SPECT检测精神分裂症病人的局部脑血流研究

目的了解精神分裂症病人的局部脑血流特征,探讨局部脑血流与精神病临床症状和疗效的关系.方法采用PANSS量表评定患者的精神症状,应用99m TC-ECD-SPECT技术,对17例从未接受过抗精神病药物治疗的精神分裂症病人,在接受治疗前与治疗后测量局部脑血流,并与11例正常对照组比较.结果治疗前病例组右侧额叶与右侧颞叶rCBF低于对照组(各P<0.05),治疗后右侧额叶与右侧颞叶rCBF较治疗前明显增加(各P<0.05);治疗前不同脑区rCBF与精神病理症状(含单个症状评分和因子分)和疗效均无显著性相关.结论结果提示精神分裂病人存在右侧额叶与右侧颞叶局部脑功能减退,但未发现局部脑血流与精神病理症状和疗效有关.     

脑梗死急性期MRI表现与发展为血管性痴呆的关系

目的 探讨脑梗死急性期患者的MRI表现与发展为血管性痴呆(VD)的关系.方法 对卒中半年以上的患者,根据简易精神状态检查量表(MMSE)、临床痴呆评定量表(CDR)评分分为VD组及脑卒中后无痴呆(SWD)组,并回顾性分析两组在卒中急性期的MRI资料.结果 VD组中额叶皮质下、颞叶皮质下、内囊前肢、内囊膝部、尾状核及丘脑梗死的发生率明显高于SWD组(P<0.05～0.01);梗死灶≥3个部位的患者显著多于SWD组(P<0.05);3级脑白质疏松(LA)发生率(35.0%)明显高于SWD组(10.0%)(P<0.05). VD组放射冠及基底节的LA发生率明显高于SWD组(P<0.05).VD组与SWD组间脑萎缩的线性指标海马钩回间距及侧脑室体部宽度指数的差异有统计学意义(P<0.05～0.01).结论 额叶及颞叶皮质下、内囊前肢及膝部、尾状核和丘脑梗死者,且梗死灶≥3个,并出现3级LA,放射冠、基底节的LA,以及海马钩回间距、侧脑室体部宽度指数可作为发展为VD的预测指标.     

强迫症与抑郁症的脑单光子发射计算机断层扫描对照研究

目的探讨强迫症、抑郁症局部脑血流量(rCBF)特点。方法应用单光子发射计算机断层扫描(SPECT)技术,对首发且未经治疗的39例强迫症患者、36例抑郁症患者和39名正常人于静息状态下行脑血流显像。以小脑皮质的放射性计数值为参考,对局部脑血流进行半定量分析。结果强迫症组两侧前额叶、前颞叶rCBF高于正常组(P<0.01);抑郁症组两侧前额叶、枕叶、扣带回及右前颞叶、右顶叶rCBF低于正常组(P<0.05);在两侧前额叶、前颞叶、顶叶、枕叶及右后额叶、扣带回,强迫症组rCBF高于抑郁症组(P<0.05)。结论强迫症组的前额叶及前颞叶呈高灌注改变,抑郁症组脑血流普遍低灌注,SPECT技术可望作为二者鉴别诊断的客观依据之一。     

