^(18)F-FDG符合线路与^(99)Tc^m-ECD显像对缺血性脑血管病搭桥术疗效观察

The value of ^(18)F-FDG MCD-SPECT and ^(99)Tc^m-ECD SPECT imaging in patients of ischemic cerebrovascular disease with STA-MCA bypass surgery

目的比较脑血流灌注显像和脑葡萄糖代谢显像在评估缺血性脑血管病搭桥手术中的价值。方法对5例正常对照和15例缺血性脑血管病患者手术前后的脑^(18)F-脱氧葡萄糖(FDG)符合线路显像与^(99)Tc^m-双半胱乙酯(ECD)脑血流灌注显像进行对比分析。结果 15例患者术前缺血脑组织的葡萄糖代谢水平因患病时间不同而表现为增高、无变化或降低,手术前后脑^(18)F-FDG 显像病变区与对侧相应区域放射性比值差异无显著性(P>0.05),但术前表现为葡萄糖摄取增高的患者术后症状改善明显。同法处理脑血流灌注显像,15例患者术前病变血管支配区的血流灌注均减低,术后14例患者的病变区血流灌注有不同程度改善,1例无改善者为手术失败;除额叶外,手术前后病变脑不同部位与对侧相应区域放射性比值差异有显著性(P<0.01)。结论脑血流灌注显像可较好地反映手术前后缺血脑组织的血流变化,脑葡萄糖代測的变化对了解手术前后脑功能变化及判断手术疗效有一定作用。

Objective To evaluate the clinical value of brain glucose metabolism and perfusion imaging in patients with ischemic cerebrovascular disease before and after superficial temporal artery-middle cerebral artery （STA-MCA） bypass surgery. Methods A comparative study of ^18F-fluorodeoxyglucose （FDG） brain metabolism and ^99Tc^m-ethylcysteinate dimer （ECD） brain perfusion imaging was performed in 5 normal persons and 15 patients with ischemic cerebrovascular disease before and after STA-MCA bypass surgery. Results The glucose metabolism of ischemic cerebral tissues in 15 patients had three （increased, unchanged or decreasing） forms different with the course of disease before surgery. The ratio of the impaired area to the opposite normal area showed no significant difference （ P 〉 0.05 ） in glucose metabolism before and after STA-MCA bypass surgery. But the patients with high glucose metabolism before surgery improved significantly after surgery. In ^99Tc^m-ECD imaging, there was decreased perfusion of the affected vessels territory in 15 patients before surgery and it increased after surgery except one unsuccessful case. Except the frontal area, the ratio of the impaired area to the opposite normal area in brain perfusion imaging was signifi- candy different （P 〈 0.01 ） before and after STA-MCA bypass surgery. Conchusions The hemodynamic change of the ischemic brain tissue can be better reflected by cerebral blood flow perfusion imaging before and after surgery. Although the change of brain glucose metabolism in ischemic brain tissue is not significant, it plays an important role in observing cerebral function and predicting the effect of surgery.