2013,12The nuclear medicine in Nervous systemContent1 Anatomy structure and image of brain2 Radio pharmaceutical3 Patient and instrument Methodology4 Normal image of brain5 Clinic application of brain scan1 Brain anatomy structure and imageThe blood-brain barrierThe blood-brain barrieris both an anatomical is both an anatomical and a physiological and a physiological barrier that preventsbarrier that preventsmost substances in the most substances in the blood from entering blood from entering the CNS the CNS 2 Radiopharmaceutical Functional brain imaging requires strict adherence to a standard protocol. The radiopharmaceuticals should always be injected under the same environmental circumstancespp Patient preparation: quiet, dark,p Radiopharmaceutical: Tc-99m ECD and F-18-FDGp Instrumentation: SPECT and PET/CT p Imaging procedurep Process3 Patient and instrument Methodologyphysiological and biochemical imagingFunctional and molecular imaging It has played an impartment role in the medical health in 21 century with functional and molecular or gene and pharmaceuticals each other4 Normal imaging of brainnuclear medicine imaging definition Brain scintigraphy has long played an importment role in the practice of nuclear medicine.Until the advent of computed tomography in the 1970s, conventional nuclear medicine brain scanss were only noninvasive clincal method available for imaging the brain and represented a large portion of nuclear medicine practice. In current practice ,magnetic resonance imaging(MRI) and CT play preeminent roles in clinical brain imaging,producing superb anatomical imagings of the central nervous system(CNS) The role of nuclear medicine is now funcational brain imaging .Positron emission tomograpgy(PET) led the way by imaging physiological and biochemical processes in the brain,including cerebral blood flow(CBF),glucose metabolism,and oxygen utilization,which had both important research and clinical impact.Subsequently,single-photon blood flow radiopharmaceuticals became available for use with single-photon emission computed tomography(SPECT) cameras.Clinical diagnoses based on abnormalities of CBF and glucose metabolism are now made rountinely using various single-photon and Positron radiopharmacecuticals with both PET and SPECT instrumentation. Conventional Brain Imaging Cerebral Perfusion Imaging Positron Emission Tomography Cisternography Brain tumorsCentral Nervous imaging typeCerebral Perfusion ImagingLipophilica small molecular size, neutral chargeUptake correlated with cerebral blood flow 99mTc-ECD (technetium )are permitting rapid diffusion across the BBB gray matter image， white matter background， no radioactivity in ventricular and cisterns nuclear medicine imaging principal Positron radiopharmaceticals Positron radiopharmaceticals PET technical methodPET technical method quantitation analysequantitation analyseEpilepsy focus Alzheimer diseaseAlzheimer disease Parkinson diseaseParkinson disease Brain Tumor Brain Tumor Brain function Brain function etcetcPositron Emission Tomographyu High High uptake: gray matter, uptake: gray matter, cerebellum, basal ganglion,cerebellum, basal ganglion, thalamus, brain stem, thalamus, brain stem, Cortical circuitry, lateral fissure, Cortical circuitry, lateral fissure, diastema,central sulcus diastema,central sulcusu radioactiity : symmetry and uniformradioactiity : symmetry and uniform u Grey Grey, white matter and the , white matter and the ventricleventricleu The The thalamusthalamus and basal ganglia, depending on the and basal ganglia, depending on the crosscrossu Normal rCBF Normal rCBF: :44.24.5ml 100g44.24.5ml 100g-1-1minmin-1-1 Uptake ratio: Uptake ratio: L/R= L/R=0.90.91,1 normal1,1 normal L/R=L/R=0.80.80.6,abnormal (ischemia0.6,abnormal (ischemia 0.80.80.6,infarct0.6,infarct0.60.6 ) ) Imaging interpretation Normal imaging horizontal sliceslevelCoronal slices中央沟是额顶叶之间的分界标志由枕前切迹到顶枕沟的连线是顶叶和枕叶的分界标志连线以前，外侧沟以下，构成颞叶SPECT/CT18F-FDGTime