SPECT,MRI和PSA对复杂部分性发作癫痫病灶定位诊断的相关比较

对３３例复杂部分发作癫痫患者进行单光子计算机断层摄影（ＳＰＥＣＴ），磁共振（ＲＭＩ）和脑电频谱分析（ＰＳＡ）检查，其中有３０例在发作间期进行ＳＰＥＣＴ检查，均显示颞叶局灶性脑血流减低，１４例定位在左侧，１０例在右侧，６例为双侧病灶。ＭＲＩ结果显示２６例存在颞叶异常改变（１６例在左侧，７例在右侧，３例为双侧病灶）。ＰＳＡ发现３０例有明确的病灶（１１例在左侧，１６例在右侧，３例为双侧）。ＳＰＥＣＴ和Ｐ     

SPECT定位指导治疗顽固性癫痫的疗效评估

目的 探讨单光子发射型计算机断层扫描（SPECT）脑血流灌注显像在癫痫发作期和发作间期癫痫病灶定位中的应用价值.方法 选取39例住院顽固性癫痫患者,在癫痫发作期和发作间期行脑部SPECT定位致痫灶,并与发作间期正电子发射计算机断层扫描（PET）、MRI、脑电图（EEG）比较检查结果符合率;根据SPECT定位行开颅致痫灶切除手术治疗或定位放射治疗;随访患者接受手术或放疗后2～3年癫痫发作次数及发作程度,采用ILAE分级法进行临床疗效评估分级.结果 39例顽固性癫痫患者脑致痫灶SPECT与PET、MR1、EEG检查结果符合率分别为15.4％、5.1％、0.0％;治疗前后每日平均发作频次比较差异有统计学意义（P＜0.05）.结论 应用SPECT脑血流灌注显像在癫痫发作期和发作间期对顽固性癫痫病灶进行定位指导治疗效果较好,具有较高的临床应用价值.     

SPECT脑血流显像在难治性癫癎灶定位诊断中的价值

目的 :探讨单光子发射计算机断层(SPECT)脑血流显像在癫灶定位诊断 ,指导癫外科治疗的价值。方法 :对88例难治性癫患者进行了脑电图(EEG) ,磁共振成像(MRI)和SPECT脑血流显像检查 ,其中42例患者进行了外科(开颅手术或γ刀放射)治疗。结果 :SPECT脑血流显像的阳性率最高 ,为90.9 % ,EEG和MRI的阳性率分别为76.1 %和40.9 %。外科治疗患者SPECT与EEG定位结果的一致及相对一致率为83.3 % ,SPECT与MRI定位结果的一致及相对一致率为81.3 %。3者定位结果的一致及相对一致率为75.0 %。外科治疗的有效率为83.3 %。结论 :SPECT脑血流显像是诊断癫灶灵敏而有效的方法 ,对正确选择癫手术或γ刀治疗方案并取得较好的治疗效果具有重要意义     

发作期SPECT显像对小儿癫痫病灶定位的价值

目的评价发作期单光子发射计算机断层扫描（SPECT）脑血流灌注显像在小儿癫痫灶定位诊断的价值。方法对24例已行发作间期SPECT检查的癫痫患儿行发作期SPECT检查,并与脑电图（EEG）和核磁共振（MRI）检查结果比较。结果发作期SPECT、发作间期EEG和MRI的异常率分别为91．67％、70．83％和33．33％;发作期高灌注状态病例中以局部和单侧邻近区域性病灶为主（81．82％）;EEG与发作期高灌注部位相符达87．5％,但EEG定位范围广泛,常超出高灌注区。结论发作期SPECT脑血流高灌注显像是诊断小儿癫痫病灶灵敏而有效的方法,其对致痫灶定位价值大于MRI和EEG,若与发作间期SPECT结合分析,更可提高癫痫定位的特异性。     

