脑出血患者99Tcm-HL91 SPECT脑乏氧显像的初步研究

目的采用锝(99Tcm)标记的乏氧组织显像剂4,9-二氮-2,3,10,10-四甲基十二烷-2,11-二酮肟(HL91),行单光子发射计算机断层扫描(single photon emisson computed tomography,SPECT)脑显像,观察脑出血患者血肿周围是否存在乏氧组织。方法起病28 d内的大脑半球出血患者21例和对照者9名行99Tcm-HL91 SPECT脑乏氧显像,显示乏氧组织。其中5例脑出血患者同期行99Tcm-ECD SPECT脑血流灌注显像。结果对照组乏氧显像均为阴性。脑出血患者出血量为2～24 mL,乏氧显像阳性者4例,为出血量较大的患者。行脑血流灌注显像患者,均显示出血侧大脑半球血流灌注减少,其中2例乏氧显像阳性。结论部分脑出血患者血肿周围存在乏氧组织,可能与出血量有关。     

99mTc-HL91单光子计算机断层扫描对脑梗死灶周围乏氧组织的检测

目的探讨99mTc-HL91单光子计算机断层扫描(SPECT)对脑梗死灶周围乏氧组织的检测。方法应用99mTc-HL91 SPECT对29例脑梗死患者和5名健康对照者进行脑显像检测,并对脑梗死患者进行血压、血糖和血浆纤维蛋白原(Fib)水平检查。结果 SPECT示脑梗死组脑组织乏氧显像阳性18例(62.1%),正常对照组均阴性。Spearman秩相关分析显示,梗死体积≤30 cm3的患者乏氧显像阳性范围与SPECT检测时间呈负相关(rs=-0.624,P<0.05),与脑梗死体积呈正相关(rs=0.715,P<0.001)。结论99mTc-HL91SPECT检测可显示脑梗死灶周围乏氧组织。梗死灶体积≤30 ml的脑梗死患者SPECT检测时间越早,则乏氧显像的阳性率越高。     

99Tcm-HL91 SPECT脑显像显示急性脑梗死患者存活脑组织的初步研究

目的 观察99Tcm-HL91 SPECT脑显像能否显示急性脑梗死的乏氧组织(处于缺血缺氧状态但尚存活的脑组织)。方法 起病96小时内的大脑半球梗死患者行99Tcm-HL91 SPECT脑显像和同机CT扫描,并进行图像融合。在连续2个以上层面和两个以上不同轴向断层上,在梗死侧大脑半球出现放射性浓集区,为乏氧显像阳性。结果43例患者中,乏氧显像阳性者24例,均属完全或部分前循环梗塞。乏氧显像区位于梗死灶周围。9例住起病后7～17天复查SPECT,仍呈阳性,但乏氧组织已减少。腔隙性梗死者,乏氧显像均阴性。结论99Tcm-HL91 SPECT显像能清晰地显示完全及部分前循环梗塞患者的脑乏氧组织,能提示急性脑梗死后脑组织的存活,有助于指导治疗。     

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.     

自发性脑出血后神经功能与脑血流动态变化相关研究

研究66例SICH患者急性期、亚急性期、恢复期SPECT脑血流显像和神经功能,发现:(1)临床神经功能与rCBF的变化密切相关;(2)失语组与无失语组者Broca区和Wernicke区rCBF亦存在显著差异,失语的恢复与rCBF的恢复相一致;(3)CDD现象与出血量及出血部位有关,出血量大和/或优势半球出血易引起CDD。提示积极改善脑出血患者亚急性期和恢复期脑血流量,有助于临床神经功能的恢复。     

