SPECT在脑积水诊断和治疗中的应用价值

The value of SPECT in the diagnosis and treatment of hydrocephalus

目的探讨单光子发射型计算机体层摄影(SPECT)在脑积水诊断和治疗中的应用价值。方法选择经CT或MRI检查确诊的脑积水患者36例进行SPECT检查。采用99mTc-DTPA185MBq,经腰穿注入脊髓蛛网膜下腔,注药后1,3,6,24,48h摄取图像进行分析。结果36例患者中梗阻性脑积水26例,交通性脑积水9例,脑萎缩1例。正常情况下SPECT前后位像脑脊液动力学表现为典型的上行三叉影像。梗阻性脑积水其核素明显蓄积于腰池和基底池或囊腔内,其早期典型的三叉上行影像亦消失。交通行脑积水表现为上行三叉影像圆钝,核素在脑表面和纵裂区蓄积且消散时间延长。26例梗阻性脑积水患者均行神经内镜治疗,术中及术后均未发生严重并发症且恢复满意,随访1～30个月均无复发。9例交通性脑积水行脑室腹腔分流术。随访6～28个月,8例恢复良好,1例症状体征及脑室系统无明显改善。结论应用SPECT进行脑脊液动力学评价,对于判断和区分不同类型的脑积水及指导临床治疗具有重要意义。

Objective To investigate the value of the single-photon emission computed tomography （SPECT） in the diagnosis and treatment of hydrocephalus. Methods By CT or MRI examination, 36 cases were confirmed having hydrocephalus and were taken for a SPECT examination. ^99mTc-DTPA 185MBq was injected into the spinal subarachnoid by lumbar puncture. The images at 1, 3, 6, 24 and 48 hrs after the injection of this drug were obtained and an analysis was performed. Results In the 36 cases, obstructive hydrocephalus is 26 cases, traffic hydrocephalus is 9 cases, one case is brain atrophy. The cerebrospinal fluid dynamics of normal frontal view SPECT shows a typical uplink trigeminal image. Obstructive hydrocephalus ： its obvious radionuelide accumulation in lumbar cisterna and the basal cistern or intracyst, the early typical uplink trigeminal images disappears. Traffic hydrocephalus： the performance of uplink trigeminal image is blunt, radionuclide in the brain surface and fracture zones accumulates, prolonged dissipate. 26 cases of obstructive hydrocephalus patients underwent endoscopic treatment, and no severe postoperative complications, are satisfied with the restoration. Though a follow-up of 1-30 months, no recurrence takes place. 9 cases of traffic hydrocephalus underwent ventricle peritoneal shunt. Through a follow-up of 6-28 months, 8 cases have a good recovery, one case has the signs and symptoms and ventricular system not of a significant improvement. Conclusions SPECT for evaluation of eerebrospinal fluid dynamics is of great significance, for the judgement and distinguishing between different types of hydrocephalus, as well as for guiding clinical treatment.