发射计算机断层脑血流显像在儿童癫癎诊断的应用

对127例癫痫儿童于癫痫发作间歇期进行单光子发射计算机断层(SPECT)脑血流显像,并与脑电图(EEG)、脑CT和MRI检查进行比较。结果表明,SPECT脑血流显像阳性率高达82.7％,EEG、脑CT和MRI的阳性率分别为50.4％,18.4％和32.1％。EEG出现异常时,SPECT脑血流显像常亦有异常,二者定位结果的一致及相对一致率为78.1％(25/32)。脑CT出现局灶性异常时,SPECT脑血流显像亦会有相应部位的异常。说明SPECT脑血流显像在癫痫灶的检出和定位诊断上有一定价值。     

SPECT脑血流显像在难治性癫痫灶定位诊断中的价值

目的：探讨单光子发射放射断层（SPECT）脑血流显像在癫痫灶定位诊断，指导癫痫外科治疗的价值。方法：对88例难治性癫痫患者进行了脑电图（EEG），磁共振成像（MRI）和SPECT脑血流显像检查，其中42例患者进行了外科（开颅手术或γ刀放射）治疗。结果：SPECT脑血流显像的阳性率最高，90．9％，EEG和MRI的阳性率分别为76．1％和40．9％。外科治疗患者SPECT与EEG定位结果的一致及相对一致率为83．3％，SPECT与MRI定位结果的一致及相对一致率为81．3％。3者定位结果的一致及相对一致率为75．0％。外科治疗的有效率为83．3％。结论：SPECT脑血流显像是诊断癫痫灶灵敏而有效的方法，对正确选择癫痫手术或γ刀治疗方案并取得较好的治疗效果具有重要意义。     

AEEG、SPECT及神经影像学检查在癫痫诊断中的应用

目的　观察 2 4h动态脑电图 (AmbulatoryelectroencephalographyAEEG)、单光子发射计算机断层扫描(Singlephotonemissioncomputedtomography ,SPECT)、头颅CT或MR检查在癫痫诊断中的价值。方法　 52例已确诊的癫痫患者 ,部分性发作 4例 ,全面性发作 48例 ;分别施行 2 4h动态脑电图、发作间期SPECT、头颅CT或MR检查 ,观察此 4种诊断方案应用的阳性检出率及互相之间的关系。结果　 2 4h动态脑电图检查显示 ,52例患者中 50例 (96 15% )记录到癫痫样波形 ,SPECT扫描 ,44例患者 (84 62 % )在发作间期可见局限性脑血流灌注降低区。两种诊断方法阳性检出率比较 ,差异无显著性意义 (P >0 0 5) ,AEEG癫痫样波形发放区与发作间期SPECT血流灌注降低区定位符合率差异无显著性意义 (P <0 1)。CT或MR检查仅 5例患者有确定的病灶。与AEEG癫痫样波形发放部位及发作间期SPECT局限性脑血流灌注降低区相符。结论　 2 4h动态脑电图、发作间期SPECT与CT或MR检查联合应用 ,有助于提高对癫痫患者的检出率     

颞叶癫痫患者43例的临床特征和睡眠脑电图特点分析

目的探讨颞叶癫痫临床特征及睡眠脑电图特点。方法对颞叶癫痫患者43例的临床特征、睡眠脑电图进行回顾性分析。结果43例中,仅表现为全身性强直－阵挛发作23例,复杂部分性发作15例,合并单纯部分性发作5例。患者睡眠脑电图和24h脑电监测中,除5例正常外,双侧颞叶癫痫样波9例,左侧颞叶癫痫样波10例,右侧颞叶癫痫样波8例,左额、颞癫痫样波2例,右额、颞癫痫样波3例,双额、颞癫痫样渡6例。颞叶癫痫继发全身强直－阵挛发作最多,颞叶癫痫强直．阵挛发作患者不容易与全身性强直．阵挛性癫痫相区别。部分性和全身性癫痫用药不同,区别是部分性癫痫还是全面性癫痫非常重要。结论睡眠脑电图对颞叶癫痫的定位及其放电机制的了解有着重要意义。     

