임상PET : Clinical Positron Emission Tomography

책소개




1994년 우리나라에 PET을 처음 도입한지 이제 16년이 지났습니다. 그 동안 PET 진료는 매년 두 배 가까이 성장하여 2010년 전국
연간 30만 건을 넘는 진료가 이루어지고 임상에 필수적인 진료행위가 되었습니다. 이는 130여대의 PET/CT, 30여대의 사이클로트
론 등 진료인프라의 확충과 2006 년에 이룬 의료보험 적용, 그 동안 우리나라 정부의 국산사이클로트론 보급정책 등 여러분의 비
전 과 노력이 이룬 성취라 생각합니다.

이번에 초판을 발간하게 된 임상PET은 서울대학교 핵의학동문들이 축적한 경험을 바탕으로 PET 진료의 현황과 미래비전을 서술
한 최초의 한글 교과서입니다. 이 우리말 책에서 저자들은 어떤 경우에 PET검사를 적용하면 환자한테 도움이 되는지에 대한 가이
드라인을 임상의사의 관점에서 제시하는데 애썼습니다. 아울러 새로운 PET용 방사성의약품, PET/MRI를 포함한 하이브리드 PET,
PET를 이용한 신약개발 등 향후 PET의 발전방향도 조명하였습니다. 아무쪼록 이 책이 PET을 처 음 접하는 학생, 더 깊이 알고 싶
은 전공의, PET의 요점을 빨리 파악하고자 하는 임상의사의 친숙 한 길잡이가 되길 바랍니다.

2010년은 이문호, 고창순 선생님이 서울대학교 핵의학을 시작한지 50주년이며 2011년 올해는 대한핵의학회 창립 50주년입니다.
1984년 제가 우리나라 처음으로 Johns Hopkins University에 PET 연수를 다녀온 후 10년 만에야 우리나라 최초의 PET 센터를 서
울대학교병원에 설립하였는데 이제 학회 50주년에 임상PET 교과서를 출간하여 특히 감회가 큽니다. 학생 때부터 거의 40년간 저
를 한결같이 지도하여 주신 고창순 선생님께 특별한 존경과 감사를 드립니다. 끝으로 우리나라 핵의학 및 PET 발전을 이끄는데
늘 함께하여 준 정준기 교수, 이 책의 각 장을 저술하느라 애쓴 서울 대학교 핵의학동문들과 이 책의 기획, 편집, 교정에 애써
준 이동수 주임교수, 이종진, 오소원 선생에게도 감사드립니다.