非痴呆型血管性认知功能障碍患者脑血流与MMSE及MoCA评分的相关性研究

目的应用单光子发射计算机断层扫描(SPECT)成像术研究非痴呆型血管性认知障碍(VCIND)患者的局部脑血流(rCBF)改变,并分析其与神经心理评分的关系。方法纳入1VCIND患者45例(VCIND组),其中男25例、女20例;2认知功能正常脑卒中(SNC)患者28例(SNC组),其中男16例、女12例;3健康对照者15例(HC组),其中男6例、女9例。所有研究对象行一般检查、神经心理评定(MMSE量表、MoCA量表、CDR量表、NIHSS量表、ADL量表、Loeb量表、Hamilton抑郁量表)及SPECT rCBF检查。结果 1与HC组比较,VCIND组两侧额叶、两侧顶叶上部、左侧丘脑rCBF明显降低(P0.05),SNC组左侧额叶、左侧顶叶下部、左侧颞叶、两侧丘脑以及两侧纹状体rCBF明显降低(P0.05);2与SNC组比较,VCIND组左侧额叶、左侧顶叶上部以及左侧丘脑rCBF明显降低(P0.05);3VCIND组内,左侧额叶、左侧顶叶上部、左侧丘脑均较右侧相应部位rCBF明显降低(P0.05);4相关分析显示VCIND组MMSE评分与左侧额叶、左顶叶上部、两侧颞叶内侧、左侧纹状体rCBF呈正相关(r=0.73~0.84,P0.05),MoCA评分与左侧额叶、右侧顶叶下部、两侧颞叶内侧rCBF呈正相关(r=0.65~0.85,P0.05)。结论 SPECT探查VCIND患者rCBF改变具有重要临床意义,MMSE及MoCA评分与局部rCBF改变具有一定相关性。     

缺血性脑卒中后血管性痴呆的相关因素分析

目的探讨缺血性脑卒中后血管性痴呆的相关因素。方法抽取2013-06—2016-02我接收治的245例缺血性脑卒中患者为研究对象,其中122例血管性痴呆患者为研究组,123例非血管性痴呆患者为对照组。CT扫描检查2组脑白质疏松情况、梗死病灶特征及位置等基本信息。比较2组基本资料、血管性疾病情况、生活习惯、脑卒中史、多发性脑梗死发生率及脑梗死发病部位。结果 2组性别比较差异无统计学意义(P0.05),文化程度、年龄比较差异有统计学意义(P0.05);研究组高脂血症、冠心病、糖尿病、高血压、饮酒及吸烟发生率均显著高于对照组,差异有统计学意义(P0.05);脑卒中史及多发性脑梗死发生率均显著高于对照组,差异有统计学意义(P0.05);2组丘脑、枕叶、顶叶处脑梗死发生率比较差异无统计学意义(P0.05),但研究组基底节、颞叶及额叶处脑梗死发生率显著高于对照组,差异有统计学意义(P0.05)。结论文化程度、年龄、高脂血症、冠心病、糖尿病、高血压、饮酒、吸烟、脑卒中史、多发性脑梗死、基底节、颞叶及额叶脑梗死均是引发缺血性脑卒中后血管性痴呆的高危因素,临床应了解患者是否具备以上指征,从而制定有效治疗方案。     

帕金森病患者认知功能与脑电活动及脑影像学改变的相关性研究

目的研究帕金森病（Parkinsondisease,PD）患者认知功能、脑电活动及脑影像学的相关性。方法对70例PD患者及40例正常人进行中文版简易智能状态检查（MMSE）量表、BEAM频谱分析及脑影像学检查,对经MMSE初步测查后可疑认知功能障碍者进一步行成套神经心理学评估（FOM、RVR、DST、BD、BNT、HAMD）。结果PD痴呆组的神经心理学评估分值明显降低,痴呆组慢波（δ、θ频段）相对功率谱较非痴呆组明显增高（P〈0.01）,而快波（β1、β2频段）的相对功率谱显著降低（P〈0.05）;痴呆组额叶、颞叶的皮质萎缩及皮质下萎缩程度明显增加,且合并脑白质疏松症（LA）者明显高于非痴呆组;PD认知功能损害与额叶脑沟宽度、外侧裂宽度、三脑室宽度、脑室指数、前角指数及δ波功率值相关。结论神经心理学测验有利于发现PD患者的认知功能障碍,PD认知功能障碍与额颞叶皮质萎缩、皮质下机构萎缩程度、δ波功率及抑郁障碍密切相关,合并LA者痴呆发生率高。     

听觉P300对血管性痴呆早期诊断及鉴别诊断的价值

目的探讨P300对血管性痴呆(VD)的早期诊断及与Alzheimer病(AD)鉴别的价值.方法分别对20名正常人(NC)、20例VD患者、24例无痴呆脑梗死患者(CI)及20例AD患者进行神经心理学量表长谷川智力量表(HDS)评分,并选用听觉oddball序列分别对上述各组进行P300测试.结果 (1)VD组与CI组及NC组比较,N2、P3潜伏期(PL)明显延长(均P<0.05);P3PL与HDS评分呈负相关(r=-0.686,P＜0.01),且较HDS更为敏感;梗死部位与P300变化有一定关系,梗死位于颞叶、额叶的患者与其他梗死部位的患者相比,P3PL异常率明显增高(P＜0.05).(2)AD组与VD组相比,N1 PL更长,差异有显著性(P<0.05).结论 (1)P300对VD的早期诊断具有重要意义.(2)N1PL在VD与AD的鉴别诊断中有一定的意义.     

