核醫(yī)學(xué)教學(xué)課件：核醫(yī)學(xué)緒論

核醫(yī)學(xué)緒論TheTrialofO.J.SimpsonTheIncriminatingEvidence

曾經(jīng)，有一份真誠(chéng)的愛(ài)情放在我面前，我沒(méi)有珍惜，等到我失去的時(shí)候才后悔莫及，人世間最痛苦的事莫過(guò)于此……如果上天能夠給我一個(gè)再來(lái)一次的機(jī)會(huì)，我會(huì)對(duì)那個(gè)女孩子說(shuō)三個(gè)字：“我愛(ài)你?！比绻且谶@份愛(ài)上加上一個(gè)期限，我希望是……一萬(wàn)年！

圖像融合的新突破功能與分子顯像，基因和藥物相互滲透，將在21世紀(jì)對(duì)醫(yī)療衛(wèi)生具有重大影響SPECT、PET顯像：功能、代謝、分子顯像、高特異、高靈敏解剖圖像功能成像解剖圖像功能成像解剖圖像功能成像個(gè)性化醫(yī)療新紀(jì)元PersonalisedmedicinePredictDiagnoseInformTreatMonitor一核醫(yī)學(xué)定義

研究核技術(shù)在醫(yī)學(xué)的應(yīng)用及其理論的學(xué)科，是用放射性核素診斷、治療疾病和進(jìn)行醫(yī)學(xué)研究的醫(yī)學(xué)學(xué)科。1、放射性示蹤和靶向內(nèi)照射是

核醫(yī)學(xué)的基本原理年發(fā)現(xiàn)者/發(fā)明者發(fā)現(xiàn)/發(fā)明諾貝爾獎(jiǎng)1895W.K.RoentgenΧ射線(xiàn)1896H.Becquerrel發(fā)現(xiàn)了鈾的放射性1903,與Curie夫婦共享物理獎(jiǎng)1898-1902P.Curil和M.Curie分離出放射性釙1911，M.Curie獲化學(xué)獎(jiǎng)1913-1924G.Hevesy用201Pb,210Pb,212Pb進(jìn)行礦、植、動(dòng)物體內(nèi)Pb含量和轉(zhuǎn)移等的示蹤測(cè)定1925H.Blumgart用Ra測(cè)定人體血流速度1930E.Lowerence回旋加速器1939，物理獎(jiǎng)1934I.Curie和F.JoliotG.Hevesy人工制備放射性核素30P用32P示蹤研究P的生態(tài)循環(huán)1935，化學(xué)獎(jiǎng)1943，化學(xué)獎(jiǎng)1959，原子能和平利用獎(jiǎng)1936J.Hamilton和J.Lowerence用32P治療白血病1938G.SeaborgS.Hertz人工制成131I，發(fā)現(xiàn)了99mTc研究128I在兔甲狀腺內(nèi)的聚集1951，化學(xué)獎(jiǎng)1942S.Hertz用131I治療甲狀腺功能亢進(jìn)癥1946E.Fermie核反應(yīng)堆歷屆核醫(yī)學(xué)諾貝爾獎(jiǎng)獲得者19031911193919351943195120072、放射性示蹤技術(shù)與其他醫(yī)學(xué)先進(jìn)技術(shù)相結(jié)合，持續(xù)拓寬和深化核醫(yī)學(xué)的內(nèi)容核物理內(nèi)分泌核醫(yī)學(xué)更新的領(lǐng)域腦功能核醫(yī)學(xué)心臟核醫(yī)學(xué)放免分析放射性示蹤劑和藥物核醫(yī)學(xué)儀器腫瘤核醫(yī)學(xué)基因核醫(yī)學(xué)醫(yī)學(xué)先進(jìn)理論技術(shù)核醫(yī)學(xué)內(nèi)容稀釋原理血容量測(cè)定、血漿容量測(cè)定、紅細(xì)胞容量測(cè)定血流動(dòng)力學(xué)血流速度測(cè)定、心功能顯像和測(cè)定跨膜肝腎功能顯像，心肌、腦血流顯像和測(cè)定代謝甲狀腺顯像和功能測(cè)定、葡萄糖代謝測(cè)定免疫理論、單抗技術(shù)放射免疫分析、放射免疫顯像受體學(xué)說(shuō)受體顯像、神經(jīng)遞質(zhì)顯像、轉(zhuǎn)運(yùn)蛋白顯像基因理論和基因工程技術(shù)基因顯像、反義顯像、轉(zhuǎn)基因顯像3、放射性藥物和放射性?xún)x器是診斷核醫(yī)學(xué)發(fā)展的基石放射性藥物報(bào)告者用途32PG.Hevesy(1935)P代謝研究和血液病治療131IS.HERTZ(1938)碘代謝研究和甲狀腺疾病診治99mTc201Tl18FP.Harper(1963)Lebowitz(1975)M.Reivich(1979)肝顯像心肌顯像和腫瘤顯像葡萄糖代謝顯像131I(Anti-CEAAb)D.M.Gordenberg(1978)腫瘤放免顯像和放免治療11CH.N.Wagner(1983)神經(jīng)受體PET顯像99mTc(MIBI)J.Maddahi(1987)心肌顯像和腫瘤顯像99mTc(ECD)G.Demonccau(1988)腦血流顯像123I(Octerotide)J.C.Reubi(1990)腫瘤受體研究和受體治療111I(Octerotide)W.H.Bakker(1991)腫瘤受體顯像111I(ASON)M.K.Dewanjee(1994)反義顯像124I(FIAU)J.G.Tjuvajev(1996)轉(zhuǎn)基因顯像99mTc(TRODAY-1)H.F.Kung(1996)神經(jīng)SPECT顯像18F(FLT)Vesselle(2001)胸腺嘧啶顯像18F(FDU)Buchmanna(2001)脫氧尿嘧啶核苷顯像18F(FDDNP)Agdeppa(2001)組織病理學(xué)印跡顯像124I(MBP-Ane5)Dekker(2002)細(xì)胞凋亡顯像①放射性藥物Radiopharmaceuticals

