SPECT/CT脑血流灌注显像的临床应用进展

SPECT/CT脑血流灌注显像是SPECT(单光子发射计算机断层显像)技术和CT(计算机断层扫描技术)同机融合的一种检查方法,能够将解剖显像与功能显像完美的结合在一起,提高定位准确率的同时还可以对疾病进行多角度的分析,兼具了SPECT灵敏度高和CT特异性、分辨率高的优点,因此,对很多疾病如脑梗、TIA、癫痫等缺血性病变的病灶定位、治疗指导和预后评估以及正常脑功能的研究有着独特的优势.本文结合国内外资料对SPECT/CT脑血流灌注显像的原理、技术和临床应用的进展进行综述.     

SPECT显像在NPC放疗后所致脑损伤中的初步应用

目的评价单光子发射型电子计算机断层(SPECT)脑血流灌注显像在鼻咽癌(NPC)放射治疗后放射性脑损伤中的临床价值. 方法采用SPECT脑血流灌注显像检查,对16例鼻咽癌放射治疗后有放射性脑损伤症状的患者和8例未经放疗的鼻咽癌患者作半定量分析并对测量结果作统计学分析.16例放射性脑损伤患者同期做电子计算机体层检查(CT)对比.结果 16例有放射性脑损伤症状的鼻咽癌患者双侧颞叶局部脑血流灌注(rCBF)在横断面层面-放射性曲线相应部位上可见局部放射性下降峰或曲线变窄小,峰值降低,其曲线局部下降峰值与鼻咽癌放疗剂量的生物效应剂量(BED)值呈正相关(r=0.8976,p<0 .01).8例未经放疗的鼻咽癌患者,在横断面图像上其双侧颞叶局部脑血流灌注的层面-放射性曲线大致呈正态分布曲线,未见异常的局部下降峰或曲线变窄小,峰值未见降低.SPECT显像检查发现鼻咽癌放射治疗后放射性脑损伤的阳性率高于同期CT检查. 结论 SPECT脑血流灌注显像可以早期发现鼻咽癌放疗后所致的放射性脑损伤,并可以作出定性诊断;鼻咽癌患者放疗所致的放射性脑损伤程度与NPC放射治疗的生物效应剂量成正相关.     

99Tcm-MDP全身骨显像联合局部SPECT/CT断层融合图像诊断原发性肝癌胸腰椎转移的临床价值

目的 探讨⁹⁹Tc^m-MDP全身骨显像联合局部CT融合图像诊断原发性肝癌胸腰椎转移的临床价值。方法 65例排除其他恶性肿瘤病史的伴有腰背痛的原发性肝癌患者行全身骨显像及胸腰椎局部SPECT/CT断层融合图像,根据患者综合表现诊断为肿瘤骨转移和无肿瘤骨转移,以手术病理或随访结果为最终诊断标准。采用四格表χ²检验比较全身平面显像与平面显像联合局部SPECT/CT断层融合图像对原发性肝癌胸腰椎转移的检出率,采用两组间的t检验比较两种方法检出胸腰椎转移灶数目的差异性。结果 65例伴有腰背痛的原发性肝癌患者经全身骨显像,检出骨转移病例12例,检出率为18.46%;共检出胸腰椎转移灶57个,有骨转移病灶的患者平均胸腰椎转移灶为4.07䥺SymbolqB@1.27个;全身骨骼联合局部SPECT/CT断层融合图像检出骨转移病例30例,检出率为46.15%;胸腰椎病灶136个,有骨转移病灶的患者平均胸腰椎转移灶4.53䥺SymbolqB@1.20个;两方法间检出率差异有统计学意义(χ²=11.40,P<0.05...     

SPECT显像在NPC放疗后所致脑损伤中的初步应用

目的 评价单光子发射型电子计算机断层（ＳＰＥＣＴ）脑血流灌注显像在鼻咽癌（ＮＰＣ）放射治疗后放射性脑损伤中的临床价值。方法 采用ＳＰＥＣＴ脑血流灌注显像检查,对１６例鼻咽癌放射治疗后有放射性脑损伤症状的患者和８例示经放疗的鼻咽癌患者作半定时分析对测量结果作统计学分析。１６例放射性脑损伤患者同期做电子计算机体层检查（ＣＴ）对比。结果 １６例有放射性脑损伤症状的鼻咽癌患者双侧颞叶局部脑血流灌注（ｒＣＢＦ）在横断面层面－放射性曲线相应部位上可见局部放射性下降峰或曲线变窄小,峰值降低,其曲线局部下降峰值与鼻咽癌放疗效量的生物效应剂量（ＢＥＤ）值呈正相关（ｒ＝０．８９７６,Ｐ〈０．０１）。８例未经放疗的鼻咽癌患者,在横断面图像上其双侧颞叶局部脑血流灌注的层面－放射性曲线大致呈正态分布曲线,未见异常的局部下降峰或曲线变窄小     

