短暂性脑缺血发作患者脑血流变化研究

目的 通过对脑血流(rCBF)SPECT检查，探讨短暂性脑缺血发作患者的局部脑血流变化。方法 对29例短暂性脑缺血发作患者在发病6～48h内同时行头部CT及SPECT检查，并于发病48～72h后再次复查头部CT。另外对30例健康志愿者进行头部CT及SPECT检查。结果 SPECT检出阳性率为72．4％(21／29)。且神经功能缺损越重，rCBF的灌注缺损就越低。结论 在患者尚未发生脑组织结构异常的代谢和功能性损伤时，SPECT可灵敏的探测到损伤局部的脑血流变化，对估计患者的预后，有一定的指导意义。     

31例癫痫患者发作间期SPECT脑显像结果分析

目的探讨SPECT局部脑血流断层显像,对发作间期癫痫灶的诊断价值.方法对31例癫痫患者于发作间期进行SPECT99mTC-ECD局部脑血流断层显像,并与同期CT和(或)MRI、长程脑电图(AEEG)检查结果进行比较.结果31例患者SPECT脑显像均异常,低血流灶占84%(26例),局限性高灌注灶16%(5例).阳性病灶79个,额叶25,颞叶26个,顶叶17个,枕叶17个,基底神经节4个,旁中央小叶1个.单个病灶5例,单侧病灶19例.CT和(或)MRI阳性率50%(15/31),10例显示局部病灶,AEEG阳性率93%(29/31),单侧病灶8例,其余为弥漫性病变.病灶阳性检出率SPECT与CT和(或)MRI比较差异显著,P＜0.005,而与AEEG之间无显著差异,P＞0.05.结论SPECT局部脑血流显像是诊断癫痫的有效方法,SPECT对癫痫灶检出的灵敏度优于CT和MRI,定位价值优于AEEG.手术前SPECT检查是为了确定手术范围,而精确的癫痫灶的定位还要皮层EEG.     

短暂性脑缺血发作间期局部脑血流及脑细胞功能状态

目的 通过对短暂性脑缺血发作(TIA)患者发作间期局部脑血流及脑细胞功能状态的研究，探讨TIA的有效治疗依据。方法 41例处于发作间期的TIA患者与55名做对照的健康成人均行单光子发射电子计算机断层显像(single-photon emission computed tomography，SPECT)、CT灌注成像(computed tomography perfusion imaging，CTPI)和正电子发射体层摄影术(positron-emission tomography，PET)等检查，对检查结果进行相关分析。结果 SPECT显示放射稀疏和(或)缺损39例，检出率为95．1％。CTPI显示灌注异常26例，检出率为63．4％，提示TIA发作间期仍有半数以上存在相应区域局部脑血流动力异常。而对于CTPI显示脑血流正常者，SPECT仍显示有放射稀疏和(或)缺损，考虑为局部脑细胞功能减低所致，PET检测结果亦显示细胞代谢异常。结论 TIA发作间期患者虽无临床症状及体征，但脑细胞功能未完全恢复正常，部分患者仍处于脑血流异常状态。提示临床医师应重视TIA患者的治疗，防止TIA复发，预防脑梗死的发生。     

金纳多治疗慢性脑供血不全的临床研究

目的探讨银杏叶提取物一金纳多治疗脑梗塞的疗效和SPECT脑血流灌注显像对慢性脑功能不全患者的诊断价值。方法对52例眩晕患者和20例正常对照者进行SPECT脑血流灌注显像检查,用金纳多20ml治疗疗程一周,金纳多片1片一日三次共30天,治疗前后进行疗效评价和SPECT脑血流灌注显像检查。结果52例患者全部出现脑血流量下降,多数分布在左颞,额叶;40%患者的脑缺血程度与健侧相比下降20%以上.60%患者脑血流量减少程度低于20%,39例患者表现为大脑两侧之血流量减低。金纳多治疗后脑血流量灌注显像结果显示大部分脑血流低灌注区恢复或不同程度改善。临床症状消失。全部患者脑CT/MRI及TCD检查均正常。结论金纳多对慢性脑供血不全治疗是十分安全有效的药物,SPECT脑血流量灌注显像有助于眩晕患者的病因学诊断,和治疗效果的评价。     