全球放射性核素供應(yīng)和使用

全球共有54個(gè)反應(yīng)堆在生產(chǎn)同位素，其中僅有6個(gè)反應(yīng)堆生產(chǎn)鉬-99及其他醫(yī)用同位素。中國(guó)原子能研究院101堆（停堆）中國(guó)原子能研究院492堆（通量低）成都核動(dòng)力院反應(yīng)堆（半停堆）綿陽(yáng)九院新堆（20MW明年運(yùn)行）中國(guó)原子能研究院新堆（60MW明年運(yùn)行）國(guó)內(nèi)Mo-Tc每周需求量：<200Ci日本Mo-Tc每周需求量：1000Ci韓國(guó)Mo-Tc每周需求量：400CiSPECT+SPECT/CT70臺(tái)PET+PET/CT12臺(tái)費(fèi)城人口:150萬(wàn)

四川省人口：9000萬(wàn)SPECT+SPECT：18臺(tái)PET+PET/CT：4臺(tái)重慶地區(qū)人口：3000萬(wàn)PET/CT2臺(tái)，PET1臺(tái)SPECT10臺(tái)（SPECT/CT3臺(tái)）2011年核醫(yī)學(xué)診療人數(shù)/千人/年--------------MettlerFAJr,etal.RadiologicandnuclearmedicinestudiesintheUnitedStatesandworldwide:frequency,radiationdose,andcomparisonwithotherradiationsources--1950-2007.Radiology.2009;253(2):520-31.影像+治療SPECT+SPECT/CT臺(tái)數(shù)/百萬(wàn)人SPECT或SPECT/CT年檢查人數(shù)核醫(yī)學(xué)儀器發(fā)明者蓋革計(jì)數(shù)器H.Geiger(1929)閃爍掃描儀B.CassenERTZ(1951)γ相機(jī)橫斷層掃描儀PETH.O.Anger(1957)D.E.Kuhl(1963)

M.M.Ter-pogosium(1975)SPECTR.J.Jaszczak(1977)SPECT/PETG.Muehllehner(1995)microPETPET/CTS.R.Cherry(1997)D.W.Townsend(1999)②