SPECT/CT骨显像对脊柱单发阳性病灶的应用价值

目的评价99Tcm-亚甲基二膦酸盐（MDP）SPECT/CT骨断层显像对脊柱单发阳性病灶良恶性鉴别诊断的价值。方法对921例99Tcm-MDP全身骨显像提示脊柱单发阳性病灶的患者,行SPECT/CT局部断层显像,得到局部SPECT、CT及融合影像。阅片由两位有经验的核医学医师分别独立进行,所有病灶均以病理学结果及6个月以上的影像随访为＂金标准＂。结果在921例患者中,161例诊断为肿瘤骨转移（17.5%）,4例诊断为原发骨肿瘤（0.4%）,2例诊断为骨髓瘤（0.2%）,5例诊断为骨结核（0.5%）,689例诊断为良性病变（74.8%）,59例诊断为外伤致椎体压缩性骨折（6.4%）,1例诊断为许莫氏结节（0.1%）。肿瘤骨转移病例共161例,其中颈椎9例（5.6%）,胸椎46例（28.6%）,腰椎82例（50.9%）,骶椎24例（14.9%）。按部位分类,颈椎病变共30例,肿瘤骨转移9例（30%）;胸椎病变共224例,肿瘤骨转移46例（20.5%）;腰椎病变共606例,肿瘤骨转移82例（13.5%）;骶椎病变共61例,肿瘤骨转移24例（39.3%）。结论99Tcm-MDP SPECT/CT同机融合骨显像,对常规全身骨显像单发阳性病灶提供了准确的定位,同时显示了该病灶的形态及周围软组织影像特征,显著降低了骨显像中椎体单发阳性病灶的假阳性率,在脊柱单发阳性病灶的鉴别诊断中较常规全身骨显像具有更高的临床诊断价值。     

13N-NH3 PET脑血流灌注显像早期诊断缺血性脑梗死的研究

目的探讨氮-13-氨水(13N-NH3)脑血流灌注显像在早期缺血性脑梗死的诊断价值.方法对5例缺血性脑梗死、10例对照组(无脑血管病史的成年人),在首次CT检查后1小时内静脉注射13NH3* 740～925MBq,3分钟后,行T+E三维方式脑血流灌注显像.图象分析采用视图分析及镜像比值法测量左/右侧相应脑区SUV比值(SUVr).结果对照组左/右脑区SUVr为1.0±0.1.脑梗死组SUVr均<0.7(比值介于0.33～0.69,平均0.51).5例缺血性脑梗死患者共发现病灶12个,明显多于其他影像手段所检出病灶数.结论 13N-NH3PET显像作为一种灵敏度高、定位准确且安全的功能影像学检查手段值得在临床中进行推广,对缺血性脑梗死的早期诊断具有重要临床价值.     

阻塞性睡眠呼吸暂停的脑血流灌注成像研究进展

阻塞性睡眠呼吸暂停（OSA）是一种常见的睡眠呼吸障碍,可致局部脑血流量改变,脑血流灌注成像对于评估OSA严重程度及预后进展具有重要意义。目前应用于评估OSA患者脑血流灌注的成像技术主要包括单光子发射计算机断层显像、磁共振脑血流灌注成像等。本研究旨在对脑血流灌注成像技术在OSA的研究进展进行综述,客观分析各脑血流灌注技术的优势和局限,以期提高各技术在OSA的早期筛查、评价疾病严重程度以及预后进展的临床适用性,并展望未来研究方向和提出目前潜在的挑战。     

