强迫症与抑郁症的脑单光子发射计算机断层扫描对照研究

目的探讨强迫症、抑郁症局部脑血流量(rCBF)特点。方法应用单光子发射计算机断层扫描(SPECT)技术,对首发且未经治疗的39例强迫症患者、36例抑郁症患者和39名正常人于静息状态下行脑血流显像。以小脑皮质的放射性计数值为参考,对局部脑血流进行半定量分析。结果强迫症组两侧前额叶、前颞叶rCBF高于正常组(P<0.01);抑郁症组两侧前额叶、枕叶、扣带回及右前颞叶、右顶叶rCBF低于正常组(P<0.05);在两侧前额叶、前颞叶、顶叶、枕叶及右后额叶、扣带回,强迫症组rCBF高于抑郁症组(P<0.05)。结论强迫症组的前额叶及前颞叶呈高灌注改变,抑郁症组脑血流普遍低灌注,SPECT技术可望作为二者鉴别诊断的客观依据之一。     

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。     

尼莫地平负荷SPECT脑血流灌注显像在急性非致残性脑血管病中的诊断价值

目的分析尼莫地平负荷脑血流灌注显像在急性非致残性脑血管病中的诊断价值。方法选取2017-01-01-2017-11-01在厦门大学附属第一医院就诊的35例急性非致残性脑血管病患者,行MRI、99Tcm-ECD静息及尼莫地平负荷SPECT脑血流灌注显像。分别在双侧额叶、颞叶、顶叶、枕叶、基底节区、小脑、脑干对称部位勾画感兴趣区(regions of interests,ROI),并记录各个ROI平均放射性计数,分析负荷前后SPECT图像及局部脑血流量(regional cerebral blood flow,rCBF),观察负荷前后脑血流灌注的变化情况,比较MRI、静息及尼莫地平负荷SPECT脑血流灌注显像对急性非致残性脑血管病责任病灶诊断阳性率的差异。采用卡方检验分析数据。结果在急性非致残性脑血管病中,MRI、静息及尼莫地平负荷SPECT脑血流灌注显像诊断阳性率分别为45.7%(16/35)、71.4%(25/35)、91.4%(32/35)。负荷前后rCBF变化的4种类型情况:A型:静息显像rCBF正常,负荷后rCBF减低5个;B型:静息rCBF减少,负荷后rCBF降低无明显改善11个;C型:静息rCBF减少,负荷后rCBF降低更明显8个;D型:静息时rCBF降低,负荷后rCBF改善11个。结论联合尼莫地平负荷前后SPECT脑血流灌注显像可明显提高急性非致残性脑血管病病灶诊断阳性率,且能够有效评估脑血管储备功能。     

血管性痴呆患者SPECT脑血流灌注显像特点

目的　探讨血管性痴呆 (VD)患者 SPECT局部脑血流灌注显像特点 ,为 VD的早期诊断和痴呆严重程度的评估寻找客观的生物学指标。方法　分别对 45例 VD、3 0例卒中无痴呆 (SWD)和 3 0例正常对照者 (NC)3组进行 SPECT局部脑血流灌注显像 ,半定量分析各脑区血流灌注情况。结果　 VD组额叶、顶叶、颞叶和基底节局部脑血流灌注比 SWD组减少 (P<0 .0 5 ) ;并以额叶、颞叶血流灌注的减少最为显著 (P<0 .0 1)。与 NC组相比 ,SWD组额叶、顶叶、颞叶和基底节局部脑血流灌注均减低 (P<0 .0 5 )。额叶、颞叶血流灌注减低与 MMSE评分间存在正相关关系 (r=0 .75 5 ,P<0 .0 1)。结论　 VD患者存在明显的脑血流灌注减低 ,以额叶、颞叶最为显著 ,且与MMSE评分间存在正相关 ,SPECT脑血流灌注显像有助于 VD的诊断和病情评估     

