核 WG.indd

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1 15 平成 25 年度ワーキンググループ報告 25 3 MDCT SPECT FDG-PET γ 8

2 16 25 MDCT SPECT 6 MDCT SPECT Dual source CT SPECT 5 (rt-pa) MDCT SPECT 2 MDCT SPECT 7 rt-pa 95% rt-pa 8.1% 17% 1) 65 rt-pa 7 rt-pa 2 MDCT (submassive massive) SPECT (Fig. 1) prospective study retrospective study (9.6%) 15 (28.8%) 3 (20%) 1 32 (61.5%) MDCT SPECT SPECT (12.5%) 2 MDCT SPECT

25 17 Fig. 1 A 51-year-old man with depression.

CT pulmonary angiography (CTPA), which was performed 3 hours after the onset, shows filling

99m Tc- MAA perfusion studies (planar and SPECT images), which were performed 24 hours after

CTPA, which was performed 2 weeks after an intravenous injection of rt-pa of 1.

the thrombolytic therapy, reveal improvement of multiple perfusion defects in the lungs.

3 25 17 Fig. 1 A 51-year-old man with depression. He suddenly complained of dyspnea in the early morning. CT pulmonary angiography (CTPA), which was performed 3 hours after the onset, shows filling defects in the pulmonary trunk and right and left arteries. 99m Tc- MAA perfusion studies (planar and SPECT images), which were performed 24 hours after the onset, demonstrate multiple perfusion defects in the lungs (upper column). CTPA, which was performed 2 weeks after an intravenous injection of rt-pa of 1.6 million units, shows disappearance of the filling defects shown in the CTPA before the thrombolytic therapy. 99m Tc-MAA perfusion studies (planar and SPECT images), which were performed 2 weeks after the thrombolytic therapy, reveal improvement of multiple perfusion defects in the lungs. Coronal images of SPECT demonstrate subsegmental defects more clearly than planar images (lower column). 28 MDCT SPECT 5 (17.9%) 23 (82.1%) MDCT SPECT 4 (14.8%) SPECT (acute on chronic) SPECT MDCT SPECT estimated pulmonary artery systemic pressure 124 mmhg 2) SPECT MDCT SPECT SPECT SPECT 2 SPECT

4 Mo/ 99m Tc 99m Tc-Technegas 99m Tc-MAA MDCT SPECT ONE-HOUR PROTOCOL 3,4) 結論 (82.1%) SPECT MDCT SPECT 文献 1) Niwa A, Nakamura M, Harada N, Musha T: Observational investigation of thrombolysis with the tissuetype plasminogen activator monteplase for acute pulmonary embolism in Japan. Circ J 2012; 76: ) Stern J, Heist EK, Murray L, Alabiad C, Chung J, Picard MH, et al: Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy. Pacing Clin Electrophysiol 2007; 30: ) Roach PJ, Gradinscak DJ, Schembri GP, Bailey EA, Willowson KP, Bailey DL: SPECT/CT in V/Q scanning. Semin Nucl Med 2010; 40: ) : INNERVISION 2013; 28:

5 25 19 FDG-PET J-ADNI PET QC 1) はじめに FDG-PET FDG-PET FDG-PET J-ADNI FDG-PET J-ADNI PET 5 6 J-ADNI 2) 対象および方法 PET PET MRI MMSE CDT RCPM RAVLT WMS-R TMT ±6.4 Biograph mct TOF PSF J-ADNI FDG ) 結果 leave-one-out

6 NDB 5 5 NDB leave-one-out 30 J-ADNI NDB NDB PET 4) 考察 PET/CT J-ADNI FDG TOF PSF J-ADNI DB

7 25 21 γ はじめに Cadmium-Zinc-Telliride CZT SPECT Discovery NM530c (GE Healthcare) Anger γ γ 4 SPECT 2. 目的および方法 SPECT (1) (2) (3) Discovery NM530c 3 1, 結果 (1) 99m Tc Anger 1,100 MBq γ 5 1) 3 2) (2) Discovery NM530c 99m Tc Anger 3) (3) 1, % 26% 79% 40% 24% 10% 31% 53% Tc 71% Tl 29% 10 (1%)

8 22 25 表福山循環器病院 99m Tc MBq MBq m Tc MBq MBq Tl 74 MBq MBq 東京医科大学病院 99m Tc MBq MBq 3 99m Tc-tetrofosmin MBq MBq Tl 74 MBq MBq 愛媛大学付属病院 99m Tc-tetrofosmin MBq MBq m Tc-tetrofosmin MBq MBq m Tc-sestamibi MBq MBq m Tc-tetrofosmin MBq MBq 5 5 新古賀病院 201 Tl 74 MBq % LAD LCX RCA 感度特異度正診率図 1 1,000 LAD = left anterior descending artery LCX = left circumflex artery RCA = right coronary artery

9 25 23 A B % % 感度特異度正診率 LAD LCX RCA 0 LAD LCX RCA 図 2 A 99m Tc B 201 Tl 99% SPECT 68% 57% 87% 64% 92% 63% 85% 99m Tc 201 Tl 2 4. まとめ γ SPECT Discovery NM530c 5. 文献 1) Tanaka H, Chikamori T, Hida S, Uchida K, Igarashi Y, Yokoyama T, et al: Comparison of myocardial perfusion imaging between the new high-speed gamma camera and the standard Anger camera. Circ J 2013; 77: ) Tanaka H, Chikamori T, Tanaka N, Hida S, Igarashi Y, Yamashita J, et al: Diagnostic performance of a novel cadmium-zinc-telluride gamma camera system assessed using fractional flow reserve. Circ J 2014; 78: ) Nishiyama Y, Miyagawa M, Kawaguchi N, Nakamura M, Kido T, Kurata A, et al: Combined supine and prone myocardial perfusion single-photon emission computed tomography with a cadmium zinc telluride camera for detection of coronary artery disease. Circ J 2014; 78:

Microsoft Word 年度DPCによるSPECT検査動向に関する報告 _02表紙.doc

Microsoft Word 年度DPCによるSPECT検査動向に関する報告 _02表紙.doc DPC SPECT 2 2013 9 DPC/PDPSDiagnosis Procedure Combination / Per-Diem Payment System 1 DPC DRG/PPS: Diagnosis Related Groups / Prospective Payment System 2003 2008 7 2008 DPC 2012 1,500 DPC SPECT 70% DPC