脑损伤后综合征患者SPECT局部脑血流灌注显像

目的 探讨SPECT脑血流显像在脑损伤后综合征的临床价值。方法 对78例脑损伤后综舍征的患者行^99Tc^m-双半胱乙自酯（ECD）SPECT脑血流灌注断层显像并和临床症状、体征及CT扫描检查进行对比分析。结果 78例患者中57例（73．1％）脑SPECT显像阳性，其中弥漫性血流灌注减低8例，局部血流灌注减低41例。结论 SPECT局部脑血流显像在脑损伤后综合征的诊断中具有重要临床意义。     

抑郁症患者局部脑血流灌注变化研究

目的 分析抑郁症患者单光子发射型计算机断层显像(SPECT)局部脑血流(SCBF)灌注变化的特点,并初步探讨rCBF显像在抑郁症患者中的诊断价值. 方法 对10例正常人及临床诊断为抑郁症的32例患者分别进行SPECT局部脑血流灌注显像,利用感兴趣区(ROI)法观察rCBF情况;11例患者同期行MRI普通扫描.结果 32例抑郁症患者中31例发现rCBF显像异常,共检出71个病灶,分别位于双侧额叶、颞叶、基底节、海马、扣带回及左侧岛叶,其中57个病灶位于颞叶、海马、扣带回及岛叶,即边缘系统,9个病灶位于额叶,5个病灶位于基底节;基底节区病灶局部脑血流灌注均增高,其他部位病灶均降低;双侧大脑半球rCBF病灶构成比差异无统计学意义(χ~2=409,P=0.790).11例患者同期做MRI扫描,3例发现异常(2例轻度脑萎缩,1例海马萎缩),而此11例患者rCBF显像均发现异常.1例正常人rCBF未发现异常显像.结论 大多数抑郁症患者存在脑边缘系统rCBF降低,部分患者存在基底节区rCBF增高.SPECT能敏感地发现抑郁症患者rCBF灌注的变化,对抑郁症的诊断具有一定的价值.     

核素脑灌注显像在癫癎诊断及定位中的应用价值

目的探讨SPECT核素脑灌注显像在癫癎诊断及定位中的特点.方法对48例癫癎患者行发作期及发作间期SPECT检查2次,对结果进行分析,并与EEG、CT/MRI 进行对比.结果发作间期SPECT显像结果：48例中发现异常34例;发作期SPECT 检查结果：48例中35例可见明显高灌注,6例基本正常,7例呈局部低灌注.48例患者均行EEG检查,异常32例;36例行CT/MRI检查,异常14例.结论 SPECT脑灌注显像能显示脑血流及功能情况,对于癫癎的诊断及定位具有重要的临床价值.     

核素脑灌注显像在癫癎诊断及定位中的应用价值

目的探讨SPECT核素脑灌注显像在癫诊断及定位中的特点。方法对48例癫患者行发作期及发作间期SPECT检查2次,对结果进行分析,并与EEG、CT/MRI进行对比。结果发作间期SPECT显像结果:48例中发现异常34例;发作期SPECT检查结果:48例中35例可见明显高灌注,6例基本正常,7例呈局部低灌注。48例患者均行EEG检查,异常32例;36例行CT/MRI检查,异常14例。结论SPECT脑灌注显像能显示脑血流及功能情况,对于癫的诊断及定位具有重要的临床价值。     

抑郁症患者局部脑血流变化的SPECT研究

目的用SPECT测定抑郁症患者的局部脑血流(rCBF),比较乙酰唑胺脑负荷试验后脑血流灌注变化,观察抑郁症患者脑血管的调节能力,以及是否存在潜在缺血灶。方法以18例未经抗抑郁治疗的抑郁症患者为研究对象,19名正常人作为对照组,行单光子发射计算机断层扫描(SPECT)检查。抑郁症患者48h后口服乙酰唑胺2g,再行SPECT检查。观察服用乙酰唑胺前后脑内血流的变化。结果抑郁组患者双侧额叶、颞叶的rCBF显著下降(P<0.01～0.05),左顶叶、右基底节rCBF也明显降低(P<0.05);同时,抑郁症患者局部脑血流低灌注存在不对称性,左侧灌注更低。服用乙酰唑胺后,原脑内各血流灌注下降部位恢复正常血供,未发现潜在缺血病灶。结论抑郁症患者某些特定部位存在脑血流灌注下降;乙酰唑胺脑负荷SPECT试验未发现抑郁症患者存在潜在缺血部位,而且使其局部脑血流低灌注状态恢复正常。     

