儿童孤独症的脑功能影像学改变及其与行为表现关系分析

目的 探讨孤独症儿童脑功能影像学的改变及其与行为表现的关系。方法 对26例孤独症患儿和8例非孤独症患儿进行脑（[99m]Tc)-ECD单光子发射型电子计算机断层显像（SPECT）检测,并采用孤独症治疗评估量表对26例孤独症患儿进行临床行为测量,分析比较其SPECT改变与量表总分及各单项分值的关系。结果 与对照组相比,孤独症患儿有明显的局灶脑血流灌注减少（76．9％）,主要发生部位是海马回13例次（13／33）,颞叶12例次（12／33）,额叶3例次（3／33）。孤独症患儿有局灶脑血流灌注减少组与未减少组的量表总分及各单项分值无显著性差异。结论 包括海马回路和岛叶的边缘系统及颞叶、额叶的功能异常与孤独症的发生及表现有关。     

儿童孤独症213例病例分析

目的：探讨孤独症的病因、发病机制和诊断。方法：对213例孤独症患儿进行生物学因素（妊娠史，出生史，家庭史，抽搐史）、家庭因素（父母性格，家庭教育情况），病历主诉和辅助检查（脑CT／MRI，EEG，BAEP、SPECT）的研究分析。结果：孤独症病例在生物学因素（妊娠史，出生史，家族史，抽搐史）上的异常情况十分普遍，病历主诉以语言发育障碍为主，脑部的CT／MRI，EEG，BAEP，SPECT辅助检查中，SPECT异常检出率高，主要表现为左侧大脑血流灌注降低，血流异常的部位主要是颞叶、额叶和边缘系统（海马回，扣带回等）。结论：妊娠史、出生史、家族史、抽搐史的异常和孤独症的发病有密切关系，以语言发育迟缓为主诉的儿童病例应考虑孤独症的可能。脑SPECT呈血流灌注降低，对诊断孤独症有一定帮助。     

神经影像学评价颅内外血管搭桥术的疗效

目的:探讨神经影像学在颅内外血管搭桥术评价中的作用.方法:收集首都医科大学宣武医院神经外科2003年3月～2004年1月行颞浅动脉-大脑中动脉(STA-MCA)搭桥术病人共10例,其中烟雾痛3例,颈内动脉闭塞2例,大脑中动脉闭塞3例,颈内动脉合并大脑中动脉狭窄1例,颈内动脉闭塞合并大脑中动脉狭窄1例,所有病人术前均行脑血管造影、MR灌注成像(perfusion weighted imaging PWI)和SPECT脑血流(rCBF)检查,行SPECT脑代谢(18F-FDG)检查7例,术后复查脑血管造影9例、MR灌注成像6例、SPECT脑血流 脑代谢检查6例.结果:术前PWI示相对脑血流(rCBF)降低1例、达峰时间(TTP)延迟5例、相对脑血流降低伴达峰时间延迟4例,术后1～2周复查PWI示好转1例、略有好转5例;术前SPECT检查示脑血流降低8例、大致正常2例,脑代谢大致正常3例、略减少3例、明显减少1例,术后SPECT检查示脑血流改善5例、脑代谢改善3例;术后复查脑血管造影9例示吻合口均通畅.结论:随着现代技术逐步发展,评价颅内外搭桥术方法多样化,脑代谢检查是目前认可的重要手段之一.     

SPECT脑血流灌注显像应用于多发性硬化患者认知功能障碍的临床研究

目的探讨SPECT脑血流灌注显像应用于多发性硬化(MS)患者认知功能障碍的临床效果。方法入选我院2010年1月至2013年1月收治的MS患者30例作为观察对象,根据CT、MRI等影像学检查分为脊髓型14例和脑/脑脊髓型16例,与同期15例健康体检人群进行对比,分析MS认知功能障碍患者的脑血流改变。结果脑/脑脊髓型MS组和脊髓型MS组认知障碍发生率62.5%(10/16)和42.9%(6/14),均显著高于对照组6.7%(1/15),MS病例组在多处放射性比值低于对照组,以右丘脑和左顶叶更明显,差异均具有统计学意义(均P<0.05)。结论 SPECT脑血流灌注显像可早期诊断MS患者认知功能障碍。     