非痴呆型血管性认知障碍与脑梗死部位及TCD的相关性分析

目的分析非痴呆型血管性认知障碍与脑梗死部位及经颅多普勒超声(TCD)的相关性。方法选择2013-10—2014-11来我院治疗的急性脑梗死患者108例,根据有无认知障碍分成对照组和研究组,每组54例。对照组为无认知障碍脑梗死患者,研究组为非痴呆型血管认知障碍脑梗死者。2组患者均采用磁共振成像(MRI)和经颅多普勒超声(TCD)检查,判断病灶位置及TCD检查结果。结果研究组额叶、颞叶、丘脑部位发生脑梗死的几率及病灶数量≥3个均明显高于对照组,颅内动脉PI值高于对照组,差异均有统计学意义(P0.05);研究组BA值及左右侧MCA值、ACA值、PCA值及VA值均明显高于对照组,差异均有统计学意义(P0.05);经多因素分析,额叶梗死、颞叶梗死、丘脑梗死及病灶数量与非痴呆型血管认知障碍的发病呈正相关性。结论额叶、颞叶、丘脑部位的脑梗死及多灶梗死发生非痴呆型血管性认知障碍的几率较高,临床医生在治疗脑梗死时,可通过TCD检查进行早期诊断及防治非痴呆型血管性认知障碍。     

不同类型痴呆脑代谢改变图型:~(18)F-FDG PET显像

目的探讨不同类型痴呆患者基于像素水平的脑代谢图型特点。方法对最终临床诊断为阿尔茨海默病(20例)、额颞叶痴呆(20例)、路易体痴呆(10例)、进行性核上性麻痹(7例)、原发性进行性失语(3例)、皮质基底节变性(1例)和多系统萎缩(1例)等认知功能障碍患者的18F-FDG PET显像资料进行回顾分析,描述各种神经变性疾病脑代谢降低区域和程度。结果 SPM分析表明,各种神经变性疾病引起的痴呆18F-FDG PET显像均表现为皮质代谢降低,但其代谢图型变化明显不同:阿尔茨海默病组以双侧颞顶叶和额叶皮质代谢降低为主,基本感觉运动皮质、枕叶、基底节和丘脑活性保留;额颞叶痴呆组额叶和颞叶皮质不对称性代谢降低,伴部分顶叶皮质和基底节、丘脑等皮质下核团不同程度代谢降低;路易体痴呆组枕叶、视皮质和双侧颞上回前部代谢降低;进行性核上性麻痹组双侧前额叶背外侧、颞叶前外侧、中脑和双侧尾状核代谢降低;原发性进行性失语组左侧额叶Broca区、左侧颞叶皮质(除左侧颞上回后部)和右侧颞叶内侧皮质代谢降低;皮质基底节变性组双侧中央沟周围额顶叶皮质(右侧显著)、右侧基底节代谢降低;多系统萎缩组双侧小脑背外侧皮质和左侧壳核代谢降低。结论神经变性疾病所致痴呆在18F-FDG PET显像中表现出各自特征性脑代谢降低图型,18F-FDG PET显像有可能成为痴呆鉴别诊断的一种辅助手段。     

