spect - ctelearning.kocw.net/contents4/document/lec/2013/gachon/... · 2014-03-04 · gantry...

12 주차

SPECT - CT

SPECT-CT

자료: Simens

Gantry Overview – 전면부

XTA – X-ray Tube Assembly

Blowers –

CT 겐트리의 냉각장치로써 냉각 및 정화된 공기를 주입

High Voltage Tank –

고전압 발생장치로 X-

Ray 의 Part.

DMS – Data Measurement System

Ultra Fast Ceramic (UFC) 및 DAS

component로 구성되어 있습니다.

Gantry Overview – 후면부

XTA – X-ray Tube

High Voltage Tank

HV Tank로 부터 XTA에

고전압을 공급하는 케이블

Power Box –

Main Inverter를

장착하고 있으며 HV

tank 전체에 고전압을

공급합니다. XRS – 고전압 발생기의

Control Center 입니다.

PSR – Power Supply Rotating.

Tube와 디텍터를 회전시키는

프레임에 전원을 공급합니다.

PCU –

DMS의

전원

공급

장치.

SRS – Slip ring system.

별도의 Wire 없이 Tube와 Frame간에

전기적 신호를 전송하는 장치

자료: Simens

자료: Simens SPECT-CT Fusion image

Proven Outcomes

LAD LCx RCA All Vessels

NC CTAC NC CTAC NC CTAC NC CTAC

Sensitivity 69 93* 61 72 78 81 69 88*

Specificity 25 38 63 78 31 75* 45 69*

Accuracy 60 81* 62 73 59 78* 60 79*

* p<0.05

25% improvement in most MPI diagnostic parameters

James R. Corbett, MD, University of Michigan Health System, Ann Arbor, MI

We see a way to ... Increase specificity, sensitivity, and accuracy of Myocardial Perfusion SPECT by more than 25%

자료: Simens

Data Courtesy of University of Michigan, Ann Arbor, MI, Dr. James Corbett

Uncor Stress

COR Stress

Uncor Stress

COR Stress

Uncor Stress

COR Stress

Uncorrected Stress – FPB, Endocardial Perfusion Blackout Corrected Stress, Endocardial Perfusion Blackout

Myocardial perfusion - effect of attenuation correction using CTAC

66 year old male, 94 kg (207 lbs) – typical angina with multiple coronary risk factors and two vessel disease. Abnormal scan. Stress slices displayed are FPB uncorrected verses CT corrected. Total proximal RCA and total mid LAD occlusions both with extensive collaterals from normal LCx.

자료: Simens

111In Octreotide SPECT·CT study. SPECT·CT Octretide study performed 48 hours after injection with 3 phase Liver contrast CT study. Fusion of venous phase of 3phase contrast CT study with In 111 Octreotide SPECT shows small focal contrast blush in segment VII of liver which corresponds to focal area of uptake of In 111 Octreotide suggestive of metastasis from Carcinoid tumour. Another small foci of In 111 Octreotide uptake in the inferior margin of the right lobe of liver in segment V suggestive of metastasis but without any abnormality on contrast CT.

Data courtesy of Dr.Shahid Mahmood Radiology Clinic Parkway Hospitals Singapore

Liver Metastasis from Intestinal Carcinoid Tumor

자료: Simens

SPECT is distributed; PET is mostly oncology The overlap of PET and SPECT is only in

oncology….

Source: IMV SPECT Census Report, 2003; IMV PET Census Report 2003; PET and Molecular Imaging Report Europe 2004; SMI CRM Understand and Strategic Planning

SPECT ~40 million procedures

PET ~2 million procedures

WORLD

92%

4%4%

Oncology

Cardiology

Neurology

31%

35%

4%

30%

Oncology

Cardiology

Neurology

General Imaging

25%

55%

1%

19%

Oncology

Cardiology

Neurology

General Imaging

자료: Simens

Clinical Results – Diagnostic Confidence

Benefits of SPECT/CT in bone cancer imaging

More than 90% of cancer patients leave the clinic with a definite diagnosis

W. Römer, MD, University Clinic of Nuclear Medicine, Erlangen, Germany

Malignant

Indeterminate

Benign

44

52

28

0

25

50

75

100

125

SPECT

Lesions

43

77

SPECT•CT

4

SPECT vs. SPECT•CT Diagnostic in Oncology Clarify more than 90% of

SPECT findings initially classified as indeterminate.

Reduce patient radiation exposure by limiting the CT scan to the body region of interest identified by SPECT

Preliminary results suggest change in patient management in 20~30% of cases.

자료: Simens

PM- tube Crystal

Collimator

SPECT Phantom

Jaszczak ACR SPECT Phantom

SPECT Phantoms

SPECT phantom을 이용한 횡단면상의 분해능 성능검사

Jaszczak Phantom

자료: 핵의과학

IAEA Phantom

자료: 핵의과학

SPECT 방사성 의약품

1) Brain - 99mTc-HMPAO, 99mTc-ECD, 201Tl, 123I-IMP,

HIPDM

2) Heart - 99mTc-sestaMIBI, Tetrofosmin, 201Tl

3) Bone - 99mTc-MDP, HMDP, EHDP, MHDP

4) Kidney - 99mTc-DMSA

5) Liver - 99mTc-phytate (colloid), 99mTc-PYP, RBC

6) Lung - 99mTc-MAA, HAM

7) Tumor – 67Ga-citrate, 99mTc-sestaMIBI, Tetrofosmin

A : Transverse, B : Sagittal, C: Coronal

A : Transverse, B : Sagittal, C: Coronal

Hoffman Brain Phantom

3-D Hoffman Brain Phantom

심근관류 SPECT에서 단층영상 구성

Cardiac Insert Phantom

Lung phantom