椎基底动脉供血不足患者的SPECT脑血流灌注研究

目的 利用单光子发射计算机断层扫描(SPECT)观察椎基底动脉供血不足(VBI)急性发作期患者局部脑血流灌注(rCBF)情况.方法 将临床确诊为VBI患者32例进行SPECT检查,与12名健康体检者同期进行时照观察,分析VBI患者脑血流灌注的情况.结果 目测示VBI发作期患者右侧低灌注明显高于左侧,经半定量分析后VBI组的脑血流灌注在多处较时照组减低;VBI组左右比较,右侧脑血流灌注普遍低于左侧.结论 SPECT对VBI的诊断有一定价值,且VBI发作期患者脑血流灌注异常在椎基底动脉系为主的基础上还波及颈内动脉系.     

短暂性脑缺血发作合并抑郁患者单光子发射计算机断层扫描局部脑血流灌注的特点

目的探讨短暂性脑缺血发作(TIA)合并抑郁患者单光子发射计算机断层扫描(SPECT)局部脑血流灌注(rCBF)特点。方法对TIA患者进行汉密顿抑郁量表(HAMD)测试筛选出45例抑郁患者,41名正常人作为对照组,均进行SPECT检查。结果 TIA合并抑郁患者SPECT脑血流低灌注发生率为73.3%,重症抑郁患者100%存在脑血流低灌注;TIA合并抑郁组双侧海马及丘脑、额叶、颞叶、顶叶rCBF较对照组显著下降(P0.01),枕叶也明显减低(P0.05);右枕叶、右顶叶rCBF较左侧显著下降(P0.01),右额叶、颞叶rCBF低于左侧但两侧比较无统计学差异(P0.05)。结论 TIA合并抑郁患者存在某些特定部位rCBF下降;右侧r CBF减低更多见;rCBF减低发生率与抑郁症状严重程度有关。TIA患者增加脑灌注治疗对改善其抑郁症状可能有益。     

脑血流灌注SPECT显像评价依达拉奉治疗外伤性脑出血

选择外伤性脑出血患者80例,随机分为依达拉奉组和常规治疗组,依达拉奉组在常规治疗的基础上加用依达拉奉60mg／d静脉滴注,连续5d。于治疗前、治疗1、3、5d采用SPECT脑血流灌注显像测定局部脑血流量（rCBF）。发现依达拉奉治疗后第1、3、5d病灶部位rCBF值高于同期常规治疗组（P〈0．01）。认为依达拉奉对改善外伤性脑出血患者rCBF有明显疗效,脑血流灌注SPECT显像可以用于评价依达拉奉对外伤性脑出血疗效。     

与大脑中动脉扩张有关的偏头痛

一些研究认为,伴有先兆症状的偏头痛发作起初存在局部脑血流量(rCBF)灶性减少,其神经系统先兆症状与大脑区域性组织血液灌注降低有关;而无先兆症状的偏头痛发作与脑组织血液灌注无关。为了探讨偏头痛时脑血管的改变,作者测定了 rCBF 和大脑中动脉(MCA)的血液流速。病人和方法偏头痛患者10例,男2例,女8例,平均年龄为50岁。要求病人偏头痛一旦发作尽快来院检查。病人来院后先测定rCBF,接着作经颅多普勒检查     

驱铜治疗对肝豆状核变性患者局部脑血流量的影响

目的明确肝豆状核变性（HLD）患者局部脑组织血流灌注情况,探讨驱铜治疗对HLD患者局部脑组织血流灌注的影响。方法采用磁共振灌注成像技术检测研究组24例HLD患者驱铜治疗前后豆状核、丘脑等部位的局部脑血流量（rCBF）,并采用同法检测18例对照组;根据治疗阶段将HLD患者分为治疗前、短期治疗后、长期治疗后3个水平。结果研究组治疗前双侧豆状核、右侧尾状核等多部位相对局部脑血流量（rrCBF）均值较对照组减低（P〈0．05）。长期治疗后双侧豆状核、尾状核、丘脑等部位rrCBF均值较治疗前升高（P〈0．05）,短期治疗后各部位rrCBF均值与治疗前比较差异无统计学意义（P〉0．05）。结论HLD患者存在广泛部位的rCBF减低,短期驱铜治疗对HLD患者rCBF的影响不明显,长期、正规的综合驱铜治疗能使HLD患者的rCBF得到改善。     