SPECT显像与美解眠诱发试验对癫癎病灶定位诊断价值的探讨

目的探讨美解眠激发癫癎脑血流灌注显像对癫癎致癎灶的定位诊断价值,为立体定向放射治疗提供定位依据.方法32例药物治疗失败并准备r-刀手术治疗的癫癎患者,发作间期行SPECT检测;应用美解眠诱发,观察亚临床发作期SPECT的变化.结果32例癫癎患者,发作间期SPECT呈低灌注者26例,阳性率81.3%,而MR、x-CT阳性率分别为56.2%和40.6%.SPECT显示病灶部位42个,于颞叶位病灶最多,占47.6%,其次为额叶、枕叶、顶叶等.发作间期SPECT 26例低灌注者及其余6例正常灌注中的3例,用美解眠诱发后的亚临床发作期SPECT均出现脑血流增多,呈(相对)高灌注,其中6例高灌注患者病灶范围较低灌注区域减少.这29例患者r-刀手术治疗有效率达86.2%.结论发作间期SPECT的脑血流低灌注结合美解眠诱发的亚临床发作期的SPECT脑血流灌注增高,对癫癎病灶定位诊断具有重要的临床意义.     

Cerebral blood flow distribution and reactivity during the symptom-free stages of transient ischemic attacks--a 99mTc-HMPAO SPECT study]

Even during the symptom-free stages, patients with transient ischemic attacks (TIA) often show cerebral blood flow (CBF) disturbances. For evaluating the factors which cause these abnormalities, we studied CBF and CBF reactivity to acetazolamide (Diamox) using a 99mTc-hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT). The results from CBF-SPECT were compared with X-ray computed tomography (CT), cerebral arteriogram, clinical characteristics of TIA and cerebrovascular risk factors. The overall sensitivity rates in detecting the lesion were 68% in CBF-SPECT and 9% in CT. The size of the hypoperfused area tended to be wide in patients who had intracranial, severe stenotic or multiple arterial lesions on the ipsilateral side. No such relations were found between CBF and other examinations. Brain hypoperfusion was located in the subcortical region in eight patients; two patients showed a small hypodense lesion on CT which corresponded to the hypoperfusion on SPECT, and three patients showed no arteriographic abnormality. Hypoperfusion in the cortex was seen in seven patients; all patients showed arteriographic abnormality, but no CT abnormality. The severity rating of the vascular stenosis and hypoperfusion, and the incidence of the intracranial lesions were higher in this group than the group with subcotical hypoperfusion. Seven patients showed fixed normoperfusion before and after diamox injection. Two patients with a subcortical small infarction showed fixed hypoperfusion even after diamox injection. Twelve patients showed focal hypoperfusion before diamox with a new filling-in after diamox. Only one patient showed resting hypoperfusion and decreased CBF reactivity to diamox.(ABSTRACT TRUNCATED AT 250 WORDS)     

SPECT在脑部疾病中的应用

本文报告２５９例脑部疾病病人ＳＰＥＣＴ脑显像结果，并与ＣＴ，ＭＲＩ，ＥＥＧ及ＴＣＤ等检查作比较。结果表明：ＳＰＥＣＴ对脑梗塞的早期确诊，ＴＩＡ的辅助诊断和癫痫的定位诊断有较大价值。脑血流断层显像诊断意义大，但其他核素显像方法在某些疾病中仍有很大诊断价值。     

Decreased Cerebral Blood Flow in Neuro-Behcet''s Syndrome Patients With Neuropsychiatric Manifestations and Normal Magnetic Resonance Imaging—A Preliminary Report

Involvement of the brain is one of the most important complications of Behcet's disease, but its diagnosis is difficult because of the lack of effective imaging tools. Therefore, technetium‐99m ethyl cysteinate dimer (Tc‐99m ECD) single‐photon emission computed tomography (SPECT) of the brain was used to detect abnormal regional cerebral blood flow in patients with neuro‐Behcet's syndrome (NBS). Tc‐99m ECD brain SPECT was per‐formed to detect hypoperfusion areas of the brain in 10 NBS patients with definite neuropsychiatric symptoms or signs and normal brain magnetic resonance imaging (MRI) findings. Tc‐99m ECD brain SPECT demonstrated hypoperfusion areas of the brain in all of the 10 NBS patients. The parietal lobes were the most common areas with hypoperfusion lesions. Tc‐99m ECD brain SPECT is a more sensitive and useful tool than brain MRI for detecting hypoperfusion areas of the brain in NBS patients.     