核醫(yī)學(xué)儀器Nuclearmedicineequipments

80年代90年代Γ照相機(jī)本世紀(jì)初PET/CTSPECT/CT70年代SPECT

X-1895

19711973美國(guó)伊利諾伊大學(xué)的PaulC.Lauterbur1974英國(guó)諾丁漢山大學(xué)的SirPeterMansfield20世紀(jì)80年代4、診斷核醫(yī)學(xué)的發(fā)展方向和當(dāng)今熱點(diǎn)器官水平分子水平總體功能局部功能局部功能分子識(shí)別單光子核素靈敏度定向診斷正電子核素特異性

定量和定位診斷單純?cè)\斷對(duì)治療方案的影響單純技術(shù)效益價(jià)格分析JNM2011-2012.1

分子顯像：分子顯像是對(duì)正?；虍惓５膮^(qū)域性分子水平活動(dòng)進(jìn)行的顯像，并涉及到相關(guān)的基因型、組織病理和患者的臨床表現(xiàn)（即表現(xiàn)型）。人體內(nèi)所進(jìn)行的數(shù)千個(gè)分子過(guò)程所帶來(lái)的分子顯像信息使我們不再依賴(lài)于醫(yī)師的經(jīng)驗(yàn)就可以對(duì)顯像本身進(jìn)行解讀并根據(jù)其余的信息對(duì)其進(jìn)行進(jìn)一步的整理。核醫(yī)學(xué)將在其他任何臨床學(xué)科之前迎接這一革命所帶來(lái)的挑戰(zhàn)。

