SPECT脑灌注显像在椎基底动脉供血不足的临床研究

目的 探讨单光子发射计算机断层扫描(SPECT)脑灌注显像在椎基底动脉供血不足(vertebrobasilar insuf-ficiency,VBI)的临床应用价值,并与其他对VBI的研究方法相比较,力图找出一个研究VBI较客观理想的临床方法。方法 将临床确诊VBI的患者50例,全部进行了经颅多普勒超声(TCD)、颈部血管彩色超声多普勒(CDFI)、SPECT检查,将其中普通SPECT显示正常的19例患者,48 h后予以口服乙酰唑胺2 g,2 h后再行SPECT检查。50例患者中26例进行了核磁共振血管成像(MRA)检查,其中1例还进行了正电子发射计算机断层扫描(PET)检查。结果50例患者TCD阳性率为66％,CDFI阳性率为56％,普通SPECT阳性率为62％。三种方法阳性率无明显差异,加用乙酰唑胺后的SPECT检查阳性率提高到86％,与TCD和CDFI比较有显著性差异。SPECT显示缺血部分多在枕颞叶等椎基底动脉(VBA)系统供血区域。26例患者MRA显示有2例椎动脉狭窄。其中1例患者MRA、SPECT显示正常,口服乙酰唑胺后SPECT检查及PET检查显示有颞枕叶缺血。结论 TCD和CDFI在VBI的诊断上可作为粗略的筛选手段,MRA在VBI的诊断价值可能不大,加用乙酰唑胺后SPECT阳性率明显提高,我们认为其对VBI的诊断具有重要价值,值得临床推广。

Clinical study on SPECT cerebral perfusion image in patients with vertebrobasilar insufficiency

Objective To investigate the clinical use of SPECT brain perfusion image in vertebrobasilar insufficiency (VBI) and it values in comparison to other VBI lab methods in order to find out a more objective and ideal lab method for VBI studies. Methods TCD, CDFI and ordinarv SPECT techniques were done in a 50 VBI patients. For those patients with normai routine SPECT examination, they then took 2 g acetazolamide 48 h after orally, another SPECT was repeated 2 h later. Twenty six of the 50 patients underwent addilional MRA examination and one underwent PET examination. Results The positive percentage through TCD was 66% , CDFI was 56% , ordinary SPECT was 62% and there were no differences when compared with each other. But the posilive percentage through SPECT (ordinary and acetazolamide) was up to 86% which indicated a marked difference. SPECT showed the ischemic area in the occipital and temproal lobes supplied by VBA system. The MRA showed two of the 26 patients with the narrowing of vertebral artery. One palieni with normai temporal lobes ischemia in acetazolamide SPECT examination and PET scan. Conclusions TCD and CDFI can be used as a relatively simple but not so accurate method for VBI studies. The MRA in detecting VBI is not precise. SPECT (ordinarv and acetazolamide) examination is an useful clinical investigation for VBI, and should be more widely used in clinical practice.