PET脑代谢显像与SPECT脑血流灌注显像在癫痫灶定位中的应用

目的 探讨PET显像与SPECT显像在顽固性癫痫灶定位中的应用价值.方法 86例癫痫患者均行发作间期PET和SPECT显像,36例发作间期PET结果为多灶改变(包括15例存在脑软化灶)的患者行发作期SPECT检查,结果分析采用半定量分析及目测法.结果 86例患者均见不同程度异常改变.发作间期PET显像示低代谢者中50例(58.1％)表现为单叶局限性低代谢,发作间期SPECT显像示低灌注者中48例(55.8％)表现为单叶局限性低灌注.对36例发作间期PET结果为多灶改变的患者行发作期SPECT检查示,35例(97.2％)例高灌注灶,高灌注中24例(68.6％)为单叶局限性高灌注,5例(14.2％)仍见多个病灶,但未见弥漫性高灌注.1例(2.8％)未发现高灌注区.15例(41.7％)脑软化灶患者经发作期SPECT检查后均定位为局限性病灶,且在脑软灶边缘.结论 发作间期PET显像与发作间期SPECT定位局限性单叶癫痫病灶的符合率较高,两者相互印证可提高特异性;发作间期PET检出多灶性改变时,结合发作期SPECT显像可提高定位特异性.存在脑软化灶病例行PET检查意义较小,进行发作间期及发作期SPECT两次显像即可较好的定位病灶.     

自发性小脑出血的临床、脑CT扫描及治疗分析

通过对62例经脑CT扫描或脑MRI检查确诊为自发性小脑出血的病例进行分析,结果显示小脑出血的临床症状、治疗方案、预后与出血量密切相关。出血量<5ml者临床症状轻,内科保守治疗预后好,出血量越大预后越差,出血量6～15ml者可根据病情决定是否手术,出血量>15ml者病情重,宜尽快手术。     

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。     

大鼠脑梗死后乏氧组织长时间存在与星形胶质细胞的关系

目的 探讨大鼠脑梗死后乏氧组织的长时间存在与星形胶质细胞的关系.方法 利用大鼠脑缺血1.5 h再灌注(1.5 h IR组)和持续缺血(PI组)的大脑中动脉闭塞模型,采用EF5和胶质纤维酸性蛋白(GFAP)免疫荧光双标方法观察乏氧组织和星形胶质细胞增殖活化情况,比较两组术后1、3、7、14d缺血侧大脑半球皮层的星形胶质细胞GFAP荧光强度以及与乏氧组织的关系.结果 1.5 h IR组术后1、3、7、14 d均见乏氧组织存在,PI组乏氧组织仅存在3 d.各观察时间点乏氧组织内的GFAP荧光强度均较周围区域高,差异有统计学意义(P<0.05).随着时间的延长,两组的GFAP荧光强度均不断增强,在术后7 d达到高峰,14 d时下降,差异有统计学意义(P<0.05);且各时间点的1.5 h IR组的GFAP荧光强度均高于PI组,差异有统计学意义(P<0.05).结论 脑梗死后星形胶质细胞在乏氧组织内增殖活化尤为明显,乏氧组织的长时间存在与星形胶质细胞密切相关.     

难治性癫痫的致痫灶定位及手术治疗研究

目的评价难治性癫痫的致痫灶定位方法和皮层电极监测下致痫灶切除,加行多处软脑膜下横纤维切断术(MST)治疗癫痫的疗效。方法对47例难治性癫痫病人的致痫灶,采用CT MRI EEG 单光子发射计算机体层摄影(SPECT) 皮层脑电脑(ECoG)联合检测定位。对检出的阳性病灶在皮层电极监测显微镜下行致痫灶切除,切除后监测仍有癫痫波者加行MST;致痫灶位于重要功能区者单行MST。结果致痫灶阳性检出率86%。皮层电极检测显微镜下致痫灶切除加MST,术后91%的病人癫痫发作停止,半年后约15%的病人复发,但症状较术前减轻,持续时间较术前短。结论CT MRI EEG SPECT ECoG联合检测,对手术定位具有较高价值。皮层电极监测下致痫灶切除术及MST创伤轻微、效果比较可靠、治愈率高、并发症少、复发率低。病灶及致痫灶的不完全切除和形成皮层软化及疤痕,可能是导致癫痫复发的重要原因。     

SPECT在常见脑血管疾病中的应用研究

SPECT脑血流显像能灵敏反映局部脑血流量的变化,在脑血管疾病中有重要应用价值:能早期诊断脑梗死,指导临床治疗,并评价疗效和估计预后;有利于短暂性脑缺血发作的早期诊断和及时治疗,预防脑卒中;脑出血后存在局部脑血流量降低,且持续时间长,出血后亚急性期和恢复期行SPECT检查有助于指导临床治疗。     