Imagesacquiredina54-year-oldpatientwithisletcelltumor:CT;(B)octreotidescintigraphy;(C)18F-DOPAPET;(D)11C-5-hydroxytryptophanPETFIGURE3.Imagingapoptosisinvivoinmouse2dafterocclusionofleftanteriordescendingartery(allimagescoronalview).(Left)18FFDGscanshowsmassivelydecreaseduptakeinanteriorwall,whereas18F-FDGuptakeinremainingmyocardialareasispreserved.(Middle)Sumimageoflast30minof90-min68Ga-annexinVscaninsameanimal,showingspecificuptakeinareaofdecreasedmetabolism,indicatingpresentapoptosis.(Right)Fusionof18F-FDGand68Ga-annexinVscans.FIGURE2.Smallmesentericlymphnodemetastasis(arrows)ofpancreaticNETin71-y-oldman:portal-venousCT(A),68Ga-DOTATOCPET(B),andfusedPET/CT(C).NotmeetingCTmalignancycriteria,withdiameterof0.55cmperpendiculartolongestaxisandroundconfiguration,thislesionwasdetectedonlybecauseofincreaseduptakeonPETFIGURE4.(A–D)Pretreatmentimages.(A)Contrast-enhancedT1-weightedMRIshowsasmallcentralnecroticcontrastenhancinglesioninventralpartofthetumor(L1,cT1-positive)andnonenhancingtumorlesionindorsaltumormass(L2,cT1-negative).(B)MRIshowsT2-hyperintensetumorandperifocaledema(E).(C)MRI/FETPETimagefusionrevealstraceruptakeinbothMRIlesionsL1andL2.(E–H)Imagingafter12wkoftreatment.(EandF)MRIshowsdecreaseinT1contrastenhancement(L1)aswellasinT2signalhyperintensityinperitumoraledema(E).(G)18F-FETPET/MRIimagefusionshowspartialresponseforcT1-positiveventralmetaboliclesions(L1)butprogressionfordorsaltumorpart(L2).(DandH)MRIperfusionrevealsincreasedlocalcerebralbloodvolumeinbothtumorfractions(whitearrows).Thisobservationsuggestsdifferentlyinvolvedmolecularpathwaysintumorangiogenesisandgliomagenesis(ventrallesion:VEGF-dependent;dorsallesion:VEGF-independent).E5peritumoraledema;L15ventral,cT1-positivetumorpart;L25dorsal,cT1negativetumorpart.SPECT/CToftumor-bearingratinjectedwith40MBq111In-octreotide(top).Inthebottomimage,exvivoautoradiography(toprow)iscomparedwithinvivoSPECTimages(bottomrow).TheauthorsconcludedthattheirsmallanimalSPECT/CTdevicewasahighlyaccuratetoolforfollowingphysiologicprocessesinthesameanimalovertimewithdifferenttracers.Ratimage(topright)acquiredwiththeU-SPECTIIclearlyshowstherightandleftventricles.Collimatorimages(left)andmouseimage(bottomright)indicatetheincreasedspatialresolutionpossiblewiththisdevice.動(dòng)物顯像TriisotopeSPECTwithCTimageacquiredwithaminiaturized,stationary,multiringCZTSPECTsystemthatprovides24uniqueangularsamplesandhascomponentsthatarefunctionalinMRfieldsupto7T.Intheimage,orange=99mTctargetingofbone;blue=123Itargetingofthyroid;andgreen=201Tlcardiactargeting.FIGURE3.SPECT/CTimagesoffemalemicebearinghumanovarianIGROV-1tumorxenografts(arrows),4hafterinjectionof111In-DTPA-folatealone(A)andincombinationwithpredosedpemetrexed(B)(28).Vol.52?No.1?January2011FIGURE3.Representativewhole-bodySPECT/CTimageofB16/F1melanoma–bearingmouse(10daftercellinoculation)2hafterinjectionof14.8MBqof111In-DOTA-GGNle-CycMSHhexEffectsoftheAminoAcidLinkersontheMelanoma-TargetingandPharmacokineticPropertiesof111In-LabeledLactamBridge–Cyclizeda-MSHPeptides18F-fallypridePETimaginginanuntreatedpatient(left)andapatienttreatedwithziprasidone(right)suggestthatthistracermaybeusefulintherapeuticmonitoringofnewtypicalantipsychoticmedications功能性成像FIGURE1.Transaxialviewsof18F-FLTPET,helicalCT,and18FFDGPETfor2patientswithDLBCL.(A)A41-y-oldmanwithretromandibularlymphomashowingintense18F-FDGand18F-FLTuptakeinprojectionofretromandibularlymphnode.ThisstageIApatientrevealedPDundertherapy.(B)A40-y-oldwoman(stageIVA)withhistologicallyprovenlymphomainrightiliacboneandsacrum.18F-FDGPETshowsintenselyincreaseduptakeinrightiliumandsacrum.Corresponding18F-FLTPETimagesallowdetectionofincreasedasymmetricuptakeinrightiliumandsacrumdespitehighphysiologic18F-FLTuptakeinproliferatingbonemarrow.TransaxialviewsofhelicalCTdisplayosteodestructionofrightilium.RestagingafterendoftherapyrevealedCR.StressandrestimagesacquiredwithadualdetectorAngercamera(top)andanewsystemforhigh-speedmyocardialperfusionimaging(bottom)ina66-year-oldmalewithleftcircumflexarteryischemia.StressandrestimageswiththeAngercamerawereacquiredover19and11minutes,respectively，thesefigureswere4and2minutesforthehighspeedsystemResultswithintegratedsoftwarefusionof64-sliceCTangiographyandSPECT.Stress(left);rest(right)FIGURE2.Inpatient13,positiveosteomyelitisresultsconcordantbetweenWBCscintigraphy(T/Bratio.2.0andincreasingovertime)and18F-FDGPET/CT(SUVmax.2.0andCT-confirmedlocalizationinbone):clinicalimageofdiabeticfoot(A);anteriorandposteriorWBCscintigraphyimagesafter30min,3h,and20h(B);transaxial18F-FDGPET/CTimagesafter1h(C).Ant5anterior;Post5posterior.FIGURE1.Inpatient3,negativeresultsconcordantbetweenWBCscintigraphy(T/Bratio,2.0anddecreasingovertime)and18F-FDGPET/CT(SUVmax,2.0):clinicalimageofdiabeticfoot(A);anteriorandposteriorWBCscintigraphyimagesafter30min,3h,and20h(B);transaxial18F-FDGPET/CTimagesafter1h(C).Ant5anterior;Post5posterior.核醫(yī)學(xué)科常用設(shè)備和項(xiàng)目1、常規(guī)體外檢測(cè)設(shè)備：化學(xué)發(fā)光儀，放免儀2、顯像設(shè)備：GE符合線(xiàn)路SPECT/CT3、功能測(cè)定設(shè)備：甲功儀，腎圖儀4、131I治療甲亢和甲癌、89Sr,153Sm治療轉(zhuǎn)移性骨腫瘤5、雙能X線(xiàn)骨密度儀X線(xiàn)顯像系統(tǒng)按裝在旋轉(zhuǎn)的γ相機(jī)上X線(xiàn)球管正對(duì)CT探頭18F-FDG，其他正電子核素顯像PET/CTCardiovascularSystemSkeletalSystemEndocrineSystemCentralNervousSystemPulmonarySystemGenitourinarySystemGastrointestinalSystemHepatobiliarySystemSPECT,SPECT/CT成像Cardiovascular

System

心肌灌注顯像

statusofmyocardiumandcoronaryperfusion.