血管性认知障碍不同亚型患者认知功能及MRI检查的对比研究

目的探讨血管性认知障碍各亚型患者之间及其与认知功能正常者之间的认知功能及脑组织影像学表现的差异。方法采用简易智能状态检查量表、认知能力筛查量表和简易智能-认知能力联合检查量表对62例血管性认知障碍患者(无痴呆型血管性认知障碍34例、血管性痴呆18例、混合性痴呆10例)和50例正常对照者的认知功能进行评价,通过磁共振成像分析其容积测量值、脑叶萎缩、皮质下白质疏松和腔隙性脑梗死等影像学参数的差异。结果与对照组比较,血管性认知障碍各亚组患者认知功能评分呈逐步递减趋势(均P<0.05),但血管性痴呆与混合性痴呆患者之间差异无统计学意义(P>0.05)。血管性认知障碍各亚组患者双侧前额角容积、第三脑室容积测量值以及额叶、颞叶、顶叶、枕叶萎缩,皮质下白质疏松和腔隙性脑梗死评分均高于对照组(P<0.05),其影像学异常改变在进展为痴呆后更为明显。混合性痴呆患者的特征性表现为双侧海马容积、内嗅叶皮质容积减小,颞叶萎缩(均P<0.05),但无明显的腔隙性脑梗死(P>0.05)。结论血管性认知障碍患者的影像学异常改变可部分反映不同亚型的病理改变,但对认知障碍程度的反映尚缺乏敏感性,能否联合认知功能评分共同作为血管性认知障碍临床预测指标尚待进一步研究。     

单纯脑白质疏松症与脑白质疏松症合并脑梗死记忆障碍的对比研究

目的 探讨单纯脑白质疏松症(LA)记忆障碍特征及合并脑梗死(CI)对LA记忆障碍的影响。方法 用临床记忆量表对30例单纯LA患者,30例LA+CI患者及30例健康老年人进行记忆测查,同时对LA患者进行简明精神状态检查表(MMSE)测查。结果 单纯LA组各项记忆量表分及MQ均明显低于正常对照组(P<0.01),其中图象自由回忆,人像特点联想回忆下降明显;LA+CI组与单纯LA组比较,各项记忆量表分及MQ均显著降低(P<0.05或P<0.01),其中指向记忆下降最明显;MQ≤79者痴呆发生率低于MQ≤69者(P<0.05),符合痴呆者7例均属LA+CI组,单纯LA组无痴呆发生。结论 单纯LA患者有明显的记忆障碍,其记忆损害既有主动回忆困难也有再认障碍,但无痴呆发生。合并脑梗死加重记忆障碍,脑梗死的存在对LA记忆障碍中的主动回忆困难影响更大,同时增加痴呆发生率,且记忆损害越重,痴呆发生率越高。     

Heterogeneous factors in dementia with Parkinson's disease: IMP-SPECT study

BACKGROUND: Nature of the dementing process in Parkinson's disease, and particularly its relationship with Alzheimer's disease, diffuse Lewy body disease or frontal dementia remains controversial. OBJECTIVE: We hypothesize that origins of dementia in Parkinson's disease are heterogeneous, so we compared cortical regional cerebral blood flow (rCBF) between Parkinson's disease patients with and without dementia. PATIENTS: Forty consecutive patients with Hoehn-Yahr stage III or IV Parkinson's disease were used (13 patients had dementia (PDD group), and 27 patients had no dementia (PDND group)). RESULTS: There were significant rCBF reductions in the left parietal association cortex and left frontal association cortex in PDD. Multiple logistic regression analysis demonstrated that only rCBF of the left frontal association cortex was significant. PDD patients were divided into three groups according to rCBF patterns: frontal hypoperfusion group, Alzheimer's disease-like group, and diffuse Lewy body disease-like group. CONCLUSIONS: Controversial study results involving PDD patients may be mainly due to heterogeneity in dementing processes in Parkinson's disease.     

Speech Fluency in Aphasia: Regional Cerebral Blood Flow Correlates of Recovery Using Single-Photon Emission Computed Tomography

This study investigated the relationship between diminished regional cerebral blood flow (rCBF) and the recovery of fluent speech in aphasia. Single-photon emission computed tomographic brain scans using [¹²³I]N-isopropyl-p-iodoamphetamine were obtained from 14 nonfluent aphasic patients within 30 days of cerebral infarction. Measurements of speech fluency were acquired initially and at 3 months after infarction. Nearly all of the patients exhibited significant hypoperfusion to combinations of the anterior and posterior regions of the basal ganglion, the periventricular white matter, and the inferior frontal regions. Only the inferior frontal area was significantly associated with recovery of fluent speech. This region was hypoperfused in 4 of 5 patients with poor recovery while 8 of the 9 patients with good speech fluency recovery demonstrated normal rCBF to the inferior frontal region.     

