脑SPECT灌注显像在老年人脑血管疾病中的应用

目的：旨在研究脑SPECT血流灌注显像对老年脑血管疾病的诊断价值。材料和方法：对132例脑血管疾病患者进行脑SPECT血流灌注显像，并将SPECT结果与MRI、CT相比较。结果：脑梗塞患者96．1％有阳性发现，有些灌注减低灶较MRI，CT显示的范围大．可能由于包括了梗塞区及周围缺血半影区的缘故。对神经机能联系不能征象进行了观察．短暂性脑缺血发作患者在发作间期有61.9%阳性．病灶与发作期临床症状相符。脑供血不足、脑动脉硬化、脑出血的阳性率分别为64.3%、80%．95.5%。结论：脑SPECT灌注显像为老年人脑血管疾病的诊断提供了客观依据，有重要应用价值。     

神经梅毒的MRI特点及SPECT脑灌注成像的表现三例

目的 提高对神经梅毒的MRI特点的认识,并探讨SPECT脑灌注成像技术在神经梅毒的诊断和治疗中的作用.资料与方法 回顾性分析确诊的3例神经梅毒患者的有临床资料,包括头颅MRI和SPECT脑灌注成像的资料.结果 3例患者的头颅MRI表现各有特点:1例患者表现为右顶叶占位病变,另2例患者主要表现为脑实质多发性斑点状缺血性改变,其中麻痹性痴呆患者伴有脑萎缩.SPECT检查3例患者的脑血流,都表现出局部脑血流降低.结论 头颅MRI是神经梅毒患者影像学检查首选技术,对血清学复发和治疗后随访的神经梅毒患者可进行SPECT脑血流检查.     

持续植物状态99Tcm-ECD脑SPECT显像

目的：观察持续植物状态（PVS）患者脑血流灌注情况及其对高压氧配合药物治疗疗效和预后判断的意义，方法：用99Tc^m－双半胱乙酯（ECD）局部脑血流（rCBF）显像方法对26例不同病因所致的PVS患者进行了检测，9例进行了动态观察。结果：26例PVC患者脑血流灌注均显著, 部位可与脑CT或MRI检查相符或不符，随病情恢复，脑血流灌注亦恢复正常。结论：99Tcm-ECD脑SPECT显像观察rCBF可反映PVS患者脑血流灌注情况，并可作为高压氧配合药物治疗PVS疗效及预后判断的指标。     

脑SPECT血流灌注显像对老年人Alzheimer病和多发性梗塞痴呆的诊断研究

目的：本文旨在研究脑SPECT血流灌注显像对老年人阿尔海默氏病和多发性梗塞痴呆的诊断价值。材料和方法：对6例阿尔海默氏病及6例多发性梗塞痴呆患者进行脑SPECT血流灌注显像，使用放射性药物为^99m锝-六甲基丙叉二胺肟(^99mTc—HMPAO),SPECT结果与MRI、CT相比较。结果：阿尔海默氏病表现为大脑皮质血流灌注的广泛减低，以颞，顶叶较为明显．个别病例一侧大脑皮质灌注减低较对侧明显者伴有同侧基底节或对侧小脑的低灌注，可能与“神经机能联系不能”有关。多发性梗塞痴呆患者，呈不规则、局灶性大脑皮质灌注减低；伴有基底节或小脑的低灌注，与阿尔海默氏病的脑SPECT图像有明显区别。结论：脑SPECT血流灌注显像对阿尔海默氏病与多发性梗塞痴呆的诊断与鉴别诊断有重要价值。     