CCVI患者局部脑血流量及血流动力学改变的临床研究

目的观察慢性脑血管功能不全（CCVI）患者局部脑血流量（rCBF）及脑血流动力学改变。方法对20例经头颅CT或MRI检查证实无脑组织结构异常、临床确诊为CCVI患者行SPECT显像及经颅多普勒超声（TCD）检查，分别测定rCBF、局部脑血流量降低百分比、脑动脉的平均血流速度（MV）、脑动脉搏动指数（PI）。对照组为年龄、性别相匹配的正常者。结果20例CCVI患者中，95％（19／20）患者出现rCBF减少，主要灌注降低区为额叶、颞叶、顶叶、基底节。80％（16／20）患者大脑前动脉、大脑中动脉血流速度加快。结论对CCVI患者进行rCBF及TCD检测，有助于观察病变部位脑血流量及血流动力学变化，对其临床早期诊断和治疗有着重要意义。早期脑血流量变化可提示患者预后，为选择合理治疗方案提供客观依据。     

数码听觉统合训练治疗小儿痉挛型脑瘫语言障碍的临床探讨

目的探讨数码听觉统合训练治疗痉挛型脑性瘫痪患儿语言障碍方面的临床效果。方法选取2011-2013年在广西壮族自治区人民医院康复科门诊随访已停止常规康复治疗的痉挛型脑性瘫痪患儿60例,随机分为接受数码听觉统合训练治疗的30例为治疗组,另30例无任何治疗的患儿为对照组。采用盖塞尔(Gesell)发育量表评估两组患儿治疗前、治疗后3个月在语言能力方面的变化情况,并用单光子发射断层成像(SPECT)技术观察患儿治疗前、后脑血流灌注情况。结果治疗组治疗后语言能力发育商(DQ)均数(57.19±6.18)高于对照组(53.44±5.49),差异有统计学意义(P0.05);治疗前、后头颅SPECT检查比较,治疗前两组脑血流异常灌注100.00%,治疗后下降到36.67%,优于对照组,差异有统计学意义(P0.05)。结论数码听觉统合训练能改善痉挛型脑性瘫痪患儿语言方面的障碍,减轻患儿大脑血液灌注异常状况,可作为治疗脑瘫合并语言发育障碍的一项重要的辅助方法。     

慢性脑供血不足患者的脑电图及SPECT显像分析

目的探讨脑电图、SPECT对慢性脑供血不足（CCCI）的诊断价值。方法对47例慢性脑供血不足患者行脑电图（EEG）检测,其中10例同时期行SPECT脑血流显像,分两年龄段观察脑电图的变化。结果脑电图正常11例,脑电图异常36例（76.60%）,其中边缘状态脑电图41例,占87.23%;轻度异常脑电图4例,占8.51%;中度异常2例;〈60岁组EEG的异常表现以泛化的慢α波为主,α活动减少、α波幅减低、调幅调节差。≥60岁组EEG改变无明显规律,出现了散在的或弥漫的θ波,同时可混有少量的δ波。两组患者均未见特异性EEG改变。10例行脑血流显像的患者SPECT结果均为阳性,表现为大脑实质广泛的血流灌注降低,以颞叶、额叶及顶叶血流降低最为明显。结论 SPECT脑血流显像能直接地评价脑组织学和功能改变;EEG对慢性脑供血不足患者的诊断还不具有特征性,但可在一定程度上反应脑缺血后脑细胞的功能改变,对慢性脑供血不足的诊疗有帮助。     

局部脑血流断层显像在小儿癫痫中的应用分析

目的探讨利用放射性核素99m锝-乙撑双半胱氨酸二乙酯(99mTc-ECD)局部脑血流断层显像对小儿癫痫诊断的临床应用价值。方法对14例癫痫患儿进行99mTc-ECD单光子发射型计算机断层显像(SPECT),了解患儿脑局部血流灌注情况。结果放射性核素99mTc-ECD脑局部血流灌注显像阳性率高(78.57%)。结论99mTc-ECD局部脑血流断层显像是诊断小儿癫痫病灶的有效方法,对制订癫痫的治疗方案有一定帮助。     