心室造影（心功能測(cè)定）

statusofheartfunction.Stress-inducedischemiainthelateralwall心肌缺血后側(cè)壁MI下壁MI心室造影（心功能測(cè)定）門(mén)控心肌斷層顯像患者男性，36歲，廣泛前壁心梗后，PET顯像見(jiàn)前壁和心尖FDG代謝缺損，提示該處心肌活力缺乏。HSA

VLA

HLA

心臟顯像發(fā)展灌注成像—99mTc-MIBI,201Tl心肌核素顯像代謝成像—18F-FDG,11C-PA,11C-AC,3N-GA,99mTc-HL91顯像

評(píng)價(jià)血流供應(yīng),血管儲(chǔ)備功能和細(xì)胞活性評(píng)價(jià)心肌細(xì)胞活性分子成像—18F-FDG,125I-MCP-1,99mTc-Annexinⅴ,125I-MIBG顯像巨噬細(xì)胞的能量底物受體激動(dòng)劑凋亡劑神經(jīng)受體干細(xì)胞移植和基因治療H.WillanStrauss,NuclMed,2004,Vol

評(píng)價(jià)胎兒細(xì)胞移植方法的療效在帕金森患者的雙側(cè)殼核中植入經(jīng)培養(yǎng)的中腦組織應(yīng)用FDOPAPET評(píng)估其療效術(shù)前術(shù)后1年62歲PD患者FDOPA/PET術(shù)后2年術(shù)后4年殼核的FDOPA攝取自體骨髓單個(gè)干細(xì)胞移植對(duì)梗死心肌的研究骨顯像的優(yōu)勢(shì):高敏感性

(Highsensitivityindetectingearlydiseaseofmanytypes).Sensitivefordetectingthechangedlocalmetablism.Ontheotherhand,a30%to50%changeinbonedensityisrequiredbeforelesionscanbedetectedradiographically.顯示全身骨骼

(Abilitytosurveytheentireskeletonquicklyatreasonableexpense).SkeletalSystemNormaladultbonescintigramBonescanofachild(4y9m).Feelpaininleftshoulder.Diffusemets.41yfemale,7yafteroperationofbreastCa.feelpaininshoulderandpelvisBonepainwithunknowncause.13ygirlwithosteosarcoma

甲狀腺顯像

甲狀腺吸碘功能測(cè)定

(RadioactiveIodineuptake,RAIU)

腎上腺顯像甲狀旁腺顯像EndocrineSystem

甲狀腺顯像

Ultrasonographyandfineneedleaspiration(FNA)biopsyhavepartiallysupplantedthyroidscintigraphyintheevaluationofpatientswithclinicallypalpablethyroidnodules.在判斷甲狀腺結(jié)節(jié)的功能狀態(tài)上具有不可替代的獨(dú)特優(yōu)勢(shì)(Uniquelysuitedtodeterminethefunctionalstatusofthyroidnodules).NormalthyroidimagewithI-123PinholecollimatorA:diffusegoiterB:coldnoduleC:autonomousnoduleD:substernalthyroidDiffuseenlargement(Grave’sdisease)ColdnoduleofleftlobeEctopicthyroid—lingualthyroid腎上腺髓質(zhì)顯像嗜鉻細(xì)胞瘤(pheochromacytomas)甲狀旁腺顯像ParathyroidadenomaTc-99mMIBIA:earlyimageB:2hrdelayedimage唾液腺顯像和功能檢查普通腦顯像(ConventionalBrainImaging(Blood-BrainBarrierScintigraphy)

腦血流灌注斷層顯像(SPECTCerebralPerfusionImaging)

PET腦代謝顯像(PositronEmissionTomography)

腦池顯像(Cisternography)CentralNervousSystemCerebralinfarctionofleftfrontallobe(Tc-99mHMPAO)Upper:MRI.Middle:perfusion.Lower:DiamoxinterventionIctalidentificationofepilepticfocus:Hypermetabolismandhyperperfusionareaisseenintherightparietallobe多巴胺功能顯像