肺灌注SPECT-CT显像对肺栓塞诊断和早期疗效评价的应用价值研究

目的探讨肺灌注SPECT-CT显像对肺栓塞(PE)的诊断效能及其在PE早期溶栓治疗疗效评价中的价值。方法回顾性收集临床确诊或可疑肺动脉栓塞患者76例,均接受了肺通气/灌注(V/Q)平面显像及肺灌注SPECT-CT显像,以临床综合资料来判定为确诊PE或排除PE。其中20例确诊为PE者,溶栓治疗后重复以上检查,盲法分析肺V/Q显像、肺灌注SPECT-CT显像对急性肺栓塞的诊断效能,通过肺段表观指数法评价治疗后灌注改善效果。结果肺栓塞患者50/76例(114个受累肺段,17个亚肺段),肺灌注SPECT-CT显像诊断肺栓塞患者47例(99个肺段,15个亚肺段)诊断PE的灵敏度、特异性、准确性分别为83.9%、90.9%,88.2%,明显高于肺V/Q平面显像(73.6%,78.2%和76%),肺灌注SPECT-CT显像对PE溶栓治疗后早期,27/41个肺段及10/12个亚肺段PE病灶可见完全恢复。结论肺灌注SPECT-CT显像在亚肺段PE及PE排除诊断方面具有一定优势,并能有效进行肺栓塞治疗疗效的评价。     

SPECT/CT融合显像结合同机CT多平面重组在骨转移瘤诊断中的增益价值

目的探讨SPECT/CT融合显像结合同机CT多平面重组(MPR)在骨转移瘤诊断中的增益价值。方法回顾性分析2016年12月至2018年10月在我院行全身骨显像+SPECT/CT局部断层融合显像的96例患者临床资料。排除"超级骨显像"及无明确随访结果者,所得图像按两种方案进行分析,其中方案一:SPECT/CT融合图像;方案二:SPECT/CT融合图像+同机CT多平面重组。统计两种方案融合图像范围内的骨病灶数目并进行分析定性,结合随访结果评价两种图像分析方案的诊断效能。结果研究纳入96例患者共197个病灶,其中转移病灶103个,良性病灶94个。方案一诊断转移病灶109个,良性病灶88个;方案二诊断转移病灶96个,良性病灶101个,两种方案诊断准确性比较差异有统计学意义(χ2=8. 470 6,P 0. 01)。结论融合显像结合同机多平面重组CT可以显著提高SPECT/CT诊断骨转移瘤的准确性,有效排除部分假阳性病例。     

核素脑脊液间隙显像在脑脊液漏中的临床价值

目的 探讨核素脑脊液间隙显像(radionuclide cisternography,RNC)在脑脊液漏(cerebrospinal fluid leak,CSFL)中的诊断价值.方法 回顾分析23例临床可疑CSFL患者RNC的SPECT与SPECT/CT断层融合影像资料,对SPECT与SPECT/CT断层融合影像资料进行对比分析.结果 SPECT、SPECT/CT断层融合显像对CSFL定性诊断灵敏度分别为95.7％、91.3％,两者之间差异无统计学意义;对CSFL定位诊断灵敏度分别为52.2％、87.0％,两者之间差异有统计学意义.结论 RNC的SPECT/CT断层融合显像既可定性CSFL、又可明确CSFL漏口定位,是CSFL诊断的理想影像学检查方法.     

梗塞性脑血管病认知电位P_(300)与局部脑血流量的相关研究

本研究应用P_(300)和SPECT观察了30例梗塞性脑血管病人,分别进行P_(300)潜伏期,脑血流显像,rCBF比值测定,探讨两者之间的依存关系,以及在脑梗塞中的应用价值。研究表明,在梗塞性脑血管病P_(300)测试的内源成分P_(300)PL即显示出有意义的变化,与对照组比较PL明显延长(P<0.001)。SPECT脑显像则显示出梗塞区及其周围放射性稀疏区,病变范围大于XCT,rCBF比值小于0.9。经统计学处理显示脑血流量与PL延长呈负相关(P<0.001)。即rCBF值越低PL延长越明显。反映了脑梗塞患者认知功能障碍与CBF的关系。因此P_(300)PL是评价脑功能状态和预后监测的指标。     

Voxel-based investigations of regional cerebral blood flow abnormalities in Alzheimer's disease using a single-detector SPECT system

PURPOSE: To evaluate the feasibility of using the Statistical Parametric Mapping (SPM) program for an automated, voxel-by-voxel assessment of regional cerebral blood flow (rCBF) deficits in Alzheimer's disease (AD) subjects relative to age-matched controls studied with a conventional, single-detector SPECT system. METHODS: We used a databank of 99mTc-HMPAO images of 19 patients with a diagnosis of probable AD and 15 elderly healthy volunteers; data were acquired using an Orbiter-Siemens single-detector SPECT system. Using SPM, images were transformed spatially, smoothed (12mm), and the data were compared on a voxel-by-voxel basis with t-tests. RESULTS: There were significant rCBF reductions in AD patients relative to controls involving regions predicted a priori to be affected in AD, namely the left temporal and parietal neocortices, and the right posterior cingulate gyrus (p<0.05, corrected for multiple comparisons). DISCUSSION: The location of rCBF reductions in AD subjects in our study is consistent with the deficits detected in previous functional imaging studies of AD using higher-resolution devices. This suggests the potential usefulness of using SPM for the analysis of data acquired with single-detector SPECT systems, despite the limited sensitivity and spatial resolution of such equipment.     