TopTop 1111CFlumazenilCFlumazenilAbnormal imaging standards Local radioactive radioactive distribution: sparse, distribution: sparse, reduce or defectreduce or defect Local radioactive distribution: increaseradioactive distribution: increase Crossed cerebellar diascbisis Crossed cerebellar diascbisis White White matter area expansion and midline matter area expansion and midline shiftshift Brain Brain structure structure disorderdisorder Abnormal Abnormal radioactive radioactive distributiondistribution Brain atrophy Brain atrophy Asymmetric Asymmetric distribution of radioactivity in the distribution of radioactivity in the brainbrain Acute Acute Cerebrovascular DiseaseCerebral embolismEpilepsyAlzheimer diseaseAlzheimer diseaseBrain Tumor Brain Tumor Brain function Brain function etcetc5 Clinical application Cerebrovascular Disease Stroke: Transient ischemic attack Stroke: Transient ischemic attack Crossed Cerebellar Diaschisis Crossed Cerebellar Diaschisis Stroke: Luxury Perfusion Stroke: Luxury Perfusion Diamox Interventional Study Diamox Interventional Studystrokestroke TIATIA，rest imaging stress imaging (intervene)Radioactivity low in left parietal lobeTIA，rest imaging stress imaging (intervene)Radioactivity low in bilateral frontal lobe and parietal lobeA 72 year old man admitted with symptoms of strokeA 72 year old man admitted with symptoms of strokeCrossed Cerebellar DiaschisisCrossed Cerebellar Diaschisis Case history(Luxury Perfusion) A previously healthy 46 year old man presented with difficulty speaking and confusion 5 hours prior to admission. The patient complained of unspecified eye problems and darkening of vision on both eyes throughout the previous day. The patient had a history of hypertension but currently was not under any medication. On examination, there was significant expressive as well as receptive aphasia. The patient also had some apraxia as well as right sided facial weakness. Limb strength and sensory exams were essentially intact. CT of the head performed without contrast and showed a large left middle cerebral artery infarct, without shift or evidence of bleeding. Luxury Perfusion, 46 years a large left middle cerebral artery infarct Luxury Perfusion, 46 years Luxury Perfusion, 46 years Diamox Interventional Study A 64 year old woman with a known history of A 64 year old woman with a known history of hypertension presented with hypertension presented with Brocas Brocas aphasia and mild facial weakness on the aphasia and mild facial weakness on the rightright. . A brain MRI showed an A brain MRI showed an ischemic infarctischemic infarct involving the involving the left inferior frontal lobe and left inferior frontal lobe and the left inferior cortexthe left inferior cortex. . The MRA showed The MRA showed a complete a complete occlusion of the left internal occlusion of the left internal carotid arterycarotid artery at its origin. at its origin. A CT scan of the brain showed the presence A CT scan of the brain showed the presence of a of a left anterior infarctionleft anterior infarction without without hemorrhagehemorrhageDiamox Interventional Study,64Diamox Interventional Study,64Diamox Interventional Study, 642005-1-13 99mTc-ECD2005-1-20 18F-FDGCerebral embolismMolecularMetabolismBlood,xyogen,glucose2005-1-20 99mTc-HL91lack oxygen agent2004-12-9HL-912004-12-1018F-FDG2005-1-6HL-91EpilepsyEpilepsy-PETMR/SPECTEpilepsy A 30 year old woman with a history of A 30 year old woman with a history of infantile infantile febrile seizuresfebrile seizures and intractable complex and intractable complex partial seizurespartial seizures since age 16 was admitted for since age 16 was admitted for monitoring and evaluation of the seizure focusmonitoring and evaluation of the seizure focus An MR study showed An MR study showed cortical heterotopiacortical heterotopia. . Depth electrode placement showed Depth