乙酰唑胺负荷试验CT灌注显像评价缺血性脑血管病患者脑血流储备

目的采用口服乙酰唑胺CT灌注显像研究缺血性脑血管病患者病变血管分布区脑血流储备力的变化。方法10例短暂性脑缺血发作（TIA）患者首先行常规脑CT灌注检查（基础态）,结束后即刻口服乙酰唑胺1．0g,延时2h后再次行脑CT灌注检查（激发态）。比较激发前后脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTY）、负荷前后双侧相对值（rCBF、rCBV、rMTr）及CBF变化率（RCBF）。结果负荷试验：基础态：病变侧MCA供血区CBF较对侧明显减低,CBV轻度增加,MTT明显延长（P均〈0．05）。激发态：健侧CBF明显升高、MTY明显缩短、CBV无明显改变;病变侧CBF、CBV及MTT均无显著变化;病侧与健侧负荷前后RCBF、RMTT及rCBF、rMTT均有统计学差异（P均〈0．05）,而RCBV及rCBV无显著统计学差异。结论口服乙酰唑胺负荷试验CT灌注显像是评估缺血性脑血管病患者脑血流储备能力的简单有效方法,具有重要临床价值。     

经颅多普勒超声观察偏头痛病人间歇期脑血流变化

目的运用经颅多普勒超声（TCD）观察偏头痛病人发作间歇期脑血流变化。方法163例偏头痛病人分为有先兆头痛组和无先兆头痛组，在发作间歇期进行TCD检测，记录颅内各动脉血流速度、频谱特征等参数，进行比较，并与64名正常对照组比较。结果先兆头痛组与无先兆头痛组偏头痛病人各动脉血流速度比较差异无统计学意义（P〉0．05），但偏头痛组较正常对照组均明显增快（P〈0．01）。结论有先兆和无先兆偏头痛于发作间歇期脑动脉血流速度变化相似，但较正常对照组均明显增快，TCD通过检测观察脑血流变化，间接反映偏头痛病人在发作间歇期颅内动脉处于紧张收缩状态。     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

磁共振动脉自旋标记技术对阿尔茨海默病脑血流量的初步研究

目的 探讨磁共振动脉自旋标记(arterialspinlabeling,ASL)技术对显示阿尔茨海默病(AD)患者脑血流异常的临床应用价值.方法 22例AD患者和20例年龄相匹配的健康对照者进行头颅ASL灌注成像和磁共振形态学检查,其中16例AD患者及11例健康对照者完成了脑单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,SPECT)检查.ASL灌注的原始数据经处理后得到脑血流图,测量双侧额叶、颞叶、颞顶交界区、顶叶和枕叶皮质和海马区的脑血流量,并比较AD患者脑血流量与健康对照者的差异.结果 22例AD患者ASL脑灌注图像均可见局部皮质灌注减低区,主要为颞叶72.7%(16例)、颞顶交界54.5%(12例)和顶叶45.5%(10例),且与SPECT表现一致.AD患者双侧额叶、颞叶、颞顶交界区、顶叶皮质及海马区的脑血流量较健康对照者显著下降(均P<0.05).AD患者右额叶、左顶叶及左颞顶交界皮质的脑血流量与简短精神状态量表(mini-mentalstateexamination,MMSE)评分呈正相关(r分别为0.49、0.54和0.64,均P<0.05).结论 ASL不仅可以清晰显示AD患者局部脑血流减低区,而且表现与SPECT一致,提示ASL技术是一种评价AD患者脑血流下降的有效工具.     

慢性酒精中毒与脑损伤

目的探讨慢性酒精中毒对脑组织的损伤。方法；对78例慢性酒精中毒患者行经脑多普勒超声（TCD）、单光子发射计算机体层扫（SPECT）、及头部CT检查，结合临床症状及体征进行统计学分析。结果78例中TCD脑血流速度减慢42例（53．8％）、SPECT测量大脑局部血流（rCBF）降低46例（58．9％）和头部CT脑萎缩33例（42．3％）。结论慢性酒精中毒患者脑损伤的程度与饮酒量、饮酒时间呈正相关。     

A higher prevalence of abnormal regional cerebral blood flow in patients with syndrome X and abnormal myocardial perfusion

To test the hypothesis that syndrome X is a systemic vascular disorder, technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in 30 patients with syndrome X. These patients were separated into group 1, 20 patients with definite myocardial perfusion defects diagnosed by thallium-201 (Tl-201) myocardial perfusion SPECT; and group 2, 10 patients without any myocardial perfusion defects. Tc-99m ECD brain SPECT demonstrated hypoperfusion brain lesions in 95% (19/20) and 20% (2/10) of patients in groups 1 and 2, respectively. This difference in the cidence between the two groups was significant. In group 1 and 2 patients, parietal lobes were the most common hypoperfusion areas, while the cerebellum was the least common hypoperfusion area of the brain. Syndrome X is a systemic vascular disorder with a high incidence of hypoperfusion lesions of the brain based on the findings of Tc-99m ECD brain SPECT, and is usually coincident with myocardial defects based on the Tl-201 myocardial perfusion SPECT findings.     

