y Hoc Hat Nhan Chan Doan - Ths Chuong

5/26/2018 y Hoc Hat Nhan Chan Doan - Ths Chuong

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BA NHM CHNH:1. NGHIM PHP THM D CHC

NNG2. GHI HNH NHP NHY CC C

QUAN, T CHC HOC TON C

TH3. CC NGHIM PHP INVITRO


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I-THM D CHC NNG:

THM D CHC NNG TUYN GIP:

- otptrung I-131 tituyngip

1.Ch nh

2.Chun bbnhnhn

3.o tptrung I-131 tituyngip sau 2h v 24h.

4.nh gi ktqu.


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II- GHI HNH NHP NHY:1. X HNH TUYN GIP:2. X HNH THN HNH TH V CHC NNG3. GHI HNH NO4. CHN ON BNH TIM MCH5. X HNH XNG

6. X HNH PHI7. X HNH GAN


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1. X HNH TUYN GIP:1.1. Nguyn l ghi hnh tuyngip: khnngbtIot vi

nngcao v gilu di trong tuyn.

1.2. Chnh

- Xc nhvtr, hnh dng, kch thcv cutrc TG.

- nhgi cc nhn TG.

- nhgi tnh trngchcnngcanhn TG.

- nhgi trcv sau phuthutbnhnhn ung thTG

- Cc trnghpvim TG

- Chnonphn bitcc u vng cv trung tht, TGlcch.


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1.3. Dcchtphng x: I-131; Tc-99m, I-1231.4. Thitbghi hnh: gamma camera, my SPECT1.5.nhgi ktqu:- TG bnh thng

- Nhngbtthng:

+ TG ph i nhngbnhnhn cnggip trng+ TG nh bnhnhn suy gip+ Cc nhn nng hocnhn lnh

+ Nhn c+ TG lcch+ Cc di cncaung thTG


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2. * X HNH THN HNH TH2.1. Nguyn l ghi hnh: sdngcc DCPX pht tia

Gamma, hpthu nhanh thn, tham gia vo qutrnh lc cuthn, chtitv bi xut cc ng

thn.2.2. Chnh:- Xc nhkch thc, vtr v giiphucathn- Nghi chnthngthn, u v nang thn

-Xc nhthnlcch

- nhgi hnh nhv chcnngthnghp- ivibnhnhn mncmvithuccnquang.2.3. Dcchtphng x: DMSA-Tc-99m


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2.4. Thitbghi hnh: my gamma camera, my SPECT

2.5.nhgi ktqu:

- Thnbnh thng

- Nhngbtthng:

+ Vng mnhthoc khuytHPX khi thnbtnthng: u, nang, nhimu, p xe, vchnthng, lao thn, .

+ Thnlcch.


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2. * X HNH THN CHC NNG:

2.1. Nguyn l: sdngcc DCPX l chtm ngbi xutduynhtra khicthl qua thn. Tim tnh mchsau ghihnh HPX catngthntheo thigian snhgi cchcnngtngthn.

2.2. Chnh:

- nhgi hotngchcnnghai thnhocring rtngthn.

- nhgi v theo di sau ghp thn

- nhgi v theo di tcngtitniu.

2.3. Dcchtphng x:- DTPA-Tc-99m

- GHATc-99m

- MAG3-Tc-99m


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2.4. Thitbghi hnh: my Gamma camera hocmySPECT.

2.5. Phn tch thn:

- Thnbnh thngc 3 phn: phnmch, phn

titv phnbi tit.

- Cc thng scbn: Tmax, T1/2

- Thnbtthng


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3. CHN ON BNH NO:

* X HNH NO QUY C

3.1. Nguyn l gh i hnh : khi hng ro mu no tn

thng, mtschttrong mu c thxm nhpvo vng tnthng.

3.2. Dcchtphng x:

- Tc-99m- pertechnetate

-Tc-99m-DTPA

- Tc-99m-GHA,


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3.3. Thitbgh i hnh:my Gamma camera, my SPECT


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* X HNH TI MU NO:- Nhmpht hinsphn bmu v stimu

nhiuvng cano.

- Chnh: + ChnonbnhAlzheimer

+ Xc nh kch thch+ Chnonchtno

+ Chnonl lndo AIDS

+ Ghi hnh sphn bcatimu notrong can thip

+nhgi tnthngno.