electrode placement showed spike spike activityactivity in a well localized, small focus in a well localized, small focus in the in the temporal lobetemporal lobeEpilepsy Epilepsy EP （EP intermittent）Left temporal lobe EP（EP seizure ） Left temporal lobe Method Sensitivity%EEG45CT17MR34SPECT65PET75Alzheimers disease cortical atrophy, ventricular enlargement, an cortical atrophy, ventricular enlargement, an excess of senile plaques and neurofibrillary excess of senile plaques and neurofibrillary tangles tangles cognitive functions, memory loss, visual spatial cognitive functions, memory loss, visual spatial deficits and apraxia deficits and apraxia frontal, medial-posterior temporal and parietal frontal, medial-posterior temporal and parietal regions regions Expression: Dementia without prominent focal Expression: Dementia without prominent focal neurologic defects, A steadily progressive courseneurologic defects, A steadily progressive course no biological markers no biological markers Alzheimer-surface A 64 old man with progressive memory loss-coronalA 64 old man with progressive memory loss-level A 64 old man with progressive memory loss-sagital A 72 year old man with history of progressive short term memory losslevellevelA 72 year old man with history of progressive short term memory loss-sagital A 72 year old man with history of progressive short term memory loss-coronal Pathological featuresof Picks diseaseAtrophyAtrophy of the frontal and the temporal lobes of the frontal and the temporal lobes (the thalamus, basal ganglia and the (the thalamus, basal ganglia and the descending fronto-pontine fiber system )descending fronto-pontine fiber system )LateralLateralA sharp lineA sharp line of demarcation between the of demarcation between the affected portions and the remaining brainaffected portions and the remaining brainFibrils in the cytoplasm Fibrils in the cytoplasm HereditaryHereditary A 66 year old man with angular gyrus syndrome, MRI showed an old right occipital CVASymptoms and signs of Picks diseaseDetreriorating mental functionDetreriorating mental function, , changes in behavior patterns, changes in behavior patterns, and lack of insight are seen in and lack of insight are seen in early stage of the disease early stage of the disease loss of language functions and loss of language functions and memorymemory (temporal lobe) (temporal lobe) grasp and sucking reflexes grasp and sucking reflexes ( (frontal lobes) can be noted frontal lobes) can be noted Rigidity, dystonic postures, and Rigidity, dystonic postures, and tremortremor may become prominent may become prominent features in late stages of the features in late stages of the diseasediseasePicks disease1111C-Raclopride C-Raclopride Dopamine D2 receptor imagingTrauma患者男性，患者男性，患者男性，患者男性，3434岁，鼻咽癌手术及放疗后岁，鼻咽癌手术及放疗后岁，鼻咽癌手术及放疗后岁，鼻咽癌手术及放疗后3 3月余，月余，月余，月余，MRIMRI见脑干及左侧海绵窦异常信号，欲鉴别放射见脑干及左侧海绵窦异常信号，欲鉴别放射见脑干及左侧海绵窦异常信号，欲鉴别放射见脑干及左侧海绵窦异常信号，欲鉴别放射性坏死或复发。性坏死或复发。性坏死或复发。性坏死或复发。tumors神经系统的发展方向是功能性脑显像神经系统的发展方向是功能性脑显像PET Cerebral blood flow (CBF)Glucose metabolismOxygen utilization. 99mTc-HL9199mTc-HL91 99mTc-ECD99mTc-ECD 18F-FDG18F-FDGquestionA previously healthy 46 year old man presented with difficulty speaking and confusion 5 hours prior to admission. The patient complained of unspecified eye problems and darkening of vision on both eyes throughout the previous day. The patient had a history of hypertension but currently was not under any medication. On examination, there was significant expressive as well as receptive aphasia. The patient also had some apraxia as well as right sided facial weakness. Limb strength and sensory exams were essentially intact. CT of the head performed without contrast and showed a large left middle cerebral artery infarct, without shift or evidence of bleeding. Question 1 Brain imaging show: _，_,_, Question 2 The diagnose of imaging is_.重庆医科大学附属第二医院核医学科袁耿彪重庆医科大学附属第二医院核医学科袁耿彪2013年年Thanks !