发作期SPECT脑血流灌注显像和VEEG在癫痫灶定位诊断中的一致性

目的 探讨癫痫发作期SPECT脑血流灌注显像和视频脑电图（VEEG）在致痫灶定位中的一致性.方法 选择VEEG监测异常的癫痫患者45例,当患者出现临床发作和（或）脑电图出现典型癫痫波时30 s内注入锝-双半胱乙酯（^99Tc^m-ECD）,30 min后行脑血流灌注断层显像.比较癫痫发作期SPECT脑血流灌注显像和VEEG在癫痫定位诊断中的一致性,对部分性发作和全面性-强直阵挛发作患者发作期SPECT和VEEG定位的一致性进行卡方检验.结果 45例癫痫患者中,发作期SPECT定位阳性率为93.3％（42/45）,均表现为高血流灌注灶,其中40例（95.2％）表现为单叶局限性高灌注,2例（4.8％）表现为多个病灶高灌注.VEEG监测结果为：31例患者VEEG表现为局灶性异常放电,明确定位达68.9％（31/45）,各导联同步对称性异常放电不能定位者占所有患者的31.1％（14/45）.比较二者定位结果发现,对于部分性发作的患者,发作期SPECT和VEEG定位的一致性为83.9％（26/31）;对于全面性-强直阵挛发作的患者,VEEG表现为各导联同步对称性异常放电,而发作期SPECT则显示为孤立高血流灌注灶,故二者定位无一致性.部分性发作和全面性-强直阵挛发作患者发作期SPECT和VEEG定位的一致性差异有统计学意义（χ^2=24.478,P＜0.05）.结论 发作期SPECT脑血流灌注显像和VEEG在癫痫灶定位诊断中的一致性与癫痫发作类型相关.对于部分性发作的癫痫患者二者联合定位可指导手术治疗;而对于全面性-强直阵挛发作患者,发作期SPECT脑血流灌注显像和VEEG联合定位无一致性,需借助于其他检查方法方可明确定位.     

精神分裂症SPECT脑显像的影像特征及其应用价值

目的:探讨精神分裂症(SC)患者99mTcECDSPECT脑血流灌注显像的影像特征及临床应用价值。材料和方法:对10例正常对照组和24例SC组进行SPECT局部脑血流灌注(rCBF)断层显像。结果:10例正常对照组rCBF均未见异常。SC组rCBF异常者10例,阳性率为41.7%(10/24)。异常主要表现为脑灰质小范围的局限性放射性分布轻度减低,累及16处脑叶,包括颞叶、额叶、顶叶、基底节、枕叶和小脑。结论:SC患者rCBF可出现异常,SPECT对该病的诊断及脑功能异常的定位研究均有重要价值。     

儿童病毒性脑炎~(99)Tc~m-ECD SPECT脑血流显像的研究

目的　探讨99Tcm 双半胱乙酯 (ECD)SPECT脑血流显像在儿童病毒性脑炎中的显像特点和应用价值。方法　对 2 2例临床诊断为病毒性脑炎患儿进行99Tcm ECDSPECT脑血流显像 ,4例于治疗后 13～ 40d进行复查。结果　病毒性脑炎急性期 2 2例患儿中 2 1例脑SPECT显示异常。 17例为多发病灶 ,其中可有双侧对称性或不对称性改变 ;4例为单发病灶。病变处可表现为血流高灌注、低灌注或两者并存。治疗后高灌注区可转变为正常灌注或低灌注 ,低灌注区可转变为正常灌注或持续存在 ;转变为正常灌注者预后可能好于转变为低灌注者。结论　①儿童脑血流显像异常的判断需依据正常同龄儿童的脑显像特点。②99Tcm ECDSPECT脑血流显像可作为病毒性脑炎辅助诊断、预后监测的有效手段     

发作间期SPECT对难治性颞叶癫痫的诊断价值

目的:探讨难治性颞叶癫痫(TLE)单光子发射计算机断层(SPECT)的影像特征及定位诊断价值.方法:选择35例经临床手术证实的难治性TLE,术前均行发作间期SPECT脑血流灌注显像和常规MRI扫描.以临床定位结果做对照,观察难治性TLE的SPECT影像改变,分析发作间期脑血流灌注显像定位诊断颞叶致痫灶的临床应用价值.结果:难治性颞叶癫痫SPECT的影像特征为致痫灶侧前颞叶内侧和/或外侧皮质的血流灌注减低,对侧前颞叶的内侧皮质可出现轻度的灌注减低.常合并与患侧同侧的一处或以上脑区的灌注减低.SPECT致痫灶定位诊断的阳性率达77.14％00(27/35),尤其能检出52.94％ (9/17) MRI阴性TLE的致痫灶.结论:发作间期SPECT脑血流灌注显像能丰富难治性TLE的定位诊断信息,提高定位MRI阴性TLE患者致痫灶的比例.     