Single-Photon Emission Computed Tomography,Transcranial Doppler Ultrasound,and Cerebral Angioplasty for Posttraumatic Vasospasm

Intracranial arterial vasospasm is an important consequence of subarachnoid hemorrhage. In posttraumatic patients, this phenomenon is becoming increasingly recognized with noninvasive techniques that evaluate (1) vascular stenosis, such as transcranial Doppler (TCD) ultrasound, and (2) regional cerebral blood flow, such as single-photon emission computed tomography (SPECT). A posttraumatic patient developed symptomatic vasospasm that was detected by TCD and SPECT and then treated with percutaneous transluminal balloon cerebral angioplasty, which improved the symptoms. The anatomical and functional results of angioplasty were evaluated also by TCD and SPECT, which showed a reduction in the severity of stenosis and improved blood flow, respectively.     

尼莫地平对脑出血患者局部脑血流、脑水肿及不同时间用药临床变化的影响

目的　动态观察尼莫地平对高血压脑出血患者局部脑血流（rCBF）、脑水肿和不同时间用药临床变化的影响。方法　随机将108例高血压脑出血患者分为对照组和治疗组,并将治疗组再分为发病前12小时以内用药组和12小时以后用药组,行单光子发射断层扫描(SPECT)、临床疗效的动态观察;并随机从对照组和治疗组中分别抽出10例患者行SPECT、CT的动态观察。结果　治疗组rCBF、水肿带和临床疗效的改善显著优于对照组;12小时以内用药的临床疗效明显优于12小时以后用药。结论　早期使用尼莫地平对改善高血压脑出血后rCBF下降、提高临床疗效和减轻血肿周围水肿可能均有积极作用。     

钙拮抗剂对高血压脑出血局部脑血流的影响及其临床变化作用的初步报告

目的:动态观察尼莫地平对高血压脑出血患者局部脑血流及其临床疗效的影响。方法:随机将69例高血压脑出血患者分为对照组和尼莫地平治疗组,并行SPECT和临床疗效的动态观察。图像的处理和临床疗效的评定采用盲法分析。结果:治疗组在SPECT和临床疗效的改善方面显著优于对照组。结论:尼莫地平可改善高血压脑出血后的局部脑血流下降和伴随的临床变化。     

尼莫地平对脑出血患者局部脑血液、脑水肿及不同时间用药临床变化的影响

目的：动态观察尼莫地平对高血压脑出血患者局部脑血液（rCBF)、脑水肿和不同时间用药临床变化的影响。方法：随机将108例高血压脑出血患者分对照组和治疗组,并将治疗组再分为发病前12小时以内用药组和12小时以后用药组,行单光子发射断层扫描（SPECT）、临床疗效和动态观察;并随机从对照组和治疗组中分别抽出10例患者行SPCET、CT的动态观察,结果：治疗组rCBF、水肿带和临床疗效的改善显著优于对照组;12小时以内用药的临床疗效明显优于12小时以后用药。结论：早期使用尼莫地平对改善高血压脑出血后rCBF下降,提高临床疗效和减轻血肿周围水肿可能均有积极作用。     

New model of hemorrhagic hypoxic-ischemic encephalopathy in newborn mice

An easy and inexpensive method is reported for producing hemorrhagic brain damage in newborn mice, involving only exposure to hypoxia. One-day-old mice, Jcl:ICR strain, were subjected to a humidified 5% oxygen, 95% nitrogen mixture for 8 hours. After the hypoxic episode, 34% of newborn mice survived, 59% manifested cerebral parenchymal hemorrhage. Cortical hemorrhage could be detected in live mice; intracranial hemorrhage was observed through the thin skin and skull. Cortical hemorrhage usually affected the bilateral parietal regions symmetrically and neuronal destruction was observed in the deeper structures, as well as in the cerebral cortex. This pattern of damage was comparable to parasagittal cerebral injury in humans. The onset of cortical hemorrhage and neuropathology in these mice suggested that hemorrhage occurred when cerebral blood flow recovered after the hypoxic event.     