短暂性脑缺血发作患者的认知功能及脑血流改变

目的　探讨短暂性脑缺血发作 (TIA)患者的认知功能与脑血流改变及两者之间的关系。方法应用事件相关电位 (ERP)、老年认知功能量表 (SECF)、磁共振血管成像 (MRA) ,对 35例TIA患者进行检测评估 ,并将ERP及SECF检测结果与性别、年龄、利手和文化程度方面严格匹配的 33名健康对照者进行对比。结果　与对照组相比 ,TIA患者的P3 潜伏期明显延长 (P <0 0 5 ) ;有明显的记忆障碍 ,注意力、注意集中能力、信息提取能力均下降 ;TIA组 94 2 8%有脑动脉狭窄和闭塞。结论　TIA患者有多项认知功能障碍 ,尤以记忆损害突出 ;有持久的脑血流低灌注 ,认知功能损害与此密切相关     

脑白质疏松症的血流动力学及局部脑血流变化的研究

目的　观察脑白质疏松症 (LA )血流动力学及局部脑血流量的变化 ,以探讨LA的发病机制。方法　对 6 7例LA患者行经颅多普勒 (TCD)检查 ,并对其中 19例患者行单光子发射计算机断层扫描 (SPECT)检查 ,观察局部脑血流 (rCBF)灌注情况。结果　轻、中、重 3组LA患者颈内动脉系统动脉平均峰值流速 (Vm)显著低于对照组 (P <0 0 5 ,P <0 0 1) ,重度LA组椎 基底动脉系统Vm显著低于对照组及轻度LA组 (P <0 0 5 ) ;轻、中、重 3组LA患者脉动指数 (PI)显著高于正常对照组 (P <0 0 1,P <0 0 0 1) ,中、重度组LA患者PI显著高于正常对照组及轻度组 (P <0 0 1,P <0 0 0 1)。SPECT检查发现LA患者灰质rCBF减少者为 5 2 6 % ,白质rCBF减少者为 78 9%。结论　LA患者存在广泛的脑血流低灌注和脑动脉硬化 ,并有随脑血流低灌注程度加重而LA病变加重的趋势 ,低灌注和脑动脉硬化是LA的主要发病机制。     

Abnormalities of cerebral blood flow in the acute phase of bacterial meningitis in adults

Summary The frequency, course and clinical significance of changes in regional cerebral blood flow (rCBF) during bacterial meningitis were investigated in 14 adult patients. The results of^99mTc-hexamethylpropylene amine oxime (HMPAO) single photon emission computed tomography (SPECT) were compared with the clinical signs and findings using cerebral angiography and conventional CT. HMPAO SPECT was performed 2–15 days (median 4.5 days) after the onset of neurological disease. Decreased HMPAO accumulation was detected in 13 patients. SPECT studies revealed focal hypoperfusion cor responding to the clinical symptoms in 6 patients suffering from hemiparesis or hemiataxia. Conventional cranial CT disclosed brain infarction in only 1 patient. Focal hypoperfusion was also found in 7 of 8 patients without clinical evidence of focal neurological deficits. In 6 patients, HMPAO SPECT findings were abnormal although cerebral angiography was normal. At follow-up examinations 3–45 weeks after the acute disease, abnormalities revealed by HMPAO SPECT had improved or had even disappeared in all patients studied. Our results indicate that reduced rCBF is a frequent finding in bacterial meningitis in the adult. In most patients it probably represents a functional and reversible disorder without structural lesion detectable on CT.     

缺血性增殖型脑血管病2例报道及回顾性分析

目的报道2例增殖型脑血管病(CPA)病例,探讨CPA的临床表现、血流动力学特点、诊断和鉴别诊断要点以及治疗方式。方法回顾性分析2例CPA患者的病史、体格检查、辅助检查、治疗方式及随访结果,结合文献进行分析讨论。结果 2例患者均有不同程度的脑缺血症状,并经DSA诊断明确。2例患者局部脑畸形血管网及周围脑组织在单光子发射计算机断层成像术(SPECT)脑血流灌注中均显示低血流灌注信号,但同时在MRI脑血流灌注图像上显示局部脑血流量增加,呈现出高血流量低灌注状态。其中1例短暂性脑缺血发作症状较明显的患儿经脑硬脑膜-颞肌-血管融合术(EDMS)治疗后症状缓解明显,随访DSA示部分畸形血管网消失,来自颈外动脉的重建血流向颅内代偿良好;复查SPECT示局部灌注改善明显,且随访MRI灌注示畸形血管网内血流量下降。结论 CPA可因"盗血"等机制而导致局部脑缺血,EDMS治疗对于缺血明显的CPA患者是一种合理有效的方式。     