银花汤治疗慢性鼻窦炎100例疗效观察

笔者运用“银花汤”加减治疗慢性鼻窦炎2,取得满意疗效,现报告如下。1 临床资料1.1 一般资料 100例中,男56例,女44例;10～30岁者60人,占60％,31～72岁者40人,占40％;双侧上颌窦炎32例,其中伴囊肿者10例;右侧者10例,左侧者12例;额窦炎46例。1.2 病例选择 (1)病情反复发作,病程3个月以上者。并以头痛、头晕、鼻塞、流涕为主症。(2)经X线摄片确诊。(3)检查:鼻中道、鼻腔或鼻后孔有脓性分     

核素扫描对红斑狼疮脑损害诊断的评价

目的探讨狼疮脑和非狼疮脑患者脑血供的差别.方法用单光子发射电子计算机扫描(SPECT)观察脑血流的变化,选择脑感兴趣区及半定量计算非对称指数(AI)法分析,狼疮脑患者同时行核磁共振(MRI)检查.结果20例狼疮脑(Ⅰ组)和23例非狼疮脑(Ⅱ组)SPECT血流减少部位分别为83处和74处(P＞0.05);AI值Ⅰ、Ⅱ组分别为6.85±1.98和6.45±1.87(P＞0.05).两组患者血流灌注不足的部位依次主要分布在额叶、顶叶和颞叶,其次是枕叶和小脑.Ⅰ组中14例MRI检查发现87处病灶,同时有SPECT和MRI异常部位51处(占81%),其中12例患者的神经精神症状至少和一处SPECT异常有关.结论SPECT是早期判断系统性红斑狼疮脑损害的敏感检查方法.     

颞叶癫痫的手术治疗(附26例报告)

目的提高药物难治性癫痫的致痫灶精确定位和外科治疗水平。方法对26例颞叶癫痫患者应用长程视频脑电进行术前监测定位和皮层电极、深部电极进行术中定位;采用显微外科技术进行病灶+颞叶切除或颞叶+海马杏仁核切除。结果26例患者根据脑电图,18例患者根据MRI检查定位了致痫灶。术后无病死和严重并发症,服用抗癫痫药物减少;随访6～18个月,1级16例,2级6例,3级4例。结论长程视频脑电图和MRI检查是定位癫痫灶可靠的检查方法。应用显微外科技术可减少并发症,取得较好的治疗效果。     

基底动脉尖综合征34例分析

目的研究基底动脉尖综合征（TOBS）的临床与影像学特点。方法对34例TOBS的临床与影像学资料进行分析。结果TOBS主要临床表现为意识障碍，眼球运动障碍及瞳孔异常，可伴视觉障碍，偏盲，认知行为异常及小脑性共济失调等。头颅CT或MRI最其特征性改变为双侧丘脑对称性蝶形梗死灶，伴中脑、小脑、枕叶、颓叶梗死。结论TOBS诊断主要依靠临床及影像学表现，MRI诊断优干CT，早期综合治疗可提高生存率。     

Regional cerebral blood flow in alcohol-induced violence: a case study

A case is presented of a 20-year-old man who became violent on many occasions after ingesting alcohol. On one occasion he committed an armed robbery. Two brain SPECT studies were performed: one when he was alcohol free, and one after he ingested alcohol in the same pattern as the night of the crime. The "alcohol free" study revealed marked hyperactivity in the cingulate gyrus, right and left lateral frontal lobes, right and left lateral parietal lobes and the right lateral temporal lobe. The "alcohol intoxication" study showed an overall dampening effect on the hyperactive areas of the brain, with only the anterior cingulate gyrus showing excessive activity. In addition, the right and left prefrontal cortex became hypoperfused, decreasing impulse control and judgment, as did the left and right temporal lobes, increasing the likelihood for aggression. This study suggests that this man may have been "self-medicating" an overactive brain, but in the process induced a state that increased the likelihood for aggressive behavior. This case study suggests the need for further research in the area of alcohol-induced violence and the potential usefulness of SPECT imaging, although no conclusions can be drawn from one case.     