精神分裂症rCBF显像研究

目的：探测精神分裂症rCBF的显像,方法：应用双探头SPECT对106例精神分裂症患者注入^99mTc-ECD740-925MBq进行rCBF显像。结果：64例（60．4％）精神分裂症显示额叶、颞叶、顶叶、丘脑、尾状核等局部脑血流灌注减低,结论：部分精神分裂症存在局部脑血流灌注减低区。     

躯体形式障碍35例SPECT研究

目的　探讨躯体形式障碍脑灌注特点与潜在意义。方法　开放性收集门诊和住院诊断 为躯体形式障碍病人35例;进行99mTc 双半胱乙脂(ECD)单光子发射型计算机断层显像(SPECT)脑血 流灌注(rCBF)断层显像,半定量测定rCBF。结果　35例躯体形式障碍病人均出现有不同部位的脑 低灌注现象;具体为右额叶(13例,37%),左额叶(11例,31%),右颞叶(13例,37%),左颞叶(11例, 31%),右顶叶(11例,31%),左顶叶(4例,11%),右基底节(14例,40%),左基底节(17例,49%),右丘 脑(1例,3%),左丘脑(1例,3%),盐酸文拉法辛治疗2周后不同部位脑血流低灌注均明显改善,差异 有显著性(P<0.05)。结论　躯体形式障碍不同临床表现相应呈现额叶、基底节、颞叶、顶叶不同区域 脑血流低灌注,治疗后明显改善。     

抑郁症患者SPECT研究

目的 探讨抑郁症脑血流灌注的特点及与临床症状的相关性。方法 开放式收集门诊及住院诊断为抑郁症患者37例,进行治疗前后的^99mTc-双半胱乙脂（ECD）单光子发射型计算机断层扫描（SPECT）技术,测量患者治疗前后脑血流灌注（rCBF）显像,半定量测定rCBF,并与12例正常对照者比较。结果 37例抑郁症患者双侧额叶、双侧颞叶、双侧顶叶,双侧枕叶、左基底核有脑低灌注现象。治疗后临床康复者各部位脑灌注明显改善,差异有显著性（P〈0.05）。结论 抑郁症患者存在额叶、颡叶、顶叶及枕叶多区域的脑血流低灌注,其中以左侧较为明显,治疗后明显改善。     

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.     

老年期抑郁症的单光子发射计算机断层扫描研究

目的 了解老年期抑郁症(ED)的脑血流灌注特点,为相关神经科学理论提供实验室数据。方法 对26名健康老人、22例ED及26例阿尔茨海默病(Alzheimer’s disease,AD)患者作脑血流灌注检查。结果 与健康老人相比,ED存在右顶叶、双侧额叶和双侧枕叶低灌注(P<0.05),与AD相比,ED的扣带回、双侧颞叶、双侧基底节和双侧丘脑灌注明显较高(P<0.05)。ED在颞叶、额叶、枕叶和丘脑处的双侧灌注不对称(P<0.05),除丘脑灌注为左侧高于右侧外,其余均为左侧低于右侧。判别分析结果为右顶叶、左颞叶、左额叶、左枕叶和扣带回进入判别方程,ED的判别方程对ED诊断的敏感性和特异性分别为100％和94.2％。结论 ED脑血流灌注兼具一般抑郁症和本身的特点,右顶叶、左颞叶、左额叶、左枕叶和扣带回灌注对ED的诊断有重要意义,支持额叶、边缘系统及其它相关区域共同构成情绪调节回路的假设。     

Tourette综合征的局部脑血流改变

以单光子发射型计算机断层扫描（SPECT）检查Tourette综合征（TS）患者12例，重建局部脑血流（rCBF）。结果发现12例患者均存在rCBF改变；以局部脑叶缺血为主要表现，其中颞叶8例、枕叶4例、额叶3例、基底节2例、中脑1例。结果提示TS存在较广泛的脑功能变化，可以SPECT作为研究TS脑功能紊乱的手段。     

