SPECT检测在颅脑损伤中的应用

Value of SPECT detection in the traumatic brain injury

目的研究颅脑损伤后局部脑血流(rCBF)动态变化与临床病情及预后的关系。方法选择颅脑损伤病人60例,按照GCS评分标准分成轻型损伤组45例,中型损伤组8例和重型损伤组7例,20例健康员工为对照组,对入选颅脑损伤患者在伤后2d内、1周及2周后进行单光子发射计算机断层扫描(SPECT)脑血流灌注显像与CT检查,并将结果进行对比分析。结果入院初和伤后1、2周患者SPECT检测影像学异常阳性率高于CT检测(88.3%vs46.7%,P<0.05),尤其轻型损伤组患者更为明显(84.4%vs28.9%,P<0.01),2周后头部CT显示出血及水肿大部分消退,而SPECT显示多数病人仍有脑血流灌注减低。结论rCBF的变化反应了脑损伤的程度,SPECT检查所表现的颅脑损伤后rCBF的变化对判定病情及评估预后有一定意义。

Objective To investigate dynamic changes of regional cerebral blood flow （rCBF） after traumatic brian injury ,and its relation with clinical state and prognosis. Methods Sixty patients with traumatic brain injury divding into mild group （45 cases） ,median group （8 cases） and severe group （7 cases） according to GCS assessment and 20 healthy subjects as control were recruited. Single photon emission computed tomognaphy （SPECT） and CT were executed in all recruited objects. All of traumatic brain injury patients were examined in 2d,lw and 2w after injury. The results of two detective methods were compared. Results The positive rate of image abnormalities of SPECT was higher than that of CT in 2d, 1 w and 2w after injury （ 88.3 % vs 46.7 %, P 〈 0. 05 ）, especially,in mild patients （ 84. 4% vs 28.9% ,P 〈 0. 01 ）. After 2w, CT showed that most of hemorrhage and edema faded, while SPECT showed that most patients were still with decreasing brain peffusion. Conclusions The changes of rCBF can reflect the severity of brain injury, and SPECT is more significant than CT in determining the state of illness and evaluating the prognosis.