Calcipotriol-betamethasone ointment versus calcipotriol ointment in the treatment of psoriasis vulgaris

Of 17 patients (10 men and 7 women) with psoriasis vulgaris, aged between 12 and 59 years, included in this study, 4 patients were excluded (3 because of a treatment follow-up irregularity and 1 due to severe irritation). Thirteen patients completed the 6-week treatment course where each patient was instructed to apply calcipotriol-betamethasone ointment on the right side and calcipotriol ointment on the left side. The treatment effect was assessed according to the psoriasis area severity index (PASI) changes, and complete blood count and serum calcium was done prior to and at the end of the treatment. Results showed that both sides had improved by 92.3%, with a marked reduction in the mean PASI (from 11.5 to 2.2); a better reduction was observed in the right side during the second and third visits. A marked improvement to complete clearance was seen in 84.6% in calcipotriol-betamethasone side and 76.9% in calcipotriol alone. Mild irritation was reported in the left side in 15.4% which was tolerated with the continuation of treatment application. No telangiectasia or atrophy was observed on the right side. In conclusion, calcipotriol-betamethasone may be recommended in the early weeks of the treatment of psoriasis vulgaris, and it is helpful in psoriasis patients with irritation to calcipotriol alone.     

心肌磁共振显像与核素心肌灌注显像测定左心功能的对比研究

目的评价心肌磁共振显像(MRI)和门控核素心肌灌注显像(SPECT)检测急性心肌梗死(AMI)患者左心室功能的应用价值。方法AMI患者23例,分别于1周内行MRI和SPECT检查,测定左室舒张末期容积(EDV)、收缩末期容积(ESV)和射血分数(EF),将MRI检测结果作为标准,并与SPECT结果比较,行相关分析及一致性检验。结果MRI采用多层Simpson法,图像空间分辨率高,可以准确划分血池和心肌的界限。SPECT较MRI低估左室容积EDV(16±27)mL,ESV(8±21)mL,EF值两者大致相等。经相关分析,SPECT与MRI所测EDV、ESV、EF相关系数分别为0.79、0.84、0.84(P均<0.01)。经Bland-Altman一致性检验,SPECT与MRI所测左室容积及EF有等价性。结论MRI检测心功能准确、可靠。SPECT与MRI具有等价性。     

^99锝^m-双半胱氨酸乙脂脑显像对犬椎动脉狭窄早期局部脑供血变化的观察

目的：运用^99锝^m-双半胱氨酸乙脂（^99Tc^-ECD）脑显像（CBFPI）观察急性犬椎动脉狭窄早期局部脑供血变化。方法：24只家犬随机分为正常对照组（A）、中度狭窄组（B）、重度狭窄组（C）、闭塞组（D）4组,每组各6只。A组不作任何特殊处理,B、C、D组手术结扎右侧椎动脉,结扎程度分别为狭窄范围50％～69％、70％～99％及100％。结扎后0．5～1h静脉注射显像剂,1h后行SPECT断层显像。结果：CBFPI检测椎动脉狭窄早期脑供血改变灵敏度,目测分析法：B、C、D3组灵敏度分别为33．3％、83．3％、100％,总体灵敏度为72．2％;半定量分析法：3组灵敏度分别为50％、100％、100％,总体灵敏度为83．3％。CBFPI半定量结果：各部位感兴趣区（ROI）放射性比值,与A组比较：D组明显降低,C组除小脑外均明显降低,B组无明显变化。B、C、D组两两比较,右颞叶均有差别,左颞叶B．C、B—D组比较有差别,枕叶仅B、D组比较有差别,而小脑则无差别。结论：狭窄程度不同受累范围不同：颞叶最易受累,其次为枕叶,小脑则不易受累。     