Assessment of regional cerebral blood flow (rCBF) in ischemic stroke using Tc-99m HMPAO SPECT--comparison with CT and MR findings

To assess the regional cerebral blood flow (rCBF) in ischemic stroke, we analyzed the findings of single photon emission computed tomography (SPECT) using technetium-99m hexamethyl propyleneamine oxime (Tc-99m HMPAO). The SPECT images revealed abnormal areas of decreased perfusion in 29 out of 31 subjects (93.5%), which represented a higher detection rate than those for CT and MR (89.5%, respectively). Also, the areas of decreased perfusion were frequently larger than the lesions on CT and MR. Areas of decreased perfusion remote from the CT/MR lesions were found in 10 patients, including 8 with crossed cerebellar diaschisis (CCD). Thus, studies of rCBF by Tc-99m HMPAO SPECT can be useful in the assessment of ischemic stroke.     

Reduced cerebral blood flow during wakefulness in obstructive sleep apnea-hypopnea syndrome

STUDY OBJECTIVES: To investigate changes in regional cerebral blood flow (rCBF) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). DESIGN: We compared the 99mTc-ethylcysteinate dimer (ECD) single photon emission computed tomography (SPECT) images of patients with OSAHS with those of age- and sex-matched healthy volunteers. SETTING: University hospital. PATIENTS AND PARTICIPANTS: Twenty-seven patients with severe OSAHS and 27 healthy volunteers underwent 99mTc-ECD brain SPECT studies. INTERVENTION: For statistical parametric mapping analysis, all SPECT images were spatially normalized to the standard SPECT template and then smoothed using a 14-mm full-width at half-maximum Gaussian kernel. The Student t test was used for the statistical analysis. MEASUREMENTS AND RESULTS: The mean age of patients and subjects was 44.3 years (range 31-58). All patients underwent overnight polysomnography. The mean apnea-hypopnea index of patients was 60.4 +/- 17.6 per hour (range 33 -104), indicating severe OSAHS. All patients snored heavily and had daytime sleepiness (mean Epworth Sleepiness Scale score, 10.7 +/- 3.7, range 6-12). Statistical parametric mapping analysis showed that rCBF in patients with OSAHS was significantly reduced in bilateral parahippocampal gyri and in the right lingual gyrus, as compared with that of healthy volunteers (P < 0.05 with false discovery rate correction). Moreover, apnea-hypopnea indexes of patients were negatively correlated with rCBF in the right pericentral gyrus and right cuneus at uncorrected P < 0.001. CONCLUSIONS: Our results show the altered rCBF pattern in bilateral parahippocampal gyri, right lingual gyrus, pericentral gyrus, and cuneus in patients with severe OSAHS. These findings may partly explain the deficit in memory, spatial learning, executive function, and attention, which are frequently found in patients with OSAHS.     

Single photon emission tomography with 99m Tc-HMPAO in Arab patients with depression

BACKGROUND: This study investigates the rate of cerebral blood flow (rCBF) in Arab patients wth depression. METHODS: Forty-four patients with DSM-III-R major depressive disorders were studied at rest using single photon emission computerized tomography (SPECT) with 99m Tc-HMPAO in comparison with 20 normal controls. All patients were assessed using the Hamilton Rating Scale for Depression (HRSD). RESULTS: The depressed group showed greater rCBF in left and right posterior frontal and parietal cortical regions than normal controls. Within the depressed group, patients with the least severe illness (HRSD < 20) had significantly lower rCBF than normal controls, whilst those with moderately severe (HRSD 20-29) and severe (HRSD > 30) had significantly greater rCBF in most cortical regions than normal controls. Symptom scores, derived from the HRSD were predicted by rCBF principally increased rCBF in the left frontal cortex. CONCLUSIONS: These results suggest a generalized cerebral activation principally in the frontal cortex which is in contrast to the results of most previous studies but more in line with the results of studies of induced affect and some studies of depression subsyndromes.     

Regional cerebral blood flow during hyperventilation in patients with acute bacterial meningitis.