- Dcchtphng x: Tc-99m HMPAO, Tc-99m-ECD.


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NH GI KT QU:

- ivicc DCPX bnh thngkhng iqua hng

ro mu no: nubnh thngstrngHPX, nuc tnthngscho mtimnng trn nnlnh

- iviDCPX bnh thngvniqua hng romu no: bnh thngth chtphng xphn b

ngu, nuc tnthngsxuthinvnggimhoctrngHPX.


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Xhnh no bnh thng: ghi hnh bngmyGamma Camera viTc-99m-O4: khng c HPX trong tchcno.


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Khiu nguyn bo xp:

( Gliomablastoma)

Ghi hnh vimy Gamma

Camera: khiu tng

ngvivng tngHPX

btthngtrong t

chcno.


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Hnh nhxhnh no bnhnhn bchtno(brain death): khng cn HPX tptrung hai bncuino (DCPX: HMPAO: l chtqua chngro mu no)


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4. CHN ON BNH TIM MCH:(Tim hchtnhn)

Gmc ba nhm:

-Nhm 1: nhgi timu ctim v sinh lccatbo ctim

- Nhm 2: Dng cc htnhn phng xchphnhdatrn hottnh sinh hccachng nhchp

hnh dng chtngtrong vng nhimu ctim- Nhm 3: cc kthutnhgi hiuquchcnng

cahotngtim mch.


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Cc kthuty hchtnhn

dng trong chnonbnhtim mch- Kthutpha sm(first pass)

- Xtm thtk

- Timu ctim


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LU TRNH U TIN

(PHA TI MU U TIN, PHA SM)- Tim DCPX vo tnhmchvitcnhanh

dngmc, quan st sdchchuyncaDCPXny c thxc nhv nhgi ctctun

hon ttay phi(hoctay tri) ntim, cc lungthng trong tim, cc thng schcnngtim vvnngthnh ctim.

- Chnh: nhgi chcnngthtphi, thttri;

pht hincc lungthng trong tim, bnhl ccvan tim, pht hinrilonvnngthnh ctim,chnonbinchngnhimu ctim cp, chnoncnauthtngc,


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Phngphp xk tm tht

- SdngDCPX ha utrong mu, cho php

ghi lihnh nhtm tht; sthay ibmu trongtm thtqua cc giai oncachu chuyntim scho ta bitchcnngtm thu, tm trngv cc

hotngcathnh tim.- Chnh:

+ sau nhimu ctim

+ Suy tim bmsinh

+ Phnh thnh tht+nhgi chnh xc chcnngtm tht

+ theo di tc dngcathuciutrv sau PT tim.


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GHI HNH TI MU C TIM- Nguyn l: Cc DCPX pht tia gamma theo dng

mu nui dngctim v cphn btrong ;nhngvng ctimu bnh thngsth

hintrn hnh ghi l nhngvng c tptrungHPX; ngclinhngvng timu km sgimhocmtHPX.

- GHi hnh hai trngthi: ngh(rest) v gngsc(stress).

- DCPX: Thalium 201; Tc-99m-Sestamibi; Tc-99m-Teboroxime;

- Trong PET: N13H3; H2-O-15; F-18-FDG,


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- Thitb: my gamma camera, my SPECT, myPET

- Phn tch ktqu:

+ Vng gimHPX tngngvitimu km

+ Vng mtHPX tngngvivng t ctimu hocvng bnhimu hocsoctim.

+ trngthi ngh: HPX phn bngu, trngthi gngscthygimhot: vng ctim gimhotnghockhng hotng(ngmin:hibernation)

+ trngthi nghv gngscuthymtHPX:soctim hocc nhimu.


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5. X HNH XNG:5.1. Nguyn l ghi hnh: vng xngbtnthng

thngikm viti toxng, tnghotng

chuynha calci, v thdng cc DCPX c chuynha tngngvicalci th chng stptrung ticc vng ti toxngvinngcao.

5.2. DCPX: Tc-99m-MDP, Tc-99m-HMDP, Tc-99m-

EHDP,5.3. Thitbghi hnh: my gamma camera, my SPECT,

my PET.