Hypoperfusion of the motor cortex associated with parkinsonism in dementia with Lewy bodies

ObjectiveThis study aimed to investigate the impact of parkinsonism on regional cerebral blood flow (rCBF) in dementia with Lewy bodies (DLB).MethodForty-four probable DLB patients, comprising 13 patients without parkinsonism and 31 patients with parkinsonism, and 16 normal controls were selected for this study. We evaluated the rCBF in each group by means of N-isopropyl-p-[¹²³I] iodoamphetamine (IMP) and single photon emission computed tomography (SPECT). The rCBF in the different groups was compared using voxel-by-voxel Statistical Parametrical Mapping (SPM).ResultPatients with DLB showed low rCBF in the frontal, temporal, and occipital cortex with relative sparing of the paracentral region. DLB patients with parkinsonism (DLB-P) had lower rCBF in the primary motor cortex (M1) and left supplementary motor area (SMA) than DLB patients without parkinsonism (DLB-nonP). DLB-nonP patients showed decreased rCBF in the left temporo-occipital region.ConclusionThis study suggests that two distinct clinical entities are involved in DLB. In addition, CBF changes in the M1 and SMA are seen in the early stages of Parkinson's disease. This result would help in diagnosing DLB in the context of Lewy body (LB) disease.     

Focal reductions of cerebral blood flow in amyotrophic lateral sclerosis: a [99mTc]-d,l-HMPAO SPECT study.

We investigated regional cerebral blood flow (rCBF) using the [99mTc]-d,l-HMPAO technique with brain dedicated high resolution single photon emission computer tomography (SPECT) in 14 consecutive patients with amyotrophic lateral sclerosis (ALS), median age 62 years (45-77). Global CBF, expressed in % relative to the cerebellum, was significantly lower (P less than 0.05) in the ALS group (80.5 +/- 6.7%) than in the control group of 14 age-matched healthy volunteers (87.0 +/- 7.5%). Eight patients (57%) had abnormal rCBF distribution maps with reduced flow, primarily in the frontal lobes. Three of the 8 patients with abnormal rCBF had mild to moderate dementia and another one had mild aphasia. None of the patients with normal rCBF distribution maps had dementia. In the group of ALS patients as a whole rCBF was significantly reduced in the frontal cortex, the hippocampus, and the central white matter. We conclude that reduced rCBF, primarily in the frontal lobes, is a frequent finding in patients with ALS. The decreased rCBF may be associated with cognitive deficits and is most likely caused by neuronal degeneration and reduced metabolic needs.     

An analysis of regional cerebral blood flows (rCBF) in 120 patients with cerebrovascular disease

The rCBF in a group of 120 patients with cerebrovascular disease (CVD) diagnosed clinically as well as with CT scans and a group of 120 healthy subjects as controls was measured with the 133Xenon inhalation method. The result showed that the rCBF of the CVD group was significantly lower than that of the control group (P less than 0.01). The tally rate between the rCBF reduction areas and the lesion sites was 85 per cent. The areas of rCBF reduction measured with 133Xenon inhalation were larger than the extents of the lesions shown by CT scans in 47 cases of cerebral infarction. The rCBF reductions of bilateral cerebral hemispheres were found in 16 cases of cerebral infarction. The average hemispheric rCBF obviously decreased in 12 cases of multiple cerebral infarction with dementia, but showed no decrease of rCBF in 18 cases of small focal cerebral infarction.     