儿童孤独症及其语言训练探讨

【目的】　探讨儿童孤独症病因、临床表现、诊断及其语言训练的效果。　【方法】　对 116例儿童孤独症病例进行生物学因素 (妊娠史、出生史、家族史、抽搐史 )、家庭因素 (父母性格、家庭教育方式 )、病历主诉、发病年龄、确诊年龄、辅助检查 (脑CT、EEG、BAEP和SPECT)做统计分析。其中 43例孤独症儿童进行了语言训练。训练前后使用 [S S〗法检查和构音障碍检查 ,根据结果进行个体化语言训练 ,并对结果做统计学分析。　【结果】　病历主诉以语言障碍和交流障碍为主 ,脑部SPECT异常检出率高 ,主要表现为大脑局灶性血流灌注量降低。确诊年龄晚于发病年龄 2 9个月。语言训练与改善语言交流、功能性构音障碍者差异有非常显著性 (P <0 .0 1) ;不同年龄组之间的语言治疗效果差异有非常显著性 (P <0 .0 1)。　【结论】　异常妊娠史、出生史、家族史和父亲内向的性格特点与孤独症发病有较密切关系 ,临床易误诊。语言训练对促进孤独症患儿的语言交流能力的效果肯定 ,年龄越小 ,效果越好 ;疗程越长 ,效果越稳定     

SPECT脑血流灌注显像在急性闭合性脑损伤患者应用的实验研究

目的探讨SPECT脑血流灌注显像对急性闭合性脑损伤的诊断价值。方法将60例急性闭合性脑损伤病人的SPECT脑血流灌注显像与CT检查结果进行对比分析。结果60例急性闭合性脑损伤SPECT检查结果发现54例呈脑灌注缺损或减低(90％)；60例凹检查结果发现27例表现异常(45％)，SPECT检出阳性率高于CT，差异有显著性(X^2=25．68，P＜0．01)。特别是在轻型脑损伤患者中，SPECT检出阳性率(86．7％)明显高于CT(26．7％)，差异有显著性(X^2=0．59，P＜0.01)。26例CT与SPECT均为阳性的患者中，SPECT发现106个病灶，而CT仅检出50个。结论SPECT脑灌注显像诊断急性脑损伤灵敏度高，尤其对轻型脑损伤患者，可检出CT无法发现的病灶，为临床提供可靠的依据。     

脑血流灌注显像与磁共振灌注显像在早期短暂性脑缺血发作诊断中的对比研究

目的:探究脑血流灌注显像与磁共振灌注显像在早期短暂性脑缺血发作(TIA)中诊断效果的对比。方法:选取在医院检查确诊的120例早期TIA患者,测量患者血压、脉搏、血氧饱和度以及血常规检查,并对其分别进行磁共振灌注显像及脑血流灌注显像,比较两种灌注显像方法的阳性检出率、病灶主要分布以及TIA早期卒中风险预测工具(ABCD2量表)评分。结果:脑血流灌注显像阳性检出率为92.50%,其中单侧和双侧病变阳性检出率分别为90.32%和94.83%;磁共振灌注显像阳性检出率为72.50%,其中单侧和双侧病变阳性检出率分别为74.19%和70.69%,单侧和双侧病变两种诊断方法阳性检出率比较差异有统计学意义(x^2=3.245,x2=6.582;P<0.05)。脑血流灌注显像病灶主要分布在额叶、颞叶、顶叶、枕叶及基底节和丘脑,磁共振灌注显像病灶主要分布在额叶、颞叶、顶叶和枕叶部位;在阴性患者中,脑血流灌注显像ABCD2评分和磁共振灌注显像相比,差异无统计学意义(t=2.846,P=0.064);在阳性患者中,脑血流灌注显像较磁共振灌注显像ABCD2评分高,且差异有统计学意义(t=3.547,P<0.05)。结论:脑血流灌注显像比磁共振灌注显像对早期TIA的诊断更具优势。     

Early‐onset anorexia nervosa: Is there evidence of limbic system imbalance?

