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
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 6 52 5 (9.6%) 15 (28.8%) 3 (20%) 1 32 (61.5%) MDCT SPECT 2 32 15 17 33 85 62.2 SPECT 3 11 22.8 2 5 2.7 4 (12.5%) 2 MDCT SPECT
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 7.64 3.88 11 4 MDCT SPECT 50 9.5 4.0 estimated pulmonary artery systemic pressure 124 mmhg 2) SPECT MDCT SPECT SPECT SPECT 2 SPECT
18 25 99 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: 2471 2480. 2) 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: 603 607. 3) Roach PJ, Gradinscak DJ, Schembri GP, Bailey EA, Willowson KP, Bailey DL: SPECT/CT in V/Q scanning. Semin Nucl Med 2010; 40: 455 466. 4) : INNERVISION 2013; 28: 50 54.
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 24 6 22 1 41 50 51 60 61 70 71 80 81 90 4 0 7 5 0 0 2 2 1 0 16 5 63.5±6.4 Biograph mct TOF PSF J-ADNI FDG 30 10 20 30 3) 結果 13 30 5 10 15 20 25 leave-one-out 2 13 2 5 30 5 30 2 22
20 25 30 30 NDB 5 5 NDB leave-one-out 30 J-ADNI 5 10 30 NDB NDB 30 5 10 3 30 5 PET 4) 考察 PET/CT J-ADNI FDG 30 30 55 5 3 30 5 30 3 27 1 28 TOF PSF J-ADNI DB
25 21 γ 1 2 3 4 1 5 6 6 1 2 3 4 5 6 1. はじめに Cadmium-Zinc-Telliride CZT SPECT Discovery NM530c (GE Healthcare) Anger γ 2 3 4 γ 4 SPECT 2. 目的および方法 SPECT (1) (2) (3) Discovery NM530c 3 1,000 3. 結果 (1) 99m Tc Anger 1,100 MBq γ 5 1) 3 2) (2) Discovery NM530c 99m Tc Anger 3) (3) 1,000 1 69 74% 26% 79% 40% 24% 10% 31% 53% Tc 71% Tl 29% 10 (1%)
22 25 表 福山循環器病院 99m Tc 370 249 400 MBq 5 3 600 900 MBq 5 3 99m Tc 72 123 222 MBq 5 3 198 606 MBq 5 3 201 Tl 74 MBq 33 111 MBq 2 8 5 8 5 東京医科大学病院 99m Tc 59 370 MBq 5 3 740 MBq 3 99m Tc-tetrofosmin 130 185 MBq 10 3 370 MBq 6 201 Tl 74 MBq 247 111 MBq 2 5 3 10 愛媛大学付属病院 99m Tc-tetrofosmin 25 296 MBq 10 10 740 MBq 10 10 99m Tc-tetrofosmin 29 296 MBq 5 5 740 MBq 5 5 99m Tc-sestamibi 19 370 MBq 5 5 740 MBq 5 5 99m Tc-tetrofosmin 2 150 173 MBq 5 5 450 520 MBq 5 5 新古賀病院 201 Tl 74 MBq 10 9 6 9 % 100 90 80 70 60 50 40 30 20 10 0 92 87 84 85 76 79 64 63 57 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
25 23 A B % % 100 94 93 100 89 85 79 81 80 80 64 59 60 60 46 40 40 72 69 65 65 88 80 感度特異度 正診率 75 69 72 20 20 0 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: 1009 1017. 2) 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: 2727 2734. 3) 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: 1169 1175.