无症状脑梗死患者的乙酰唑胺脑负荷显像

A study of "one day protocol" of ^(99)Tc^m-ECD brain SPECT imaging with acetazolamide stress and its application in silent cerebral infarction for assessment of cerebrovascular reserve capacity

目的 探讨乙酰唑胺介入一日法脑负荷显像在无症状脑梗死 (SCI)中的应用价值。方法 对照组 7例 ,无症状脑梗死 (SCI)患者 18例 ,进行一日法乙酰唑胺负荷和静息99Tcm 双半胱乙酯脑血流显像。所有受检者均有CT或MRI结果。对负荷和静息显像进行半定量分析 ,在大脑皮质设置 35 0个方型感兴趣区 (ROI) ,结合负荷和静息显像分 4种类型 :A型 :静息与负荷显像局部脑血流量(rCBF)都正常 ;B型 :静息时rCBF正常 ,负荷时出现血流灌注减低 ;C1 型 :静息时rCBF减低 ,负荷后无改变 ;C2 型 :静息时即出现rCBF减少 ,负荷后rCBF降低更明显 ;D型 :静息时rCBF减低 ,负荷后rCBF有改善。结果 对照组 98个ROI中 ,A型 96个 ,B型 2个 ;SCI组 2 5 2个ROI中 ,A型 198个 ,B型 9个 ,C1 型 5个 ,C2 型 6个 ,D型 34个。对照组负荷后脑血流平均增加 (32 .5 0± 3.5 6 ) % ,SCI组病变半球负荷后血流平均增加 (2 4.18± 4.85 ) % (t=12 .39,P <0 .0 1)。结论 乙酰唑胺负荷脑血流显像可评价SCI患者脑血管储备功能 ,一日法脑负荷显像简便、安全。

Objective To evaluate the value of 99Tcm-ECD brain SPECT imaging with acetazolamide (ACZ, diamox) stress in silent cerebral infarction(SCI). Methods Brain 99Tcm-ECD SPECT studies before and after ACZ (1 g,i.v.) administration with in the same day were performed on 7 control subjects and 18 cases with SCI. CT and MRI were performed on all patients and control subjects as well.Imaging analysis: by semiquantitative method, 350 ROIs were set on brain cortical regions. The responses of rCBF to ACZ can be divided into the following five patterns: type A : rCBF were normal in both rest and stress test; type B : the rest rCBF was normal but new hypoperfused area appeared at stress test; type C 1 :the rest rCBF was decreased, and remained unchanged after ACZ; type C 2: the rest rCBF was decreased and decreased significantly after ACZ test; type D: the rest rCBF was decreased, but improved after ACZ test. Results There were total 98 ROIs in 7 control subjects, 96 were fit for type A and 2 for type B. There were total 252 ROIs in 18 cases with SCI, 198 were fit for type A,9 for type B,5 for type C 1,6 for type C 2,34 for type D.The average increase of rCBF after ACZ stress test was (32.50±3.56)% in control subjects; the average increase of rCBF in affected hemispheres was (24.18±4.85)% in cases with SCI ( t=12.39, P <0.01). Conclusions The vascular reserve in type B, type C 1 and type C 2 patients was poor; the vascular reserve in type D and type A patients was good. The protocol is useful for evaluating the cerebrovascular reserve capacity in SCI patients; it may be helpful for therapy programming and for predicting the therapeutic effects on this patients. 'One day protocol' ACZ test is a safe,convenient method and it is easy to perform.