难治性颞叶癫痫定位诊断的SPECT与质子MR波谱对照研究

目的：探讨单光子发射计算机断层（SPECT）和质子磁共振波谱（1H-MRS）两种分子影像学技术对难治性颞叶癫痫定位诊断的临床价值。方法：选择经手术病理证实的单侧TLE患者29例。所有患者术前均行发作间期SPECT脑血流灌注显像、常规MRI扫描和1H-MRS成像。将两种分子影像学检查技术,发作间期脑血流灌注显像和1H-MRS,对颞叶癫痫致痫灶的定位诊断结果进行对比分析。结果：29例单侧TLE患者,常规MRI发现异常18例,其中海马硬化16例,定位率62.07%。SPECT异常21例,定位率72.41%,其中,MRI阴性病例中27.27%（3/11）的患者SPECT为阳性1。H-MRS发现异常18例,定位率62.07%,但MRI阴性病例中36.36%（4/11）的患者MRS为阳性。结论：SPECT对TLE功能异常脑区敏感,尤其是颞叶新皮质的异常1。H-MRS对早期海马硬化比MRI敏感。此两种分子影像学技术都能有效定位颞叶致痫灶,相互不可替代。     

脑灌注显像定位致痫灶与皮层脑电图、术中和病理所见比较

目的：探讨SPECT脑灌注显像定位致痫灶的价值。方法：选择拟手术治疗的药物难治性部分性癫痫和其他癫痫患者23例，在发作间期和发作期分别进行SPECT脑灌注显像，用皮层脑电图（EcoG)手术和术后病理检查进行验证。结果：用EcoG探查SPECT显示病灶区，23例皆存在典型的尖慢波和棘尖波发放，发作期的局灶性放射性增高区和EcoG所示的异常电话动范围更匹配。痫波起源于相应区域的大脑皮层，而不是增厚和粘连蛛网膜或肿瘤本身，结论：SPECT脑灌注显像有助于识别致痫灶的位置，大小，血运和功能状态，对术前制定治疗方案有一定的指导作用。     

脑SPECT显像在癫痫中的应用

目的：本文主要研究脑ＳＰＥＣＴ在癫痫应用中的作用和地位。材料和方法：对８１例癫痫患者进行了１０２次发作间期脑ＳＰＥＣＴ血流灌注显像，并与ＥＥＧ、脑ＣＴ、ＭＲＩ比较。结果：８１例ＳＰＥＣＴ检查中６６例显示异常，检出率８１．４％（６６／８１），ＥＥＧ、ＭＲＩ、ＣＴ阳性率分别为８２．９８％（３９／４７）、３８．２４％（１３／３４）、４５．９５％（１７／３７）。结论：ＳＰＥＣＴ显像在癫痫诊断和定位方面与ＥＥＧ、ＭＲＩ、ＣＴ相比具有优势，且有助于癫痫病灶局部血流变化与临床症状、疗效及其他影响因素之间关系的研究。     

新生儿缺氧缺血性脑病SPECT显像研究

目的：探讨新生儿缺氧缺血性脑病SPECT显像的特点。方法：对30例符合新生儿缺氧缺血性脑病诊断和分度标准的患儿和10例正常新生儿进行SPECT脑血流灌注断层显像，并与CT，MRI进行比较，结果：22例同时做SPECT，CT和MRI的患儿中，轻度组7例，SPECT，CT和MRI阳性数分别为7例，3例和5例，中度组10例中，3种方法的阳性数分别为10例，8例和9例；重度组5例，3种方法均为阳性；SPECT，CT和MRI总的阳性检出率分别为100％，72．7％，和86．4％，结论：SPECT显像是诊断该病较灵敏的方法，与CT，MRI结合能对脑组织的生理，病理及代谢，功能状态作出诊断。     

小儿癫痫的SPECT、EEG和MRI的对比研究

目的 评价ＳＰＥＣＴ脑血流灌注显像在小儿癫痫灶定位诊断的价值。方法 对７４例发作间期、１０例发作期,共８４例癫痫患儿行ＳＰＥＣＴ脑血流灌注显像及ＥＥＧ检查,其中６７例作了ＭＲＩ检查,并对各种检查结果进行比较。结果 ＳＰＥＣＴ、ＥＥＧ和ＭＲＩ的异常率分别为８２．１４％、７１．４３％和４７．７６％;ＥＥＧ异常的６０例患儿中与ＳＰＥＣＴ异常部位完全或基本符合率为７０．５９％;ＭＲＩ异常的３２例患儿中１７     