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5.4. Chnh:

- nhkhu cc tnthngxng

- Pht hincc di cnvo xngcabnhnhn

ung thv, TLT, - Xc nhvtr sinh thitv mclan rngca

cc tnthngph hyxng

- Sng lcpht hindi cncaung thv, phi,

-Pht hincc di cnxngticc cowquan khc.


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5.5.nhgi ktqu:

Hinh nhung thphid i cnvo xng,Gh i hnh viTc-99m-MDPbngmy SPECT 2 u.

Xhnh xngviTc-99m -MDP

Tnthngung thd i cn

xnga.


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Ung thitrng di cnxng: CT(-); SPECT (+)


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6. THM D CHC NNG PHI:6.1. Nguyn l chung:

- Xhnh timu phi: Cc htnhduphng xsau khi tim tnhmchgy tcnghntmthicc

mao mch phi, v vyc thghi hnh phi. Nudng mu bnghnth skhng c HPX tivngbtnthng.

- Xhnh thng kh phi: Bnhnhn ht DCPX sau

ghi hnh. Nhngvng phic thng kh km sngliHPX, nhngvng thng kh phittsschHPX.


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6.2. DCPX:

- Ghi hnh timu phi: Tc-99m-MAA

- Ghi hnh thng kh phi: Tc-99m-DTPA

6.3. Chnh:- Xhnh timu phi: chnonnghnmch

phi, chnonluhuytphitngvng trc

phuthutctbmtphnphi.

- Xhnh thng kh phi: Chnonhuytkhi

phi, nhgi thng kh phitngvng.


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6.4. My ghi hnh: Gamma camera, SPECT6.5.nhgi ktqu:

- Xhnh timu phi: vng gimhockhng ctimu ngmchphithhinl vng lnh.

- Xhnh thng kh phi: Vng phithng kh km

th kh phng xtnngnn l vng tptrungHPX.

- Phihpghi hnh timu phiv thng kh

phi: trong chnonvng tcmchphi(pulmonary embolism): l vng tnthngtrn xhnh timu phiv l vng c thng kh phibnh thng.


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7. X HNH GAN7.1. Nguyn l: tchcgan bao gmtbo nhu m

gan v tbo lin vng nim. Sau khi tim keophng xvo tnhmch, ty loiDCPX sxm

nhpvo tbo lin vng nim hocnhdunhu m gan v cho ta ghi hnh gan.

7.2. Chnh:

* Ghi hnh gan:nhgi hnh dng, vtr, kch thc

cagan; Pht hinv nhvcc tnthngkhutr nhung thgan, p xe gan, nang gan,..

* Ghi hnh gan mt: nhgi chcnngtbo nhu mgan, ngmtv ti mt,


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7.3. Dcchtphng x: nhduhlin vng nim: keo vng, keo

Sulfua-Tc-99m, Phyton-Tc-99m

nhdutbo nhu m gan: Rose Bengal-I-131,

BSP-I-131.7.4. Thitbghi hnh: my gamma camera, spect/-ct,pet/-ct.

7.5.nhgi ktqu:

- Xhnh gan: tnthngl vng gimhockhuytHPX, thay ikch thc,

- Xhnh gan mt: khng thyhocmunHPXvng rut,


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Xhnh gan bnh thngviTc-99m-SC


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Xhnh gan viTc-99m-SC: khuytgan tri


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Xhnh gan viTc-99m-SC: lch to, xuthinhottnhtyxng(tngp lctnhmchca)


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Xhnh gan mtviTc-99m-HIDA


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Xhnh u mu gan viTc-99m-RBC


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Xhnh u mu gan viTc-99m-RBC


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III. GHI HNH KHI U:

Gm3 nhm chnh:

1. Ghi hnh khiu khng chiu:

- Xhnh bngtngphnm tnh

- Xhnh bngtngphndngtnh

2. Ghi hnh khiu chiu(ghi hnh mindchphngx- RIS)

3. Ghi hnh khiu theo nguyn tcchuynha (bngkthutPET)


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1. GHI HNH KHI U KHNG C HIU

1.1. Theo nguyn tctngphnm tnh: nic khiu l vng khuythocgimHPX.

- Ung thtuyngip: l nhn lnh(cold nodule)- U gan: trong xhnh gan l vng lnh

-Ung thphi: l vng lnh1.2. Theo nguyn tctngphndngtnh: nickhiu l vng tptrung hotphng xcao hntchcxung quanh

- U no: trn xhnh viTc-O4: khiu l vng nng

trn Scintigram- U xng.- Cc khi u nng: ung thda, ung thv, u nhn

cu.