在帕金森病中的應(yīng)用多巴胺受體和轉(zhuǎn)運(yùn)體在神經(jīng)末梢突觸前和突觸后的顯像示蹤劑多巴胺能示蹤劑1、突觸前的標(biāo)記物：18F-FDOPA;18F-FPCIT(分別與DA和DAT結(jié)合)2、突觸后的標(biāo)記物：

11C-Raclopride，spiperone（螺哌隆）的衍生物（分別為D2和D1受體的配體）用于腦功能大體評(píng)估的示蹤劑1、葡萄糖代謝類(lèi)：18F-FDG2、腦血流：15O-H2O

輕度中度重度18F－FPCITFDOPAPET評(píng)價(jià)胎兒細(xì)胞移植方法的療效在帕金森患者的雙側(cè)殼核中植入經(jīng)培養(yǎng)的中腦組織應(yīng)用FDOPAPET評(píng)估其療效術(shù)前術(shù)后1年術(shù)后2年術(shù)后4年62歲PD患者FDOPA/PET殼核的FDOPA攝取肺通氣顯像肺灌注顯像PulmonarySystem臨床應(yīng)用:肺栓塞的診斷肺氣腫下肢深靜脈顯像GenitourinarySystem99mTc-DTPA腎動(dòng)態(tài)顯像+腎小球?yàn)V過(guò)率的測(cè)定

131I-Hippor99mTc-MAG3腎動(dòng)態(tài)顯像+有效腎血漿流量測(cè)定Normaldynamicrenography:corticalfunctionphaseandclearancephaseSmallleftkidney(cause?)HydronephrosisofrightkidneyNormaltransplantkidneyAbnormaltransplantkidney:slowclearance胃排空功能Gastricmotility(Gastricemptying)幽門(mén)螺桿菌檢測(cè)

Helicobacterpyloriinfection胃腸道出血定位Gastrointestinalbleeding異位胃黏膜顯像EctopicgastricmucosaGastrointestinalSystem胃腸道出血定位靈敏度85%-90%出血率0.1ml/min9y/omale異位胃黏膜顯像肝膠體顯像Technetium-99mSulfurColloidLiver-SpleenImaging肝血池顯像Technetium-99mRedBloodCellLiver

Scintigraphy膽道顯像CholescintigraphyHepatobiliarySystemPlanarstudy.Left,immediatepostinjectionimageshowscolddefectinsuperolateralportionoftherightlobe.Smallareahasincreaseduptake.Right,delayedimage(60min.)showscompletefilling.SPECTofTc-99mSC.Well-definedcolddefect.SPECTofTc-99mRBC.正常膽囊顯像萎縮性膽囊SPECT/CT顯像FIGURE1.Lymphoscintigraphyofpatientwithnonpalpableleftbreastcancer2hafterperiareolarinjectionof99mTc-colloidalrheniumsulfide,withthe2detectorspositionedatrightangles.(A)Anteriorviewshows2axillarysentinelnodes.(B)Onleftlateralview,only1axillaryfocusisseen;the2sentinelnodesaresuperimposed.FIGURE2.Lymphoscintigraphyofpatientwith25-mminvasivelobularcarcinomaofleftbreast.(A)Anteriorplanarviewshows2axillarysentinelnodesplusinternalmammarydrainage.Medium-energycollimatorwasusedtoreducestarartifacts.(B)SPECT,CT,andSPECT/CTfusionimagesofaxillashowuppersentinelnodeatBerglevelII(beneathpectoralisminor)andothersentinelnodeatBerglevelI.(C)Internalmammarynodeisinsecondintercostalspaceanddidnotundergobiopsy.Axillarysentinelnodeswerenegative.FIGURE1.(A)Planaranteriorimageshowingdrainageof99mTcnanocolloidfrominjectionsiteinrighttesticleto2abdominallymphnodesandradioactivityalonglymphaticchannel,whichdecreasedintime,indicatinglymphatictractvisualization.(B)CoronalSPECT/CTimagefusionshowingbothsentinellymphnodes(yellow)alongsideinferiorvenacava.(C)LaparoscopicSNprocedureusingportableg-cameraandlaparoscopicg-raydetectionprobe.(D)Preexcisionimage(leftscreen)acquiredwithportableg-camerashowingbothSNsinoperationroom.Afterexcision(rightscreen),nosignificantremainingactivityisseen.FIGURE2.(A)Planaranteriorimageshowingdrainagefromrighttesticleto2adjacentlymphnodesinmedialareaofabdomen.Someuptakeisalsoseeninmorelaterallylocatedlymphnode(arrows).(B)CoronalfusedSPECT/CTimageshowingbothmediallymphnodesbetweenaortaandvenacavaandlateralnodeintrajectoryofrighttesticularvessels.(C)TransverseSPECT/CTimageshowing2SNsdisplayedinyellow.(D)CTimageshowingthatmedialSNcorrespondstosmalllymphnodeventraltoareabetweenaortaandcava,whereaslateralnodeisinareaventraltopsoasmuscle(circles).InthisfunicularSN,micrometastaseswerefoundathistopathologyPET,PET/CT成像回旋加速器合成、熱室PETESTABLISHEDVALUESOFFDGPETEvaluationofpulmonarynodulesStagingmalignanciesPredictingprognosisFollowuptreatmentoutcomeDetectingrecurrencesNatureofunknownprimaryGuidingtreatments:surgery,RT,Chemotherapy,orimmunotherapyConformalRTwithrespirationgatingSpectacularresultsinmultiplemyeloma,lymphoma,tyrosinekinaseinhibitortherapy(STI-571,Gleevec)inGIST(gastrointestinalstromaltumor)到2000年美國(guó)HCFA（HealthCareFinancingAdministration