2011년 1월 이 명 철






저자 및 역자 소개


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목차


Part 1. PET역사와 국내외 PET현황 / 1
Chapter 01. PET역사와 국내외 PET현황··········································
··········· 3
1. 임상PET의 역사···················································
·························· 3
2. 한국에서 임상 PET 도입···············································
····················· 3
3. 한국에서 임상 PET의 도약··············································
··················· 4
4. 한국의 임상 PET의 전망···············································
····················· 5
5. 결론························································
····································· 5
6. 참고 문헌······················································
································· 5
Part 2. PET/CT 기기와 영상분석 / 7
Chapter 01. PET/CT 기기와 영상분석···········································
············· 9
1. 서론························································
······································ 9
2. 기본원리······················································
································· 10
3. PET 및 PET/CT 시스템················································
···················· 12
4. 데이터 획득·····················································
······························ 14
5. 영상 재구성·····················································
······························ 16
6. 영상보정······················································
································· 18
7. 정량분석 및 추적자동역학··············································
···················22
8. 참고문헌······················································
·································25
Part 3. PET 방사성의약품과 사이클로트론 / 27
Chapter 01. PET 방사성의약품과 사이클로트론······································
····· 29
1. PET용 방사성의약품· ························· 30
2. PET용 방사성의약품의 품질관리····················· 44
3. 사이클로트론····························· 47
viii 임상 PET
4. 발생기· ······························· 49
5. 사이클로트론실의 구성 및 주요장비· ·················· 51
6. 참고문헌······························· 52
Part 4. PET 임상적용 / 55
Chapter 01. 뇌혈관 질환과 간질 PET···········································
·············57
1. 뇌신경 PET· ····························· 57
2. 뇌혈관질환의 PET· ·························· 61
3. 간질의 PET· ····························· 63
4. 참고문헌· ······························ 68
Chapter 02. 치 매···················································
···························· 71
1. FDG PET· ······························ 71
2. 아밀로이드 판 영상··························· 76
3. 참고문헌······························· 80
Chapter 03. 파킨슨병 PET················································
···················· 83
1. PET검사 종류· ···························· 83
2. PET의 임상적용 ···························· 90
3. 참고문헌······························· 94
Chapter 04. 심근관류 PET················································
·····················97
1. 서론·································· 97
2. 심근관류 PET 방사성의약품 및 영상법· ················· 98
3. 심근관류 PET의 임상응용························101
4. 참고문헌· ····························· 102
Chapter 05. 심근대사 PET················································
··················· 103
1. 심근대사 영상· ··························· 103
2. 심근관류 PET을 이용한 생존심근 진단· ················ 106
3. 참고문헌······························ 108
Chapter 06. 심장의 분자영상··············································
··················· 111
1. 서론·································· 111
2. 죽상경화증에서 PET 분자영상······················ 111
3. 심부전의 PET 분자영상·························114
4. 참고문헌· ······························ 115
목 차 ix
Chapter 07. 폐암 PET··················································
·······················117
1. 배경·································· 117
2. 참고 문헌· ······························122
Chapter 08. 유방암 PET·················································
····················· 123
1. 배경································· 123
2. 진단 및 병기결정··························· 124
3. 치료효과 판정 및 예측· ························126
4. 재발 평가· ······························127
5. 기타································ 128
6. 결론·································129
7. 참고문헌 · ····························· 130
Chapter 09. 대장암 PET·················································
······················131
1. 배경·································· 131
2. 진단 및 병기결정 · ·························· 131
3. 치료효과 판정 및 예측· ······················· 133
4. 재발 평가· ····························· 134
5. 결론································ 135
6. 참고문헌······························ 135
Chapter 10. 부인암 PET·················································
····················· 137
1. 서론··································137
2. 자궁경부암과 PET· ························· 138
3. 난소암과 PET· ····························141
4. 자궁내막암· ···························· 143
5. 기타 부인암· ···························· 144
6. 참고문헌 · ····························· 145
Chapter 11. 갑상선암 PET················································
··················· 147
1. 배경································· 147
2. FDG PET· ····························· 147
3. 124I PET································ 151
4. 기타 PET ······························· 151
5. 참고문헌·······························152
Chapter 12. 두경부암 PET················································
··················· 153
1. 배경································· 153
2. 진단 및 병기결정 · ························· 154
x 임상 PET
3. 치료 효과 판정 및 예측························ 158
4. 재발 평가· ····························· 160
5. 방사선치료계획 (RT planning)····················· 161
6. FDG 이외의 방사성의약품························162
7. 참고문헌·······························162
Chapter 13. 뇌종양 PET·················································
····················· 165
1. 서론··································165
2. 진단 및 예후 평가· ··························167
3. 치료방침 결정· ··························· 170
4. 재발 평가· ······························ 171
5. 뇌종양 PET에서 기타 고려 사항· ····················172
6. 참고문헌·······························173
Chapter 14. 식도암 PET·················································