Combined diffusion and perfusion MRI with correlation to single-photon emission CT in acute ischemic stroke. Ischemic penumbra predicts infarct growth.

BACKGROUND AND PURPOSE: More effective imaging methods are needed to overcome the limitations of CT in the investigation of treatments for acute ischemic stroke. Diffusion-weighted MRI (DWI) is sensitive in detecting infarcted brain tissue, whereas perfusion-weighted MRI (PWI) can detect brain perfusion in the same imaging session. Combining these methods may help in identifying the ischemic penumbra, which is an important concept in the hemodynamics of acute stroke. The purpose of this study was to determine whether combined DWI and PWI in acute (<24 hours) ischemic stroke can predict infarct growth and final size. METHODS: Forty-six patients with acute ischemic stroke underwent DWI and PWI on days 1, 2, and 8. No patient received thrombolysis. Twenty-three patients underwent single-photon emission CT in the acute phase. Lesion volumes were measured from DWI, SPECT, and maps of relative cerebral blood flow calculated from PWI. RESULTS: The mean volume of infarcted tissue detected by DWI increased from 46.1 to 75.6 cm(3) between days 1 and 2 (P<0.001; n=46) and to 78.5 cm(3) after 1 week (P<0.001; n=42). The perfusion-diffusion mismatch correlated with infarct growth (r=0. 699, P<0.001). The volume of hypoperfusion on the initial PWI correlated with final infarct size (r=0.827, P<0.001). The hypoperfusion volumes detected by PWI and SPECT correlated significantly (r=0.824, P<0.001). CONCLUSIONS: Combined DWI and PWI can predict infarct enlargement in acute stroke. PWI can detect hypoperfused brain tissue in good agreement with SPECT in acute stroke.     

Early and delayed SPECT images of extracerebral fluid collection in infants using 123I-N-isopropyl-p-iodoamphetamine

Cerebral blood flow in seven infants with extracerebral fluid collections was investigated using single photon emission computed tomography (SPECT) with ¹²³I-N-isopropyl-p-iodoamphetamine. Early and delayed SPECT imaging was carried out. Areas of hypoperfusion were observed in five cases. The watershed zone of the major cerebral arteries or the territory of the anterior cerebral arteries were common areas of low perfusion. The hypoperfusion area was redistributed in two cases with intracranial hypertension. Subduroperitoneal shunts produced improvement of clinical symptoms in these cases. Hypoperfusion without redistribution was observed in three patients. In these areas, permanent tissue damage caused by a primary disease existed. Normal circulation patterns were observed in two patients. They showed normal development and follow-up CT revealed a decrease in the size of the extracerebral fluid collection. Measurement of regional cerebral blood flow may be helpful in considering surgical indications and in following up extracerebral fluid collection in infants.     

Usefulness of a blood flow analyzing program 3DSRT to detect occipital hypoperfusion in dementia with Lewy bodies

In the latest criteria for the clinical diagnosis of dementia with Lewy bodies (DLB), supportive features include generalized low uptake on SPECT/PET perfusion scan with reduced occipital activity. In this study, we investigated the usefulness of a cerebral blood flow (CBF) quantification program '3DSRT' in detecting occipital hypoperfusion in DLB. Twenty two patients with probable DLB, 38 patients with probable Alzheimer's disease (AD) and 16 normal controls underwent brain perfusion SPECT. Compared with AD, DLB patients had a bilateral lower CBF in the posterior cerebral segments. The correlation of clinical symptoms and brain blood perfusion was examined by dividing the subjects into subgroups. DLB patients with Parkinsonism, when compared to non-Parkinsonism subgroup, had a lower CBF throughout the cerebrum with statistical significance in the posterior cerebral segments. The quantitative analysis of brain perfusion SPECT by 3DSRT could be a useful supportive measurement in the diagnosis of DLB.