Statistic rCBF study of extrapyramidal disorders]

We studied regional cerebral blood flow (rCBF) in 16 patients with Parkinson's disease (PD), 2 patients with dementia with Lewy bodies (DLB), 2 patients with progressive supranuclear palsy (PSP), 2 patients with striatonigral degeneration, and 16 normal volunteers, using Three-dimensional stereotactic surface projections (3 D-SSP). Decreased rCBF in PD patients was shown in the posterior parietal and occipital cortex. Decreased rCBF in DLB was shown in the frontal, parietal and occipital cortex with relative sparing of the sensorimotor cortex. Decreased rCBF in PSP was shown in the frontal cortex. Decreased rCBF in SND was shown in the frontal cortex and cerebellum. Statistic rCBF analysis using 3 D-SSP was a useful measure for the early differential diagnosis of extrapyramidal disorders.     

血管性痴呆患者SPECT脑血流灌注显像特点

目的　探讨血管性痴呆 (VD)患者 SPECT局部脑血流灌注显像特点 ,为 VD的早期诊断和痴呆严重程度的评估寻找客观的生物学指标。方法　分别对 45例 VD、3 0例卒中无痴呆 (SWD)和 3 0例正常对照者 (NC)3组进行 SPECT局部脑血流灌注显像 ,半定量分析各脑区血流灌注情况。结果　 VD组额叶、顶叶、颞叶和基底节局部脑血流灌注比 SWD组减少 (P<0 .0 5 ) ;并以额叶、颞叶血流灌注的减少最为显著 (P<0 .0 1)。与 NC组相比 ,SWD组额叶、顶叶、颞叶和基底节局部脑血流灌注均减低 (P<0 .0 5 )。额叶、颞叶血流灌注减低与 MMSE评分间存在正相关关系 (r=0 .75 5 ,P<0 .0 1)。结论　 VD患者存在明显的脑血流灌注减低 ,以额叶、颞叶最为显著 ,且与MMSE评分间存在正相关 ,SPECT脑血流灌注显像有助于 VD的诊断和病情评估     

Single-Photon Emission Computed Tomography Studies of Regional Cerebral Blood Flow in Multiple Infarct Dementia

Multiinfarct dementia (MID) and Alzheimer's disease (AD), both characterized by a decline in cognitive function, are often difficult to differentiate and may coexist. This study reports the findings of single-photon emission computed tomography (SPECT) using [²³¹]N-isopropyl-p-iodoamphetamine to determine cerebral blood flow patterns in patients with MID (n = 11 ), as compared with patients with AD (n = 22) and nondemented control subjects (n = 12). Data were acquired at two tomographic levels for dorsolateral frontal, parietal, orbitofrontal, and temporal areas of the cortex. Analyses of variance revealed that the blood flow pattern for the MID group was very similar to that in the AD patients, with both groups showing hypoperfusion in the temporal area, although blood flow in the left parietal region was lower for the patients with AD. When normal regional cerebral blood flow (rCBF) was defined as within 2 standard deviations of control values, most of the patients with MID had normal rCBF, while a few patients showed abnormal rCBF in all regions. In contrast, the majority of AD patients showed abnormal rCBF in the temporal part of the cortex. This suggests that while AD is characterized by hypoperfusion in the temporal and parietal areas, there is no characteristic rCBF pattern in MID. These findings emphasize the need to use multiple modalities when clinically evaluating patients with MID.     

CT灌注成像对烟雾病行脑血管重建术的疗效评价

目的 探讨CT灌注成像技术(CTP)在出血型烟雾病中的应用价值和评价颞浅-大脑中动脉搭桥术(STA-MCA)手术疗效.方法 20例出血型烟雾病患者在实施STA-MCA手术前、术后1周和术后3个月分别行CTP检查.对患者手术前腩血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)进行定量和定性分析,并对手术前后及随访的CBF、CBV、MTT进行对比分析.结果 10例患者术前手术侧与对侧比较,额、颞叶CBF降低,CBV增加,MTT延长;术后1周复查,术侧额、颞叶与术前比较发现,rMTT降低,rCBV不变,rCBF增加;术后3个月复查,与术后1周比较,额、颞叶rMTT、rCBV降低;差异有统计学意义(P<0.05).结论 CTP能检测脑缺血的部位,有助于出血型烟雾病术前治疗方法的选择和术后疗效观察;出血型烟雾病仍存在脑灌注严重不足,以额、颞叶明显,STA-MCA搭桥术能增加额、颞叶脑血供,预防缺血或出血性卒中发生.