SPECT与CT影像融合在烟雾病血管重建术中的应用价值

Application value of SPECT-CT fusion imaging in moyamoya disease revascularization:a clinical study

目的探讨烟雾病直接血管重建术前应用SPECT脑灌注成像与同机CT影像融合确定脑缺血灶体表位置并以此设计手术人路的应用价值。方法回顾性分析13例成年缺血型烟雾病颞浅动脉一大脑中动脉旁路移植术患者的临床资料，术前将单光子发射体层摄影（SPECT）脑灌注成像与同机CT影像融合，将皮质缺血灶在体表定位，以缺血灶为中心设计手术入路。术后随访6—12个月，观察术后临床症状的改善以及术后脑灌注改善情况。结果围手术期有1例脑高灌注综合征，其余无其他围手术期并发症发生。随访1个月时症状改善优秀者4例，良好者5例，一般者为4例，差者为0；随访6—12个月时症状改善优秀者9例，良好者4例，一般者为0，差者为0。术后SPECT脑灌注成像视觉分析提示全部患者脑灌注较术前明显改善；定量分析：目标缺血灶术前术后试验前各病灶／全脑计数比值（Fb）值差异有统计学意义[（2．13±1．06）％比（4．13±2．09）％，P〈0．05]，术前Fb与试验后各病灶／全脑计数比值（Fe）差异有统计学意义[（2．46±1．97）％比（2．13±1．06）％，P〈0．05]。术后两者差比百分率（BFCR）为（67．57±3．78）％，〉50％，提示手术疗效显著。患者术后头部CT血管成像均可见颞浅动脉向颅内供血，术后半年复查头部MRI无新增梗死灶。结论SPECT脑灌注成像与同机CT影像融合的方法用于颞浅动脉-大脑中动脉旁路移植术的手术入路设计，有助于提高手术疗效，降低手术风险。

Objecti）ve To investigate the application value of identification of the scalp surface locations of cerebral ischemia lesions before direct revascularization for moyamoya disease and to design surgical approaches according to this by using the fusion of single photon emission computed tomography （SPECT） cerebral perfusion imaging with CT imaging. Methods The clinical data of 13 adult patients with isehemic-type moyamoya disease underwent superficial temporal artery-middle cerebral artery bypass surgery were analyzed retrospectively. SPECT cerebral perfusion imaging was fused with CT imaging of the same machine before procedure. The lesions of ischemia were located on the cortical surface. The surgical approaches were designed at the center of the ischemic lesions. The patients were followed up for 6 to 12 months after procedure. The improvement of clinical symptoms and cerebral perfusion of the patients were observed after operation. Results One patient had perioperative cerebral hyperperfusion syndrome, and the others did not have any perioperative complications. At one-month follow-up, the improvement of symptoms in 4 patients were excellent,in 5 were good,in 4 were fair, and none was poor. At 6 to 12 month follow-up, the improvement of symptoms in 9 patients were excellent, in 4 were good, and none was poor. The postoperative visual SPECT cerebral perfusion imaging analysis suggested that the cerebral perfusion was improved significantly as compared with before procedure in all patients. Quantitative analysis ： There was significant difference in target ischemic lesions between preoperative Fb and postoperative Fb （ [ 2.13 ± 1.06 ] % vs. [4.13 ±2.09 ] % ;P 〈 0. 05 ）. There was significant difference between preoperative Fb and Fe （ [ 2.46 ±1.97 ] % vs. [ 2.13 ± 1.061% ; P 〈 0. 05 ）. The postoperative BFCR was [ 67.57 ± 3.78 ] % （ 〉 50% ）, which indicated that the efficacy of the procedure was remarkable. The superficial temporal arteries fed to brain of the patients were observed after procedure by using the head CT angiography. The postoperative head MRI reexamination showed no new infarcts occurred at 6 months. Conclusion Combine SPECT cerebral perfusion imaging with CT imaging to design surgical approach for superficial temporal artery-middle cerebral artery bypass surgery may improve the efficacy and reduce the risks of operation.