单光子发射型计算机断层显像与脑CT及MRI对持续植物状态患者脑血流灌注的观察

目的观察持续植物状态(persistent vegetative state,PVS)患者脑血流灌注情况,并以此判断高压氧综合治疗的效果分析.方法采用99Tcm-双半胱乙酰(99Tcm-ECD)单光子发射型计算机断层(simple porton emission computertomograph,SPECT)显像方法对26例不同病因所致的PVS患者进行了观察,9例随访60 d至3年,其中17例行脑CT,14例行脑MRI检查.结果26例PVS患者脑血流灌注全部显示异常,9例PVS患者显示部位与脑CT或MRI相符,9例不符.9例随访观察SPECT显示,6例随病情恢复,脑血流灌注亦恢复正常,另3例中,2例患者无明显变化,仍处于PVS,1例患者血流灌注进一步减少,3年后死亡.结论99Tcm-ECD脑SPECT显像检查安全可靠,可明确反映PVS患者脑血流灌注情况,弥补脑CT或MRI之不足,并可作为高压氧综合治疗PVS观察预后的指标.

Observation of cerebral blood flow in persistent vegetative state patients with single-photon emission computerized tomography in comparison with cerebral CT and MRI findings

AIM: To evaluate the therapeutic effects of hyperbaric oxygen(HBO) in treatment of persistent vegetative state (PVS)by observation of cerebral blood flow in PVS patients.METHODS: Twenty-six PVS patients received examination with 99Tcm-ethylcysteinate dimmer(ECD) single-photon emission computerized tomography(SPECT) to assess the regional cerebral blood flow(rCBF) . A dynamic study was conducted in 9 cases during a follow-up for 60 d to 3 years,and 17 cases were also examined with brain CT and 14 with brain MRI.RESULTS: All of the 26 cases exhibited abnormal cerebral blood flow. The locations of abnormal rCBF defined by SPECT were consistent with cerebral CT or MRI findings in 9 cases, but not in the other cases. Of the 9 cases followed up, cerebral blood flow recovered to normal level in 6 cases with the improvement of abnormal rCBF areas, showed no significant changes in 2cases with PVS and further worsened in 1 case who died after 3 years.CONCLUSIONS: 99Tcm-ECD SPECT is a safe and reliable diagnosticmodality for PVS, which directly reflects the status of cerebral blood flow and can be complementary to brain CT and MRI, with also value in monitoring the effect of HBO and medication for PVS and helping make prognostic judgment.