老年人脑出血后脑血流量改变的研究

目的研究老年人脑出血后脑血流量改变及影响因素。方法对４２例老年脑出血患者在发病１周内行单光子发射型计算机断层扫描（ＳＰＥＣＴ）、脑血流显像和ＣＴ扫描，部分进行动态观察。结果脑血流量下降范围１０例局限在病灶周围，３２例累及病灶以外区域，其中小脑失联络１１例，１～６个月复查仍见广泛的血流量下降，血流减少的范围及程度与出血部位、出血量密切有关。结论老年人脑出血后存在持久广泛的脑血流量下降。     

Regional cerebral blood flow between primary and concomitant fibromyalgia patients: a possible way to differentiate concomitant fibromyalgia from the primary disease

OBJECTIVES: Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) has been used to detect abnormal regional cerebral blood flow (rCBF) in women with primary fibromyalgia (FM). The main aim of this study was to investigate the rCBF deficit in concomitant FM patients and compare it with primary FM. METHODS: An observational study was designed to analyse the SPECT findings in 92 female patients recruited from January 2002 to January 2004. Differences in the rCBF hypoperfusive areas between 49 primary and 29 concomitant FM patients were assessed in different areas of the brain using the chi(2)-test for statistical significance. RESULTS: Tc-99m ECD brain SPECT in 71 FM patients revealed heterogeneous rCBF in comparison to the homogeneous scan in 14 control patients. The most prominent rCBF hypoperfusive region in both primary and concomitant FM groups was the left temporoparietal area, followed by the thalamus, right temporoparietal, frontal, and basal ganglia areas. Differences in rCBF hypoperfusion in these areas for both FM groups were not significant (all p>0.5). CONCLUSIONS: Reduced rCBF at cortical regions, in addition to previously reported areas at the thalamus and the subcortical nucleus, in FM patients was demonstrated in this study. The perfusion deficit areas were similar between primary and concomitant FM when the underlying disease activity was quiescent. The feasibility of using this neuroimaging study to differentiate FM from the primary disease, such as rheumatoid arthritis (RA)-associated depression and neuropsychiatric lupus, should be considered.     

埋线配合放血疗法治疗偏头痛临床疗效及脑血流动力学观察

目的 探讨穴位埋线及放血疗法治疗偏头痛的临床疗效及作用机制.方法 将80例患者随机分为两组.A组为治疗组,采用穴位埋线及放血疗法治疗;B组为药物组,采用口服西比灵治疗.两组患者分别在治疗前及治疗后采用偏头痛诊断、疗效评定标准进行评分,判定治疗效果.同时采用经颅多普勒超声对治疗前后的大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)平均脑血流速度进行检测.结果 穴位埋线及放血疗法能有效缓解偏头痛的症状,改善头痛发作次数、头痛程度、持续时间及伴随症状,并对颅内血流动力学产生影响.两组患者治疗效果具有统计学意义(P<0.05).结论 穴位埋线及放血疗法可提高偏头痛临床治疗效果,能对颅内血流动力学产生影响.     

脑梗死前期MR脑灌注成像的临床意义

目的 探讨脑梗死前期MR脑灌注成像的表现和分期临床应用价值。方法 采用脑MR灌注成像对18例脑血管病患者的170层脑灌注图像和对照组20例非脑血管病患者的197层脑灌注成像进行分析，计算每层图像的患／健侧比值，并与对照组的正常比值及其范围比较。以非参数统计方法、多元方差分析和两两比较分析病例组和对照组脑灌注血流动力学参数及其分期。结果 病例组和对照组的4个血流动力学参数均有显著性差异（P〈O.01）。TTP（time to peak）和MTT可（mean traasit time）与发病的相关系数较高，分别为O.422和0.371，rCBV（regional cerebral blood volume）和rCBF（regional cerebral blood flow）较低，且为负值。脑梗死前期分期特征为：I1期TTP稍有延长，I2期MTT显著延长，Ⅱ1期rCBF明显下降，Ⅱ2期rCBV下降。结论 脑灌注成像可提供脑梗死前期的血流动力学参数变化的信息，并可以对其参数变化进行分期。     

Objective evidence of abnormal regional cerebral blood flow in patients with systemic lupus erythematosus on Tc-99m ECD brain SPECT

Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in 78 SLE patients with neuropsychiatric manifestations. These patients were separated into two subgroups: group 1 including 48 cases with definite neuropsychiatric symptoms/signs and group 2 with 30 cases having no neuropsychiatric symptoms/signs. Tc-99m ECD brain SPECT demonstrated hypoperfusion brain lesions in 90% and 20% of patients in groups 1 and 2, respectively. In both groups, parietal lobe and cerebellum are the most and least common areas with hypoperfusion lesions, respectively. This study suggests that Tc-99m ECD brain SPECT may provide objective information for detection of hypoperfusion brain lesions in SLE patients.     

