腺苷负荷脑血流灌注显像的可行性研究

Feasibility study of adenosine stress brain blood flow perfusion imaging

目的探讨腺苷用于负荷脑血流灌注显像的可行性。方法2008年4月至2009年5月本科室32例非器质性精神疾病患者行隔日法静息与腺苷负荷单光子发射计算机断层（SPECT）脑血流灌注显像，在重建的横断面图像上选择3个参考层面，分别勾画其两侧镜像部位小脑、额叶、颞叶、顶叶、枕叶感兴趣区（ROI），每个ROI大小均为32．8像素，测定各ROI放射性计数。对视为正常部位的大脑ROI，以两侧小脑ROI平均放射性计数为参照，分别计算两侧大脑额叶、颞叶、顶叶、枕叶ROI放射性计数与其比值，比较同一组ROI在腺苷负荷状态下与静息状态下放射性计数比值。对视为异常部位的大脑ROI按其对腺苷负荷后脑血流灌注变化的反应进行分类。结果所有患者进行腺苷负荷显像，没有因m现严重不良反应而终止，部分患者出现轻微不良反应并在腺苷注射结束后迅速消失。共获得视为正常的174组大脑ROI，静息显像的比值与负荷显像的比值比较显示，额叶、颞叶、顶叶差异有统计学意义（0．901±O．100比0．956±0．149，0．923±0．070比0．981±0．090，0．840±0．126比0．887±0．091，均P〈0．05），枕叶差异无统计学意义（1．102±0．146比1．010±0．124，P〉0．05）。获得视为异常的49处ROI，其中静息状态局部脑血流量正常，腺苷负荷后局部脑血流量减低的有10处；静息状态局部脑血流量减低，腺苷负荷后局部脑血流量减低更加明显的有9处；静息状态局部脑血流量减低，腺苷负荷后局部脑血流量减低改善的有27处；静息状态局部脑血流量减低，腺苷负荷后局部脑血流量减低区无明显变化的有3处。结论腺苷能用于负荷脑血流灌注显像，且不良反应少。

Objective To explore the feasibility of adenosine in stress brain blood flow perfusion imaging. Methods Between April 2008 and May 2009, thirty- two patients with non- organic mental disorders registered to our department underwent rest and adenosine stress brain blood flow perfusion imaging using two clays protocol. Three reference slices in the reconstructive transverse image were selected to draw regions of interest （ROI） in bilateral symmetrical cerebellums, frontal lobes, temporal lobes, parietal lobes anti occipital lobes in the normal cerebrum lobes. The size of ROI was 32.8 pixels. The radioactive counts of each ROI were calculated. Using the mean radioactive counts of bilateral cerebellum ROI as a reference, the ratio of radioactive counts of each cerebrum ROI over mean radioactive counts of bilateral cerebellum ROI was calculated. The ratio of radioactive counts of each cerebrum ROI underwent adenosine stress or rest in the same group was compared. The response to adenosine stress of cerebrums ROI in the abnormal cerebrum lobes were analyzed, which was classified by the change of the cerebral blood flow perfusion. Results All the patients underwent adenosine stress brain blood flow imaging and none withdrew due to severe adverse effects. Mild systemic adverse reactions did occur in some patients but disappeared quickly after adenosine injection. Among the 174 normal cerebrum ROI acquired, the ratio of radioactive counts of cerebrum ROI underwent rest or adenosine stress showed statistical significance in the frontal lobe （0.901±0.100 vs 0.956± 0.149, P〈0.05）, temporal lobe （0.923±0.070 vs 0.981±0.090, P〈0.05） and parietal lobe （0.840±0.126 vs 0.887±0.091, P〈0.05）, but not in the occipital lobe （1.102±0.146 vs 1.010±0.124, P〉0.05）. Of the 49 abnormal cerebrum ROI, ten showed normal regional cerebral blood flow at rest which was lowered during adenosine stress, nine had low regional cerebral blood flow at rest which was even worse during adenosine stress, twenty-seven had low regional cerebral blood flow at rest which appeared improved during adenosine stress, and three showed low regional cerebral blood flow that was comparable at rest and during adenosine stress. Conclusion Adenosine may be used for stress brain blood flow perfusion imaging with low incidence of adverse effects.