口服乙酰唑胺负荷试验SPECT脑灌注显像早期诊断TIA的价值

目的 评价口服乙酰唑胺（ACZ）脑负荷试验SPECT脑灌注显像对短暂性脑缺血发作（TIA）患者的诊断价值。方法 10例正常志愿者和30例TIA患者进行静息和口服ACZ脑负荷试验SPECT显像。并进行视觉及半定量分析,观察口服ACZ前后血气分析变化。结果 正常ACZ脑负荷试验后^99Tc^m－双半胱乙酯（ECD）在大脑两侧对应部位呈对称分布,脑血流普通增加;TLA组ACZ脑负荷试验后,血pH值降低,PCO2增高。TIA患者ACZ脑负荷试验后总阳性率为93％。结论 口服ACZ脑负荷试验方法简单可靠,对TIA患者早期的影像学诊断有重要价值。     

Evaluation of regional cerebral blood flow with 99mTc-HMPAO in primary antiphospholipid antibody syndrome.

In this study, 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT was used to evaluate the regional cerebral blood flow (rCBF) of the brain in patients with primary antiphospholipid antibody syndrome (PAPS). METHODS: Twenty-two women who were PAPS patients, aged 28-60 y, with mild neuropsychiatric manifestations and normal brain MRI findings were enrolled in this study. Brain HMPAO SPECT was performed to detect brain abnormalities. Meanwhile, serum anticardiolipin antibodies (ACA) and lupus anticoagulant (LA) were measured. RESULTS: HMPAO SPECT revealed hypoperfusion lesions in 16 of 22 (73%) PAPS patients. Cerebral cortex and cerebellum were the most and the least commonly involved areas, respectively. Eighteen of 22 (82%) and 14 of 22 (64%) patients had positive ACA and positive LA, respectively. ACA and LA results were related to HMPAO SPECT findings. CONCLUSION: HMPAO SPECT is a sensitive tool for detecting brain abnormalities in PAPS patients with only mild neuropsychiatric manifestations and normal brain MRI findings.     

Technetium-99m-HMPAO SPECT in the evaluation of patients with a remote history of traumatic brain injury: a comparison with x-ray computed tomography.

The functional imaging modality has potential for demonstrating parenchymal abnormalities not detectable by traditional morphological imaging. Fifty-three patients with a remote history of traumatic brain injury (TBI) were studied with SPECT using 99mTc-hexamethylpropyleneamineoxime (HMPAO) and x-ray computed tomography (CT). Overall, 42 patients (80%) showed regional cerebral blood flow (rCBF) deficits by HMPAO SPECT, whereas 29 patients (55%) showed morphological abnormalities by CT. Out of 20 patients with minor head injury, 12 patients (60%) showed rCBF deficits and 5 patients (25%) showed CT abnormalities. Of 33 patients with major head injury, 30 patients (90%) showed rCBF deficits and 24 patients (72%) showed CT abnormalities. Thus, HMPAO SPECT was more sensitive than CT in detecting abnormalities in patients with a history of TBI, particularly in the minor head injury group. In the major head injury group, three patients showed localized cortical atrophy by CT and normal rCBF by HMPAO SPECT. In the evaluation of TBI patients, HMPAO SPECT is a useful technique to demonstrate regional brain dysfunction in the presence of morphological integrity as assessed by CT.     

评价99Tcm-ECD脑血流灌注显像检测中毒性脑病局部脑血流变化的价值

目的核素脑血流灌注显像观察了中毒性脑病患者的局部脑血流灌注减低的范围和程度,并且分析局部脑血流与计算机体层摄影术及临床症状的关系.方法采用99m锝-双半胱乙酯单光子发射型计算机断层扫描脑灌注显像检测46例中毒性脑病(包括一氧化碳中毒性脑病30例、一氧化碳中毒后迟发性脑病14例和硫化氢中毒性脑病2例)的局部脑血流改变.结果中毒性脑病患者局部脑血流的异常表现全部为脑皮层的血流灌注减低.单侧局限性脑血流灌注减低14例(30%),双侧局限性减低17例(37%),双侧弥漫性减低12例(26%)及阴性3例(7%).局部脑血流异常病变范围和程度与病情轻重关系密切.中毒性脑病与中毒后迟发性脑病2组患者的局部脑血流病变部位和范围的分布有显著区别(χ2=13.94,P＜0.005).观察了8例治疗前后局部脑血流变化提示局部脑血流变化可以较准确反应临床病情变化.18例(39%)同期作了计算机体层摄影术或磁共振成像检查,15例计算机体层摄影术结果阳性,其中只有6例脑皮层双侧或单侧局部密度减低,并且计算机体层摄影术或磁共振改变与临床病情无密切关系.结论 99m锝-双半胱乙酯的局部脑血流对判断中毒性脑病的病变范围、病变程度以及观察疗效有十分重要的价值.     