Migraine during systemic lupus erythematosus: findings from brain single photon emission computed tomography

OBJECTIVE: Headache in systemic lupus erythematosus (SLE) is controversial, as is evidence of brain impairment in patients with SLE and headache. Perfusion single photon emission computed tomography (SPECT) was performed to investigate brain impairment in SLE patients with migraine-like headache either from the period of diagnosis or later in the course of disease. METHODS: Eighteen patients with SLE (mean age 40.8 +/- 13.6 yrs) matching these characteristics underwent brain SPECT with 99mTc-HMPAO in the interictal period. Electroencephalography (EEG) and magnetic resonance imaging (MRI) were performed in 12 and 10 patients, respectively. SPECT was analyzed through visual and asymmetry combined analysis as well as by voxel-based statistical analysis compared to a control group of matched healthy subjects (statistical threshold: p = 0.01). RESULTS: Focal hypoperfusion was evidenced in 15 (83%) patients, often matching the main side of pain location, whereas EEG and MRI each gave a positive result in 50% of cases. Using voxel-based analysis, significant hypoperfusion was found in 8 (44%) patients, either lateralized to one side or localized to the anterior cingulate cortex, independent of pain location. CONCLUSION: Brain perfusion SPECT is a sensitive tool for identifying brain impairment in SLE-related migraine, although the mechanisms of brain damage remain to be elucidated. Besides confirming focal hypoperfusion in some patients, in 4 patients statistical analysis revealed interictal hypofunction of the anterior cingulate cortex, a key structure for cortical elaboration of pain in the midline network.     

探讨陈旧性脑梗死缺血脑区的影像学特点和加压灌注治疗

目的研究低灌注脑缺血区的影像学特点,检验经动脉内加压灌注治疗陈旧性脑梗死的可靠性和疗效,以探讨加压灌注治疗的理论依据。方法利用磁共振灌注成像技术(perfusion weighted imaging,PWI)对45例缺血性脑血管病患者的责任病灶进行局部脑血流量(rCBF),局部脑血容量(rCBV),平均通过时间(MTT)比值测定(患侧/健侧),确定低灌注脑区的影像学特点和缺血分期:代偿期(rCBF保持正常,rCBV升高,MTT延长);失代偿期(rCBF轻度下降,rCBV正常或下降,MTT延长);梗死前期:(rCBF下降,rCBV下降,MTT延长)。结合常规数字减影血管造影术(DSA)进行加压灌注治疗;术后复查PWI,对比相应区域上述血流动力学参数变化,评定治疗效果;根据美国国立卫生研究所脑卒中评分(NIHSS)标准对45例患者治疗前后进行评分。结果45例脑梗死患者经加压灌注治疗后,神经缺损症状均有不同程度的改善,NIHSS中位数由10分降到8分;对比术前和术后的脑灌注磁共振影像,大部分皮质型脑梗死(14/19)、所有分水岭区脑梗死(23/23)血流灌注状态有所好转,2例基底节区脑梗死无效(2/3)。结论脑梗死后长期存在低灌注脑区,DSA结合PWI可以较为准确的评价低灌注脑区的缺血损害程度以及治疗价值,侧支循环的建立是加压灌注治疗能否起效的关键。     

Abnormal regional cerebral blood flow in primary antiphospholipid antibody syndrome patients with normal magnetic resonance imaging findings. A preliminary report

Technetium-99m ethyl cysteinate dimer (Tc-99m ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in primary antiphospholipid antibody syndrome (PAPS) patients. The patients had mild neuropsychiatric manifestations and normal brain magnetic resonance imaging (MRI) findings in this preliminary study. Fifteen such female PAPS patients were examined with Tc-99m ECD brain SPECT in order to evaluate the rCBF. In addition, serum anti-cardiolipin antibodies (ACA) and lupus anticoagulant (LA) were simultaneously measured for comparison. RESULTS: (a) Tc-99m ECD brain SPECT revealed hypoperfusion brain lesions in 12 (80%) of the PAPS patients. Pariental lobes were the most commonly involved areas. (b) 11 (73%) and 9 (60%) cases had positive ACA and positive LA, respectively. In addition, ACA and LA results were correlated to the Tc-99m ECD brain SPECT findings. Tc-99m ECD brain SPECT is a sensitive tool for detecting abnormal rCBF in PAPS patients with mild neuropsychiatric manifestations and normal brain MRI findings.