delu možganov.
30 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN Parkinsonova bolezen Patološki izvid scintigrafije Parkinsonizmi plus Demenca z Lewyjevimi telesci Klinično neznačilen parkinsonizem ali demenca Normalen izvid scintigrafije Esencialni tremor Vaskularni parkinsonizem Jatrogeni parkinsonizem Alzheimerjeva bolezen Scherfler C. et all. Role of DAT-SPECT in the diagnostic work up of parkinsonism. Mov Disord 2007;22:
31 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN normalna aktivnost
32 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN Normalna aktivnost Znižana odsotna aktivnost v bazalnih ganglijih možganov
33 Scintigrafija dopaminskega prenašalca ( 123 I-ioflupane) - DaTSCAN Aktivnost v bazalnih ganglijih možganov je praktično odsotna.
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