缺血性脑血管疾病的乙酰唑胺脑负荷试验临床研究

Clinical Study of 99mTC-ECD Brain SPECT Imaging with Acetazulamide and Its Application in Ischemic Cerebrovascular Discases

目的 建立乙酰唑胺(ACZ)脑负荷试验的方法及脑血流量变化的正常值,提出评价脑血管储备功能的指标。 方法 正常对照者6例,脑血管疾病患者43例 用99mT-乙撑双半胱氨酸二乙酯(ECD)先做基态脑血流(CBF)及SPECT显像,36～48小时后做脑负荷显像(静脉注射ACZ 1 g,20min后按基态同样条件进行)。病人均行CT检查,部分行MRI、经颅多普勒超声(TCT)、DSA检查,7例病人治疗后进行了随访并复查SPECT显像。图象分析:(1)视觉分析 比较ACZ试验前后的变化,分三型:A型,反应差,ACZ试验后出现病变(A1)或病变扩大(A2);B型,反应好,病变缩小或消失;C型,无反应 (2)半定量分析,计算颈动脉及大脑半球峰时、半球血流占全脑血流百分数;计算ACZ试验前后病变区及病侧半球血流量增加率(△％)及放射性摄取比值(UR)。结果 (1)正常对照两侧比较各值无差别。ACZ试验后全脑△％为25.0％+809％,ACZ试验前后各区UR均>0.901。(2)32例短暂性脑缺血发作(TIA)脑CBF显像,42％有闭塞性脑血管病变,与TCD、DSA结果相符。(3)ACZ试验提高了TIA和小脑梗死灶的阳性率,前者由59.37％升至87.15％,后者由73%升至90%。(4)A型病人疗效差,B型疗效佳 。(5)小梗死伴有对侧小脑或同侧丘脑失联络者,ACZ试验后血流均恢复正常。结论 ACZ脑负荷实验安全可靠,用于CVD,其图像、

Objective To develop a routing procedure of acctazolamidc (ACZ) rest', to obtain the normal values of cerebral blood flow (CBF) response to ACZ. to enhance the sensitivity and accuracy of detecting ischemic cerebral vascular disease and to find criteria for evaluation of CBF reserve. Methods Brain 99mTC-ECD CBF and SPECT studies before and after ACZ (Ig, i.v. ,20mm postinjection) were performed on 6 normal subjects.32 eases with TIA or RIND and 11 cases with small infarcts. X - CT was performed on all patients and MCD, TCD or DSA on some of them. Image analysis: (1) Three types of response to ACZ were defined visually: typo A (poor response) , low focal CBF appearing after ACZ (type A1) or low focal CBF increasing in size (type A2); type B (good response), normal or low focal CBF with no change after ACZ. (2) Semi - quantitative analysis: measurement of the peak time of carotid arteries and hemispheres, also the percentage of hemispheric CBF in global CBF derived from the time - activity curve of radionuclide cerebral angiograuhy (RNCA); measurement of the CBF increase rate (Δ% ) and the uptake ratio (UR) of the lesion areas and hemispheres before and after ACZ. Results In normal subjects there were no differences between the peak times, Δ% of hemispheric CBF per global CBF of both sides. The mean Δ% after ACZ was 25.07% ±8.09% . The UR of all regions was more than 0.901 . (2) 42% of the TIA patients had occlusive cerebrovascular disease, as detected by RNCA. This result correlated well with that of TCD and DSA. (3)The detection rate of TIA was increased from 59.37% (baseline)to 87. 15% (after ACZ) and that of small infarcts from 73% to 90% . (4)The vascular reserve was poor in type A patients and their therapeutic effect was also poor. The vascular reserve in type B patients was good and the therapeutic effect of this type was good too. (5)CBF in the thalanius and(or)cerebellum in patients with small infarcts all recovered to normal perfusion after ACZ injection. Conclusions 'ACZ test' is a safe reliable interventional modality of cerebral perfusion SPFCT imaging. In ischemic cerebrovascular disease it is useful to evaluate the cerebral vascular reactivity of the patients and the visual- type of ACZ response may be helpful to decide the therapeutic plan and to predict the therapeutic effect of these patients.