Mechanical hyperventilation is often instituted in patients with acute bacterial meningitis when increased intracranial pressure is suspected. However, the effect on regional cerebral blood flow (CBF) is unknown. In this study, we measured regional CBF (rCBF) in patients with acute bacterial meningitis before and during short-term hyperventilation. In 17 patients with acute bacterial meningitis, absolute rCBF (in ml/100 g min-1) was measured during baseline ventilation and hyperventilation by single-photon emission computed tomography (SPECT) using intravenous 133Xe bolus injection. Intravenous 99mTc-HMPAO (hexamethylpropyleneamine oxime) was subsequently given during hyperventilation. In 12 healthy volunteers, rCBF was measured by SPECT and 99mTc-HMPAO during spontaneous ventilation. Using standard templates to identify regions of interest (ROIs), we calculated rCBF in percentage of cerebellar (99mTc-HMPAO images) or mean hemispheric (133Xe images) flow for each ROI, the degree of side-to-side asymmetry for each ROI, and the anterior-to-posterior flow ratio. On 133Xe images, absolute rCBF decreased significantly during hyperventilation compared to baseline ventilation in all regions, but the relative rCBF did not change significantly from baseline ventilation (n=14) to hyperventilation (n=12), indicating that the perfusion distribution was unchanged. On 99mTc-HMPAO images (n=12), relative rCBF and the anterior-to-posterior flow ratio were significantly lower in patients than in controls in the frontal and parietal cortex as well as in the basal ganglia. Focal perfusion abnormalities were present in 10 of 12 patients. Regional cerebral blood flow abnormalities are frequent in patients with acute bacterial meningitis. Short-term hyperventilation does not enhance these abnormalities.     

无痴呆综合症的艾滋病患者局部脑血流的变化

目的:观察无痴呆综合症的艾滋病(AIDS)患者局部脑血流(rCBF)的变化。方法:对4例无痴呆综合症的男性AIDS患者(IV期)进行了^99mTc-双半胱乙脂(ECD)脑血流灌注断层显像, 并定量测定rCBF。16例性别、年龄匹配的健康者作正常对照。结果:4例无痴呆综合症的AIDS患者双侧额、顶、颞叶、基底节和丘脑、以及直回和桥脑rCBF明显低于正常对照组(P＜0.01)。结论:无痴呆综合症的AIDS患者存在脑皮层和皮层下rCBF减少。     

Persistent pain inhibits contralateral somatosensory cortical activity in humans

To assess cortical activity during pain perception, regional cerebral blood flow (rCBF) studies were done in humans using single photon emission computed tomography (SPECT) with the radiotracer Tc99m-HMPAO and magnetic resonance imaging localization. Normalized SPECT data were analyzed by region of interest and change distribution. Contralateral somatosensory rCBF was decreased when the digits of the hand were immersed in a hot water bath for 3 min which was rated as moderately painful (persistent pain). No decrease was observed when the hand was immersed in tepid water (control). In contrast, cortical rCBF was increased during vibratory and sensorimotor tasks, in the contralateral somatosensory and sensorimotor areas, respectively. These results indicate that pain perception in man is associated with somatosensory cortical inhibition.     

脑供血不足的SPECT与BEAM比较

报告４２例临床诊断为脑供血不足病人的ＳＰＥＣＴ及ＢＥＡＭ，阳性率分别为８６％及１９％，二者有显著性差异（Ｐ＜０．０１）。ＳＰＥＣＴ在ｒＣＢＦ低于正常１０％时即可显示缺血灶，而ＢＥＡＭ较易反映大脑半球功能变化。ＳＰＥＣＴ能检出脑血流高于症状发生阈２５ｍｌ／（１００ｇ．ｍｉｎ）而低于生理阈值５０ｍｌ／（１００ｇ．ｍｉｎ）的潜在性缺血病灶，为临床提供超早期治疗依据。在脑供血不足缓解期检查ＳＰＥＣＴ，发现部分病例ｒＣＢＦ减低，提示缓解期也存在慢性低灌注状态并应进行必要的治疗。     

阴性精神分裂症患者局部脑血流与威斯康星卡片分类测验的相关分析

目的：为探讨阴性精神分裂症患者脑结构与认知功能缺陷的关系。方法：运用单光子发射计算机断层扫描（ＳＰＥＣＴ），测定了１２例阴性精神分裂症患者在安静状态与威斯康星卡片分类测验的负荷状态下的局部脑血流。结果：在安静状态下阴性精神分裂症病人的脑局部放射性分布是对称的，但在威斯康星卡片分类测验的刺激状态下左、右侧额叶的局部脑放射性计数是不对称的。结论：提示精神分裂症的阴性症状与左侧额叶的功能状态有关。