99Tcm-HL91 SPECT功能显像对急性脑梗死患者脑乏氧组织的评估价值

背景脑梗死后坏死灶边缘可能存在存活的缺血半暗带组织,该组织的存在与否对指导治疗、评估病情预后有重要参考价值.目的观察99Tcm-HL91 SPECT脑显像能否显示急性脑梗死患者梗死灶外周处于缺血缺氧状态但尚存活的脑组织.设计病例分析.单位中山大学附属第二医院神经科,核医学科和中山大学附属第一医院神经科.对象2002-09/2003-05中山大学附属第二医院收治的发病96 h内的大脑半球梗死患者43例,男20例,女23例,39例为首次发病,4例为再次发病.干预患者行99Tcm-HL91 SPECT脑显像和同机CT扫描,并进行图像融合.主要观察指标在连续2个以上层面和2个以上不同轴向断层上,梗死侧大脑半球出现放射性浓集区,为乏氧显像阳性.结果43例患者中,乏氧显像阳性者24例,均属完全或部分前循环梗死,分别有8例和16例.乏氧显像区位于梗死灶周围.9例在起病后7～17 d复查SPECT,仍呈阳性,但乏氧组织已减少.12例部分前循环梗死患者和全部腔隙性梗死患者(7例),乏氧显像均阴性.结论99Tcm-HL91 SPECT显像能清晰地显示完全及部分前循环梗死患者的脑乏氧组织,能提示急性脑梗死后脑组织的存活,有助于指导治疗及早期康复干预.

Value of 99Tcm-HL91 SPECT functional imaging on the evaluation of cerebral hypoxic tissue in patients with acute cerebral infarct

BACKGRQUND:Ischemic penumbra may exist at the margin of necrotic focus after cerebral infarct. The existence of suchtissues has important reference merits in therapy and prognosis evaluation.OBJECTIVE: To observe whether 99Tcm-HL91 brain SPECTcould display the marginal ischemic hypoxic but viable brain tissue in the infarct focus in patients with acute cerebral infarct.DESIGN: A case analysis.SETTING: Department of Neurology and Department of Nuclear Medicine of the SecondAffiliatedHospital of Sun Yat-sen University, and the Department of Neurology of the First Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: Forty-three patients including 20 male and 23 female cases of cerebral hemisphere infarct admitted within 96 hours after attack by the Second Affiliated Hospital of Sun Yat-sen University during September 2002 to May 2003 were selected in the study. Thirty-nine cases were suffered for the first time and the other 4 cases wererecrudescent cases.INTERVENTIONS: 99Tcm-HL91 brain SPECT and CT scanning on the same machine were performed in all patients as well as the imaging fusion.MAIN OUTCOME MEASURES: Positive hypoxic image was that the irradiative concentrative area ipsilateral to the infarct on more than 2 continuous slices and more than 2 different axial slices.RESULTS: Twenty-four of 43 patients who had positive hypoxic images belonged to total or partial anterior circulation infarct, which were 8 cases and 16 cases respectively. The hypoxic area located in the peripheries of the infarct focus. Nine cases were re-scanned at 7 to 17 days after onset and still had positive results but the hypoxic tissues reduced. Twelve cases of partial anterior circulation infarct patients and all lacunal infarct patients(7 cases)had negative hypoxic images.CONCLUSION: 99Tcm-HL91 SPECT can clearly display the cerebral hypoxic tissues in patients with total or partial anterior circulation infarct, whichis able to suggest the survival of the brain tissue after acute cerebral infarct and is helpful to clinical therapy.