····················· 175
1. 배경··································175
2. 진단 및 병기 결정 ···························176
3. 치료 효과판정 및 예측· ························178
4. 재발 평가 및 재병기결정· ·······················179
5. 방사선치료계획 수립· ·························179
6. 결론·································179
7. 참고문헌······························ 180
Chapter 15. 위암 PET··················································
······················ 183
1. 배경································· 183
2. 진단 및 병기 결정 ·························· 183
3. 치료 효과 판정 및 예측························ 185
4. 재발 평가· ····························· 185
5. 결론································ 186
6. 참고문헌······························ 186
Chapter 16. 간담췌암 PET················································
··················· 187
1. 췌장암과 PET· ····························187
2. 담도계 종양과 PET·························· 190
3. 분자영상의 새로운 시도························· 191
4. 참고문헌· ······························192
Chapter 17. 흑색종 PET·················································
····················· 193
1. 배 경· ······························· 193
목 차 xi
2. 진단································ 194
3. 병기결정······························ 194
4. 예후 예측· ······························195
5. 재발 평가 및 재발 시 병기결정·····················195
6. 치료효과 판정 및 조기예측· ······················196
7. 참고문헌·······························196
Chapter 18. 비뇨기암 PET················································
··················· 199
1. 배경 ·································199
2. 전립선암 PET· ····························199
3. 방광암 PET· ···························· 200
4. 신장암 PET· ···························· 202
5. 결론 · ······························· 203
6. 참고문헌 · ····························· 203
Chapter 19. 원인미상암 PET···············································
················ 205
1. 서론································· 205
2. 일반적 진단 과정 · ························· 206
3. 양전자단층촬영술·························· 206
4. 결론· ······························· 208
5. 참고문헌······························ 209
Chapter 20. 감염 PET··················································
·······················211
1. 서론·································· 211
2. 골수염································ 211
3. 합병증을 동반한 당뇨병성 족부병변 ·················· 213
4. 통증을 동반한 하지 인공관절· ···················· 213
5. 연부조직 감염· ··························· 214
6. 감염 치료평가에서 PET의 유용성· ···················216
7. 결론 · ································217
8. 참고문헌·······························217
Chapter 21. FDG 이외 종양 PET·············································
·············· 221
1. 아미노산 PET(Amino acid PET)·····················221
2. 펩티드수용체 PET(Peptide receptor PET)· ·············· 222
3. 항체 PET (Antibody PET)· ····················· 224
4. 핵산 PET (Nucleic acid PET)····················· 224
5. 저산소증 PET (Hypoxia PET)····················· 225
xii 임상 PET
6. 세포막 PET (Membrane PET)····················· 226
7. 기타································ 227
8. 참고문헌······························ 229
Chapter 22. 림프종 PET·················································
····················· 231
1. 배경································· 231
2. 진단 및 병기 결정· ························· 232
3. 치료 효과 판정···························· 233
4. 병기 재결정과 예후 예측 ······················· 235
5. 재발 발견· ····························· 236
6. 기타································ 236
7.결론································· 236
8.참고문헌······························· 237
Part 5. PET실용 / 239
Chapter 01. PET 정도관리와 프로토콜··········································
··········· 241
1. 정도관리······························· 241
2. PET 정도관리 프로그램 - 외국의 사례 ················ 243
3. PET 정도관리 프로그램과 대표적 기준 ················· 244
4. 국내 PET 정도관리 체계, 관련 기관 및 법률적 고려사항· ········ 246
5. PET 정도관리의 국내기준과 진행 현황· ················ 246
6. 결론································ 249
7. 참고문헌······························ 250
Chapter 02. PET 검사의 방사선 안전···········································
··········· 253
1. 방사선량학적인 고려· ························ 253
2. PET/CT 방사선피폭의 특성· ····················· 254
3. PET/CT로 인한 피폭· ························ 255
4. 결론· ······························· 255
5. 참고문헌······························ 256
Chapter 03. PET 방사선량평가··············································
················ 259
1. 방사선량 단위· ··························· 259
2. 방사선 내부 피폭선량 계산 (MIRD 방법)· ··············· 260
3. OLINDA/EXM 소프트웨어를 이용한 PET 영상기반 피폭선량 계산····· 263
4. 참고문헌· ····························· 264
목 차 xiii
Chapter 04. PET 신의료기술인정과 규제 및 보험급여···································
265
1. PET 신의료기술인정· ························ 265
2. 의료보험 적용 ···························· 267
3. 참고문헌······························ 269
Part 6. PET 이용연구와 PET의 미래 / 271
Chapter 01. 소동물 PET·················································
····················· 273
1. 필요성································ 273
2. 시스템 특성 ····························· 273
3. 시스템 사양· ···························· 274
4. 기타 고려사항· ··························· 274
5. 참고문헌······························ 277
Chapter 02. 분자영상과 신약개발············································
··············· 279
1. 신약개발 과정에서 PET의 역할···················· 280
2. 대리표지자로서 PET· ························ 280
3. 동반진단검사로서 PET· ······················· 282
4. PET을 이용한 약력학························· 283
5. PET을 이용한 약동학························· 283
6. 약물전달 효과를 평가하는 PET· ··················· 285
7. 유전자치료 모니터링· ························ 285
8. 세포 치료 모니터링·························· 286
9. 참고문헌······························ 287
Chapter 03. 하이브리드 PET···············································
················· 289
1. 융합영상의 필요성· ························· 289
2. PET/MRI 시스템····························291
3. MRI 기능성 정보 ADC· ······················· 294
4. 병렬형 전신 PET/MRI 시스템 임상경험················· 294
5. 저산소증 PET/MRI와 MR 초분극분광법················ 296
6. 전망································ 297
7. 참고문헌······························ 298
색인 한글·································· 301
영문·································· 312
기타·································· 319