）批準(zhǔn)保險(xiǎn)的PET項(xiàng)目已有11項(xiàng)乳腺癌淋巴瘤結(jié)直腸癌孤立性肺結(jié)節(jié)非小細(xì)胞性肺癌阿爾茨海默病黑色素細(xì)胞瘤頭頸部腫瘤腫瘤全身廣泛轉(zhuǎn)移心肌灌注心肌存活患者，男性。CT：示左、右上肺均有占位病變。

PET：右上肺FDG高代謝灶。女，39歲，CT示“右下肺占位”性質(zhì)不明5個(gè)月。PET：示右下肺高代謝病灶。術(shù)后病理女，72歲，CT示“右下肺占位”2年。無(wú)癥狀體征。注射FDG60分鐘后PET顯像：CT所示右下肺病灶處SUV最大值0.98注射FDG180分鐘后PET顯像：CT所示右下肺病灶處SUV最大值1.16注射FDG210分鐘后PET顯像：CT所示右下肺病灶處SUV最大值1.44鼻咽癌放療、化療后3年；近期CT示縱隔淋巴結(jié)腫大；PET示縱隔內(nèi)異常高代謝灶?？v隔穿刺活檢證實(shí)為泡狀核細(xì)胞癌。肺癌廣泛轉(zhuǎn)移食管癌卵巢癌晚期2例黑色素瘤一例男73歲，晚期肺癌患者;經(jīng)化療、放療2個(gè)月后復(fù)查。卵巢癌化療前后對(duì)比X刀肺門(mén)、縱隔放療2周后患者男性，34歲，鼻咽癌手術(shù)及放療后3月余，MRI見(jiàn)腦干及左側(cè)海綿竇異常信號(hào)，欲鑒別放射性壞死或復(fù)發(fā)。肺鱗癌化療后6年乳腺癌

術(shù)后10年

女，50歲，既往有子宮肌瘤子宮全切術(shù)及右側(cè)卵巢囊腫切除術(shù)史。

PET體檢。TherapyresponseFIGURE2.Baseline(top)andweek3(bottom)scansofpatientwitharesponseonallmodalities:CT(A),18F-FDG(B),H215OPET(C),andDCEMRI(D).MonitoringResponsetoAntiangiogenicTherapyin

Non–SmallCellLungCancer……bevacizumab;erlotinibJNuclMed2011;52:48–55FIGURE1.(A)HypervasculartumorsarenotedonpretreatmentMRimageof68-y-oldmandiagnosedwithHCC.(C)SPECT/CTimage(74MBqof99mTc-MAAwasadministeredviamicrocatheterplacedinlefthepaticartery)showsincreasedactivitydepositioninsuperiorlaterallefthepaticartery.(B