Comparison of SPM and NEUROSTAT in voxelwise statistical analysis of brain SPECT and MRI at the early stage of Alzheimer’s disease

Objective  Neuroimaging plays a major role in the early diagnosis of Alzheimer’s disease (AD). Recent advances in voxelwise statistical analysis after anatomic standardization of images have made this early diagnosis easier and more objective than visual inspection. We present comparative observations of NEUROSTAT, statistical parametric mapping (SPM) 99, and SPM2 in the early diagnosis of AD using brain perfusion single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Methods  We performed voxel-by-voxel statistical group analysis for brain perfusion SPECT and gray matter images segmented from MRI between 61 patients with very early AD and 82 age-matched healthy volunteers. Anatomic standardization was performed using NEUROSTAT, SPM99, and SPM2 using both original and common templates. Results  The location of significant reduction of regional cerebral blood flow (rCBF) for SPECT and gray matter concentration for MRI were identical among these three methods irrespective of the templates used. When using the original template, the significance of peak rCBF reduction in the posterior cingulate gyri was higher in SPM99 and SPM2 than that in NEUROSTAT. On the other hand, when using the common template, the significance of peak rCBF reduction in the posterior cingulate gyri was higher in NEUROSTAT and SPM2 than that in SPM99. NEUROSTAT showed almost the equal significance of peak rCBF reduction between the used templates. Almost the equal significance of reduction in gray matter concentration was observed in the parahippocampal gyri among the three methods. Conclusions  NEUROSTAT, SPM99, and SPM2 showed identical location of significant reductions in rCBF and gray matter concentration in very early AD patients. Used templates for anatomic standardization are relevant to the results of voxelwise statistical analysis in SPM, less prominently in SPM2 than in SPM99, whereas irrelevant in NEUROSTAT.     

Frontotemporal decreases in rCBF correlate with degree of dysnomia in primary progressive aphasia.

Primary progressive aphasia (PPA) is an uncommon degenerative dementia characterized by gradual impairment of language function with initial sparing of the memory domain. Using semiquantitative 99mTc-hexamethyl propyleneamine oxime (HMPAO) brain SPECT as a measure of regional cerebral blood flow (rCBF), we investigated the relationship between reduced 99mTc-HMPAO uptake and the severity of dysnomia in PPA. METHODS: Seven right-handed patients with PPA had their dysnomia assessed by the Boston Naming Test (BNT), a subtest of the Boston Diagnostic Aphasia Examination. Neuroimaging studies, including 99mTc-HMPAO brain SPECT, CT, and MRI, were performed. Correlational analysis between reduced rCBF and BNT was performed. RESULTS: Brain SPECT showed a reduction in 99mTc-HMPAO uptake involving the frontal and temporal lobes in all 7 patients. CT and MRI showed mild to moderate cerebral atrophy in 4 patients. Low scores on the BNT correlated with low frontotemporal 99mTc-HMPAO (Spearman r = 0.97, P = 0.004) in the 5 patients with left-hemisphere involvement. CONCLUSION: Decreased rCBF to the frontotemporal region characterized the cerebral abnormalities associated with PPA. The finding of focal rCBF abnormalities in the right hemisphere of 2 right-handed women corroborates that PPA symptoms may arise from a "non-left-dominant"-hemisphere degenerative process. Our results support the usefulness of rCBF SPECT imaging as a diagnostic aid in PPA.     

99Tcm-ECD脑血流灌注显像对脑牵拉伤的评价

目的 探讨＾９９Ｔｃ＾ｍ－双半胱乙酯（ＥＣＤ）脑血流灌注显像评价脑肿瘤术牵拉伤局部脑血流量（ｒＣＢＦ）改变的价值。方法 对２１例脑肿瘤病人手术前后进行脑血流灌注断层显像,测量ｒＣＢＦ减低区范围,半定时法比较和分析术前肿瘤周围皮层及术后牵拉区ｒＣＢＦ的改变。对术后牵拉伤ｒＣＢＦ减低区分为内,外侧,并测定半定量值。