99Tcm-HL91单光子发射计算机断层扫描/CT显像检测高血压脑出血缺氧组织的可行性

背景:脑出血血肿周围是否存在缺血半暗带是目前研究热点,没有得到证实。采用99Tcm标记的缺氧显像剂4,9-二氮-2,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)检测血肿周围可逆性损伤组织来反映半暗带是否可行,有待证实。目的:探讨99Tcm-HL91SPECT/CT脑显像在检测高血压脑出血出血灶周围缺氧组织中的应用价值。设计:对照分析。单位:广东省江门市中心医院神经科。对象:选择2004-03/2005-03在江门市中心医院住院的脑出血患者22例,所有患者有高血压病史或入院后诊断为高血压,均为前循环供血区出血,出血量10～63mL,有3例行微创抽吸血肿术,1例行开颅清创术,其余行保守治疗;起病至检查的时间12h～1.5年,其中5例超过1个月。对照组6例均为忧郁症或焦虑症患者,经同机CT检查排除脑出血及急性脑梗死。方法:28例受试者均进行99Tcm-HL91SPECT脑显像,同时行同机CT扫描。主要观察指标:①以2个不同轴向断面连续2个层面在病灶一侧周围区域出现肉眼可辨的放射性浓集区为缺氧显像阳性。(下转第185页)②计算病灶中心点与对侧镜像部位的放射性计数比值(R),以R<0.8或>1.2视为异常。③计算缺氧体积及出血量,由CT机采用多田公式出血最大截面的长×宽×层数×1/2得出。以缺氧检查同机CT显示血肿量为同机血肿量,以患者本次发病所有CT检查中的最多积血量为最大血肿量,分析两者与缺氧体积的关系。结果:28例受试者均进入结果分析。①22例患者中18例缺氧显像阳性,阳性率为77.78%;对照组6例均为阴性。②缺氧区大多位于出血区周围,少量出现在血肿内。18例阳性者病灶周围组织缺氧区R值高于对照组基底核区(1.75±0.10,1.05±0.11,P<0.01)。③最大血肿量与缺氧体积呈正直线相关关系,出血量越大,缺氧体积越大,相关系数r=0.7517,P<0.01。(上接第181页)结论:根据SPECT缺氧成像的原理,可能代表缺血半暗带的缺氧脑组织可存在于脑出血血肿周围,缺氧阳性部分可能是半暗带重要的部分。99Tcm-HL91SPECT显像可较好地显示高血压脑出血病病灶周围的缺氧组织,缺氧体积与出血量有密切关系,可应用于指导临床治疗。

Feasibility of 99Tcm-HL91 single photon emission computed tomography and CT imaging in detecting hypoxic brain tissue following hypertensive cerebral hemorrhage

BACKGROUND: The presence of ischemic penumbra in hypertensive cerebral hemorrhage is the hot spot and still controversial. The value of 4,9-diaza-2, 3, 10, 10-tetramethydodecan-2, 11-dione dioxime (HL91) tagged with 99Tcm on detecting the hypoxic brain tissue surrounding the hypertensive cerebral hemorrhage nidus, which represents the penumbra is still waited for confirmation.OBJECTIVE: To investigate the value of 99Tcm-HL91 single photon emission computed tomography (SPECT)/CT imaging on detecting hypoxic tissue in the patients with hypertensive cerebral hemorrhage.DESIGN: Control study.SETTING: Department of Neurology, Jiangmen Municipal Central Hospital, Guangdong Province.PARTICIPANTS: This series included 22 patients with hypertensive cerebral hemorrhage examined between March 2004 and March 2005 in Jiangmen Municipal Central Hospital. All cases revealed sudden onset of the disease, presented with the history of hypertension. These patients were diagnosed with hypertension after admission. The hemorrhage occurred in the anterior circulation territory in all cases and the volume of hemorrhage ranged from 10 mL to 63 mL. Minimally invasive stereotaxic aspiration was performed in 3 cases, craniotomy debridement in 1 case, and expectant treatment in the remaining cases. The period of time from the symptom onset to the examination was form 12 hours to 1.5 years, including more than 1 month in 5 cases. Control group consisted of 6 cases were clinically diagnosed with melancholia and anxiety disorders. Cerebral hemorrhage and acute cerebral infarction were ruled out by integrated CT scan in these 6 cases.METHODS: All 22 patients with hypertensive cerebral hemorrhage and 6 normal controls underwent 99Tcm-HL91 SPECT imaging and combined with CT scan.MAIN OUTCOME MEASURES: ① Identification of radioactive concentrations at one side of the peripheral zone of the lesions by visual analysis on two consecutive slices at two different axial directions were considered aspositive hypoxic imaging. ② The other was ROI semi-quantification measuring radiocounting ratio (R) between the region of visible radioactive concentrations, the center of the nidus, and their contralateral mirror region. R ＜ 0.8 or R ＞ 1.2 was considered to be abnormal. ③ Hypoxic region was defined by integrated CT fused imaging, and its volume was calculated using Xelerix workstation. The volume of the hypoxic tissue and hemorrhage was computed by Duotian formula: length of the maximum cross-section of the hemorrhage × width × slice number × 1/2.RESULTS: All 28 patients were involved in the final analysis. ① Perihemorrhagic radioactive concentrations which represented positive hypoxic imaging was revealed on 99Tcm-HL91 SPECT imaging in 18 cases out of 22 patients with cerebral hemorrhage, and positive rate was 77.78%. Bilateral cerebral hemisphere showed symmetric negative imaging in 6 cases of the control group. ② The fused SPECT/CT images revealed hypoxic region was around the intracerebral hemorrhage, small portion was within the nidus of hemorrhage with irregular shape. R value was 1.75±0.10 in perihemorrhagic hypoxic region in 18 cases with positive imaging, and R value was 1.05±0.11 in the basal ganglia in the control group. There was statistically significant difference between the two groups (P ＜ 0.01). ③ There was a positive linear correlation between maximum volume of hematom and hypoxia volume (correlation coefficient: r=0.7517, P ＜ 0.01).CONCLUSION: Relying on the mechanism about demonstrating the hypoxic tissue on fused SPECT/CT imaging, the hypoxic tissue would represent the penumbra may exist in the territories located around the cerebral hemorrhage. The positive territories may be reversible, I.e. The important portion of the penumbra. 99Tcm-HL91 SPECT/CT imaging can detect the hypoxic tissue surrounding the cerebral hemorrhage. The volume of hypoxic tissue is correlated with the hemorrhagic volume. The procedure is promising and could be applied in clinic.