The Quiescent Heroin Scene: Incidence and Prevalence in the San Francisco Bay Area

Abstract

A case is presented of a 20-year-old man who became violent on many occasions after ingesting alcohol. On one occasion he committed an armed robbery. Two brain SPECT studies were performed: one when he was alcohol free, and one after he ingested alcohol in the same patternas the night of the crime. The “alcohol free” study revealed marked hyperactivity in the eingulate gyrus, right and left lateral frontal lobes, right and left lateral parietal lobes and the right lateral temporallobe. The “alcohol intoxication” study showed an overall dampening effect on the hyperactive areas of the brain, with only the anterior cingulate gyrus showing excessive activity. In addition, the right and left prefrontal cortex became hypoperfused, decreasing impulse control and judgment, as did the left and right temporal lobes, increasing the likelihood for aggression. This study suggests that this man may have been “self-medicating” an overactive brain, but in the process induced a state that increased the likelihood for aggressive behavior. This case study suggests the need for further research in the area of alcohol-induced violence and the potential usefulness of SPECT imaging, although no conclusions can be drawn from one case.     

99mTc-ECD SPECT at rest and activation in young patients with schizophrenia

The aim of the study was to localize brain parts involved in executive functions in patients with schizophrenia by means of 99mTc-ECD single photon emission computed tomography (SPECT) with 3-dimensional automatic software. We examined 12 men with schizophrenia (mean age 29±3.9 years). Brain perfusion SPECT was performed at rest and during Wisconsin Card Sorting Test (WCST). Two types of quantitative SPECT analysis were applied; voxel-based and volume of interest (VOI)-based. With voxel-based approach, rest and activation SPECT were compared. VOI-based analysis allowed for correlation of regional cerebral blood flow (rCBF) in 20 VOIs with WCST scores. In voxel-based analysis, the patterns of rCBF decrease and increase after activation varied between patients, with combinations of different brain regions involved. In VOI-based approach, the only statistically significant difference between activation and rest was rCBF decrease in the left basal ganglia (p=0.028). The thalami and right temporal cortex correlated with the greatest number of WCST scores, followed by left occipital cortex and left cerebellum. In conclusion, our results suggest that patterns of WCST activation and deactivation vary between patients with schizophrenia. Among the network of involved brain structures, right temporal cortex and thalami appear to play the major role.     

Effects of unilatral‐ and bilateral inhibition of rostral ventral tegmental area and central nucleus of amygdala on morphine‐induced place conditioning in male Wistar rat

The rostral ventral tegmental area (VTAR) and central nucleus of amygdala (CeA) are considered the main regions for induction of psychological dependence on abused drugs, such as morphine. The main aim of this study was to investigate the transient inhibition of each right and left side as well as both sides of the VTAR and the CeA by lidocaine (2%) on morphine reward properties using the conditioned place preference (CPP) method. Male Wistar rats (250±20 g) 7 days after recovery from surgery and cannulation were conditioned to morphine (7.5 mg/kg) in CPP apparatus. Five minutes before morphine injection in conditioning phase, lidocaine was administered either uni‐ or bilaterally into the VTAR (0.25 μL/site) or CeA (0.5 μL/site). The results revealed that lidocaine administration into the left side, but not the right side of the VTAR and the CeA reduced morphine CPP significantly. The reduction was potentiated when lidocaine was injected into both sides of the VTAR and the CeA. The number of compartment crossings was reduced when lidocaine was injected into both sides of the VTAR and the CeA as well as the left side. Rearing was reduced when lidocaine was injected into the right, but not the left side of the VTAR. Sniffing and rearing increased when animals received lidocaine in the right side and reduced in the group that received lidocaine in the left side of the CeA. It was concluded that the right and the left side of VTAR and the CeA play different roles in morphine‐induced activity and reward.