Prediction of acute embolic stroke outcome after local intraarterial thrombolysis: value of pretreatment and posttreatment 99mTc-ethyl cysteinate dimer single photon emission computed tomography.

The aim of this study was to investigate the efficacy of pre- and posttreatment 99mTc-ethyl cysteinate dimer (99mTc-ECD) single photon emission computed tomography (SPECT) for predicting the ischemic outcome of embolic middle cerebral artery occlusion after treatment with local intraarterial thrombolysis. The authors examined 28 patients with a moderately ischemic area (ratio of affected regional activity to cerebellar activity (A/C ratio) of 0.4 to 0.7) determined using pretreatment SPECT, and with complete recanalization within 6 hours. Posttreatment dynamic and static SPECT studies were performed immediately after thrombolysis. The extent of the affected area outlined on pretreatment SPECT was used for the posttreatment SPECT images, and A/C ratios were calculated. The relative retention ratio of 99mTc-ECD in the affected area was also analyzed using posttreatment dynamic SPECT. Fourteen patients either without infarction or with small subcortical and basal ganglial infarction, 11 patients with medium or large cortical infarction, and 3 patients with hemorrhage were identified by follow-up computed tomography. Ischemic outcome correlated with the relative retention ratio of 99mTc-ECD more closely than either the pre- or posttreatment A/C ratios. In particular, a threshold value for the development of hemorrhage was distinct only in the relative retention ratio of 99mTc-ECD. Pretreatment 99mTc-ECD SPECT did not always predict the occurrence of hemorrhagic transformation, whereas dynamic 99mTc-ECD SPECT performed immediately after thrombolysis allowed clear identification of patients at risk for hemorrhagic transformation.     

Regional cerebral blood flow in the acute stage with ischemic cerebrovascular disease studied by xenon-133 inhalation and single photon emission computerized tomography

The papers about cerebral blood flow (CBF) in patients with cerebrovascular diseases have been already reported by positron emission computerized tomography (PET), single photon emission computerized tomography (SPECT), Xray CT (CT) using cold Xe, and so on. However the literature about the CBF changes in acute stage is few. We studied CBF in 68 patients with ischemic cerebrovascular disease within 48 hours after the onsets from February 1984 through February 1985. CBF was measured by a rapidly rotating single photon emission computerized tomography (SPECT) using non-invasive Xenon-133 inhalation method. Our subjects included 51 cases with cerebral infarction (male 37, female 14, average 62.9 years) and 17 cases with TIA (male 13, female 4, average 60.5 years), the patients who had a past history of stroke were excluded from the subjects. The SPECT was performed with use of Tomomatic 64 developed by Dr. Lassen, et al, SPECT and carotid arteriography were simultaneously performed within 48 hours in all cases. CT we used were GE CT 9800 scanner and Hitachi HF CT. The following results have been obtained: 1) SPECT clearly showed an ischemic focus correlated with clinical symptom after the attack rather than CT, the positive finding by SPECT was 92.2% and that by CT was 62.7% within 48 hours after the onset. 2) The remote effect phenomenon so-called crossed cerebellar diaschisis was demonstrated in 7 of 14 cases (50%) with cerebral infarction due to internal carotid artery occlusion and in 9 of 26 cases (34.6%) with that due to middle cerebral artery occlusion. 3) SPECT and CT were performed within 8 hours after the onset in 20 cases with cerebral infarction. SPECT showed decreased CBF in all cases whereas the positive finding by CT was 40.0%. The area of decreased CBF was always larger than the low density area that CT demonstrated. Mean CBF value of the cerebral hemisphere in the cases with ICA occlusion within 8 hours after the onsets was 31.0 (ml/100 g/min), and that of MCA occlusion was 36.0 (ml/100 g/min), and that of MCA occlusion was 36.0 (ml/100 g/min). 4) The positive finding by SPECT on TIA cases was 47% and that by CT was 41.1%, SPECT usually did not demonstrate a small ischemic focus especially at the deep region (ie, basal ganglia region). 5) SPECT using Xe-123 inhalation was useful and non-invasive method for the diagnosis in acute stage with ischemic cerebrovascular disease.(ABSTRACT TRUNCATED AT 400 WORDS)