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ngdnglm sng caphngphpghi hnh khng chiu:

1. Cc khiu hthnkinh trung ngKhiu nguyn bo xp:

( Gliomablastoma)Ghi hnh vimy Gamma

Camera: khiu tng

ngvivng tngHPX

btthngtrong t

chcno.


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ngdnglm sng caphngphp

ghi hnh khng chiu:2. Khiu tuynnitit: Ung thtuyngip thbitha

(thnh, thnang): xhnh viTc-99m hocI-131.


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ngdnglm sng caphngphpghi hnh khng chiu:

3. Ung thphi: xhnh viGa-67, Tl-201


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ghi hnh khng chiu:4. Ung thgan v ung thdi cnvo gan: xhnh vi

cc chtkeo nhduTc-99m hocGa-67.


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ghi hnh khng chiu:

5. Ung thv: Xhnh viTc99m-Seta MIBI


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ghi hnh khng chiu:6. Ung thxngv ung thdi cnvo xng: x

hnh xngton thn viTc-99m MDP


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2. GHI HNH MIN DCH PHNG X(Radioimmunoscintigraphy: RIS)

Nguyn l: mikhiu c mtloitbo ung th,nhngtbo ny tora nhngkhng nguyn c

hiu, khng nguyn skthpvikhng thchiucan. Sdngkhng thchiunhduVPX pht tia gamma, khng thny skthpvikhng nguyn tngngcatchcung thv tothnh phchp: khng nguynkhng th

nhduphng x; nhvykhiu trthnh ngunpht tia gamma, ktqul ta sc mthnh ghidngtnh l hnh nhcakhiu ung thchiu.


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2. GHI HNH MIN DCH PHNG X- Khng nguyn:

+ CEA (carcinoembryonic antigen),

+ HCF (human choriogonadotropin),

+ AFP (alpha-fetoprotein),- Khng th(antibody) v DCPX nhdukhng

th:

+ Khng thndng (monoclonal antibody) kt

hpchiuvikhng nguyn ung thcntm.+ DCPX nhdukhng th: ccVPX pht tia gamma

c mcnnglngthch hpv c isngngnnhTc-99m, I-123,..


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3. GHI HNH KHI U THEO NGUYN TC CHUYN HA(PET- Positron Emision Tomography)

L phngphp ghi hnh khiu c nhyv chiucao hnnhiuso vicc phngphp chnonhnh nhkhc.

Nguyn l cbncaghi hnh khiu bngPET l cstptrung chiuDCPX lachndatrnnhngkhc bitvsinh l hchocchuynhagiakhiu v tchcbnh thng.

V d: khiu thngtngtctnghpprotein sovitchclnh, do n cnnhiuacid aminhn; khiu tngphn hyglucose hndo nhucusdngglucose cao hntchclnh.


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Nhvynuta dng cc chttinthn caAND hayglucose gnviccVPX thch hp(C-11, F-18,O-15,..) cc DCPX ny sthm nhpvo trong tbo khiu theo cchchuynha. V vyta sghi hnh ckhiu mtcch kh chiuvic

thng tin vchuynha v hnh nhgiiphucakhiu.

Kthphai phngphp ghi hnh PET v CT trncng mtmy, bnhnhn sngthivachp

CT vacchpPET, ta thu chnh nhCT(hnh nhcutrc) v hnh nhcaPET (hnh nhchcnngv chuynha); hai hnh ctrnvolm mt.


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MY PET/CT

M HNH MY PET/CT

MY PET/CT TI TT YHHN&UB


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HNH CT HNH PET HNH PET/CT+

+ =

=Hnh nhcu trcgii phu

Hnh nhchuyn hachc nng

Hnh nhcu trc vchc nng

HNH PET/CT


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DCPX


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UNG TH VM DI CNXNG


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UNG TH D DY


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UNG TH TY


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UNG TH GAN


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UNG TH PHIDI CN XNG


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XIN TRN TRNG CM N

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y Hoc Hat Nhan Chan Doan - Ths Chuong