抑郁症患者局部脑血流的研究

目的：了解抑郁症患者局部脑血流灌注的特点：方法：应用单光子发射计算机断层扫描对20例抑郁症患者及18例正常对照者局部脑血流灌注进行对比分析。结果：抑郁症组双侧基底核、双侧额叶、左颞叶及左枕叶局部血流低灌注；抑郁症组与对照组左右大脑半球局部血流灌注无显著性差异：结论：抑郁症患者局部脑血流存在低灌注，但未发现局部脑血流低灌注有侧化现象。     

Regional cerebral blood flow in depressed patients with white matter magnetic resonance hyperintensity.

BACKGROUND: Functional neuroimaging studies have consistently demonstrated decreased regional cerebral blood flow (rCBF) or metabolism in the frontal lobe, temporal lobe, or anterior cingulate gyrus of depressed patients. On the other hand, white matter hyperintensity as defined by magnetic resonance imaging (MRI) has been the most consistently replicated finding in structural neuroimaging studies on depression; however, these functional and structural neuroimaging findings of depression have not been well integrated. We aimed to clarify the possible associations of MRI-defined subcortical hyperintensities with rCBF changes in depressed patients. METHODS: Twelve depressed patients with subcortical hyperintensities defined by MRI, 11 depressed patients without MRI hyperintensities, and 25 healthy volunteers underwent 99mTc ECD SPECT. Group comparisons of their rCBF and correlation analysis between MRI hyperintensity and rCBF in patients were performed with a voxel-based analysis using statistical parametric mapping (SPM) software. RESULTS: Depressed patients showed decreased rCBF compared with control subjects in the frontal lobe, temporal lobe, and anterior cingulate gyrus whether subcortical hyperintensity existed or not; however, the patients with MRI hyperintensity showed decreased rCBF in the thalamus, basal ganglia, and brainstem in addition to cortical areas. Further, the score for white matter hyperintensity correlated negatively with rCBF in subcortical brain structures, including the thalamus and right basal ganglia. CONCLUSION: Our study indicates that depressed patients with MRI hyperintensities may have dysfunction in subcortical brain structures in addition to dysfunction in the fronto-temporal cortical structures.     

强迫症患者局部脑血流灌注研究

目的　探讨强迫症(OCD)患者局部脑血流灌注(rCBF)特点及临床症状与rCBF的关系。方法　对2 8例符合国际疾病分类第1 0版(ICD 1 0 )强迫障碍诊断标准患者和1 5名正常人进行单光子发射计算机断层扫描(SPECT)脑显像分析。用耶鲁 布朗强迫评定量表(YBOCS)、Hamilton焦虑量表(HAMA)和Hamilton抑郁量表(HAMD)对患者临床症状进行评定。结果　OCD患者两侧丘脑、顶叶和基底神经节的平均放射性计数百分数(PMRC)显著高于正常组;右颞PMRC明显低于正常组;且正常组两侧颞叶和顶叶PMRC值差异非常显著。在强迫恐惧/洗涤、回避组,YBOCS强迫行为分量表评分与右基底PMRC显著正相关(r =0 .70 1 )。结论　OCD患者两侧丘脑、顶叶和基底神经节的血流灌注增加和功能亢进;右颞血流灌注减少和功能低下,两侧颞叶和顶叶血流灌注的不对称性与正常人显著不同,后者的不对称性非常显著;在强迫恐惧/洗涤、回避组,强迫行为与右基底节功能增强有关。     

Regional cerebral blood flow abnormalities in late-life depression:Relation to refractoriness and chronification

