不同程度失语症患者朗读激活试验的SPECT脑血流显像

Mechanism study of recovery from aphasia with ^(99)Tc^m-ECD SPECT brain imaging after oral read-ing test

目的分析脑损伤后的失语症患者朗读时局部脑血流(rCBF)变化及大脑激活模式。方法采用隔日法,对7例左侧脑损伤后失语症患者进行基础和词朗激活状态^(99)Tc^m-双半胱乙酯(ECD)SPECT 脑血流显像,在大脑各横断层面上选取左右对称的26个区域为 ROI,对各 ROI 进行半定量分析,比较朗读激活前后各 ROI rCBF 变化,计算出26个区域的 rCBF 变化率。结果 7例患者大脑都有明显激活区域,但每例不尽相同,其中朗读功能较好的5例患者以左侧大脑激活为主,朗读功能较差的2例患者表现为双侧大脑均有激活,但以右侧大脑激活为主。结论朗读激活 SPECT 脑显像可作为一种监测、评价语言朗读治疗对失语症患者语言功能恢复效果的有效手段。

Objective There may be two mechanisms for recovery from aphasia repair of damaged left hemisphere language network and（or） activation of compensatory areas in right hemisphere. It is, however, still controversial on which mechanism plays a more important role. The goal of this study was to compare the regional cerebral blood flow （rCBF） between baseline and during oral reading in aphasic patients who had shown definite recovery from a focal lesion in left hemisphere. It also aimed at exploring the role of the two hemispheres in recovery from aphasia, thus providing theoretic basis for rehabilitation therapy. Methods Baseline and oral reading 99^Tc^m-ethylcysteinate dimer （ECD） brain SPECT imaging were performed in 7 patients with aphasia separately in one-day interval. Semi-quantitative analysis of rCBF was conducted on 26 symmetrical ROIs in bilateral hemispheres on the transverse slices. The rCBF was estimated by the ratio of the counts per pixel of each ROI to the average counts per pixel of the whole encephalon. The change in blood flow was represented by the difference in rCBF between oral reading and baseline. Results The activated perfusion pattern of brain region was different in all 7 aphasic patients. In 5 of the 7 patients, whose reading capacity were relatively preserved, the brain perfusion pattern was mainly left lateralized, while the other two patients who had poor performance in reading showed bilateral activation foci with right-sided dominance. Conclusion Oral reading activated SPECT brain imaging may be a useful tool for monitoring the progress of speech recovery in the treatment of aphasic patients.