OBJECTIVE: This study, part of a continuing effort to understand the pathophysiology of the brain in early-onset anorexia nervosa, attempts to validate findings from an earlier study of regional cerebral blood flow and to correlate any abnormalities in blood flow with eating disorder psychopathology. METHOD: Fifteen newly referred children and adolescents with a diagnosis of anorexia nervosa (AN) underwent regional cerebral blood flow (rCBF) examination using single-photon computerized tomography (SPECT) and the Eating Disorders Examination (EDE) for children. RESULTS: Mean age was 14 years 11 months (SD = 1.35). Mean weight for height ratio was 82.79 % (SD = 10.66). SPECT findings showed that 11 (73%) had asymmetry (hypoperfusion) of blood flow in at least one area. Regions of the brain showing hypoperfusion included the temporal lobe (n = 9), parietal lobe (n = 5), frontal lobe (n = 3), thalamus (n = 3), and the caudate nuclei (n = 1). The median EDE subscale scores were high for all four subscales. Those patients with hypoperfusion had higher median EDE subscale scores than those without hypoperfusion, although the differences were not statistically significant. CONCLUSIONS: Most patients in our study had abnormal rCBF, predominantly affecting the temporal lobe, confirming our previous findings. There was no association with the EDE scores. The findings support earlier suggestions of an imbalance in neural pathways or circuits, possibly within the limbic system. This hypothesis is considered within the context of current knowledge and suggestions made with regard to how it might be tested.     

Clinical evaluation of SPECT in cerebrovascular disease

In 131 patients with cerebrovascular disease, regional cerebral blood flow was determined by 123I-IMP (N-isopropyl (123I)-iodoamphetamine) or 99mTc-HM-PAO (99mTc (d, l)-hexamethyl propyleneamine oxime) SPECT and findings were compared with those of X-CT or MRI. The perfusion deficit detected by SPECT was larger than the deficit by X-CT or MRI in every cases. The perfusion deficit area was more clearly demonstrated by SPECT than by X-CT or MRI in patients with acute cerebral infarction. The hypoperfusion area determined by 123I-IMP SPECT was wider than that by 99mTc-HM-PAO SPECT. The crossed cerebellar diaschisis was observed in 56 out of 131 cases (43%). The results of operation were quantitatively evaluated by 123I-IMP SPECT in 25 patients.     

注意力缺陷多动障碍分子影像学进展

本文概述了ADHD分子影像研究进展,主要显示了额前区和纹状体区血流灌注减少以及纹状体区DAT密度增加,以右侧为著。形态学研究也显示了右侧额前区和右侧纹状体区体积缩小。认为ADHD病理生理基础可能是额-纹状体通路相关脑区异常,而且以右侧为主导。至于颞叶区、顶叶区、枕叶区及小脑区异常在ADHD发病机理的地位应该是次要的,代偿机制或者合并其他障碍可能引起上述脑区变化。因此,在ADHD诊断及疗效评估方面,形态结构影像临床应用有限,而分子影像价值较高。     

Clinical application of brain perfusion SPECT imaging to dementia

Brain perfusion SPECT imaging has been applied to patients with dementia using 123I-IMP and 99mTc-HM-PAO. Brain blood flow closely parallels regional brain metabolism or brain function with normal cerebrovascular function. Therefore neuronal activity can be indirectly evaluated by in vivo brain perfusion imaging in dementia. This nuclear medicine technique is quite useful for the differential diagnosis, assessment of the degree and localization of the affected area, disease course, and therapeutic effect. IMP seems to be superior to HM-PAO in detecting focal decreased perfusion and quantitative analysis. Hereafter the brain perfusion SPECT study will be more widespread. Neuroreceptor imaging is highly expected as the next step of a brain SPECT study.     

Dipyridamole test in the early detection of cerebrovascular disorders?

The diagnosis of transient ischaemic attack (TIA) is mainly based on the clinical symptoms presented by the patient. Professionals in nuclear medicine have made a successful attempt to detect TIA by single photon emission tomography (SPECT) imaging. Improved sensitivity of the examination using stress test (e.g. acetazolamide) is well known in the literature. The dipyridamole stress test combined with SPECT imaging was regularly performed in patients (n = 100) with ischaemic heart disease. After injecting dipyridamole intravenously it found various forms of transient neurological deficits in 23% of the patients with considerably higher incidence reported previously in the literature (1.22/10,000). The so called "TIA positive" patients were examined further using the combination of dipyridamole stress test and brain SPECT imaging. The aim of this study was to analyse the relationship between transient neurological symptoms provoked by DPD test and the change in regional cerebral blood flow indicated by brain SPECT imaging. It is emphasized, that perfusion abnormalities revealed by brain SPECT were topographically consistent with the neurological deficits. In this article the attention was drawn to advantages of this test which may be suitable to provoke TIA safely. Combined with brain SPECT it may have an important role in the neurologic diagnostic procedures and in the prevention of stroke.