Abstract We examined patterns of regional cerebral blood flow (rCBF) abnormalities in 18 patients with major depressive disorder in late life using single photon emission computed tomography (SPECT) and (^99mTc-hexamethyl-propylenamine oxime (^99mTc-HMPAO). Compared with 13 age-matched controls, relative rCBF was significantly decreased bilaterally in the anterior cingulate gyrus, the prefrontal cortex, the temporal cortex, the parietal cortex, the hippocampus and the caudate nucleus. However, it was not correlated with the severity of depression or global cognitive dysfunction. In 10 patients with a prolonged depressive episode or prolonged residual symptoms (the refractory subgroup), robust and extensive decreases in rCBF were found compared with controls and the rCBF decreased significantly in the anterior cingulate gyrus and the prefrontal cortex compared with that in the non-refractory subgroup. In the non-refractory subgroup, rCBF decreased significandy in the caudate nucleus and tended to decrease in the anterior cingulate gyrus compared with controls. These findings indicate that dysfunction of the limbic system, the cerebral association cortex and the caudate nucleus may be implicated in late-life depression and that robust and extensive hypoperfusion, especially in the anterior cingulate and the prefrontal regions, may relate to refractoriness or chronification of depression.     

Regional cerebral blood flow deficits in mild Alzheimer's disease using high resolution single photon emission computerized tomography

In spite of its wide availability, single photon emission computerized tomography (SPECT) scanning is uncommonly used in the assessment of Alzheimer's disease (AD) and related dementias. In light of recent advances in scanning protocols and image analysis, SPECT needs to be re-examined as a tool in the diagnosis of dementia. A total of 18 subjects with early AD and 10 healthy elderly control subjects were examined with high resolution SPECT during the performance of a simple word discrimination task. SPECT images were coregistered with individual magnetic resonance imaging scans, allowing delineation of predetermined neuroanatomical Regions of Interest (ROI). There was a gradation of regional cerebral blood flow (rCBF) values in both groups, with the lowest values being in the hippocampus and the highest in the striatum, thalamus and cerebellum. Compared to healthy controls, AD subjects demonstrated lower relative rCBF in parietal and prefrontal cortices. Analysis of individual ROI demonstrated bilateral reduction of rCBF in prefrontal poles, posterior temporal and anterior parietal cortex, and unilateral reduction of rCBF in left dorsolateral prefrontal cortex, right posterior parietal cortex and the left cingulate body. There were no significant differences for hippocampal, occipital or basal ganglia rCBF. Discriminant function analysis indicated that rCBF in the prefrontal polar regions achieved the best classification of cases. SPECT has utility in the diagnostic assessment of AD if standardized and semiquantitative techniques are used.     

A review of SPECT studies in psychiatry in China

Background

Studies of mental disorders using single photon emission computed tomography (SPECT) have been done for many years in China. Many results have been obtained. We review these findings and introduce them to the outside world.

Methods

SPECT papers available on the Chinese Biomedical Bibliographic Database, focusing on depression, schizophrenia, Alzheimer’s disease (AD), vascular dementia (VD), anxiety disorder, and obsessive compulsive disorder (OCD) in China, were reviewed and the results were compared with those obtained outside China.

Results

We found that regional cerebral blood flow (rCBF) was abnormal in mental disorders, but the specificity of the abnormality is not yet consistent. Lower perfusion of rCBF could be seen in frontal, temporal, and parietal lobes of patients with depression, AD, schizophrenia, and VD. It seems that abnormality of the frontal lobe is more common in depression and schizophrenia, but temporal lobe abnormalities are more common in AD and VD. The perfusion of rCBF in the parietal lobe seems to be related to aging. Abnormalities in the occipital lobe and basal ganglia seem to be more associated with vascular problems. Thalamic dysfunction was mainly correlated with VD, and that of the cingulate largely with depression and schizophrenia. Hippocampal abnormalities were associated with AD. There were few reports on changes in anxiety disorders and other mental problems.

Conclusion

There is no specific biological marker of SPECT for individual mental disorders. Further study is needed to provide more specific information on the pathophysiology of mental disorders. It seems that brain abnormalities are similar in Chinese and non Chinese psychiatric patients.