潘生丁负荷试验脑灌注显像诊断缺血性脑血管病的价值

Clinical value of dipyridamole brain perfusion imaging in the diagnosis of ischemic cerebrovascular disease

目的 使用潘生丁负荷试验脑灌注显像评估缺血性脑血管疾病 (CVD)患者的脑储备功能。方法 正常对照组 8例 ,CVD组 6 6例。用99Tcm 双半胱乙酯先做脑潘生丁负荷显像 :按体重静脉注射潘生丁 0 .14mg·kg-1·min-14min ,30min后行脑SPECT显像 ;2～ 5d后在同样条件下进行脑SPECT基态显像。图像行视觉及定量分析。 8例患者治疗后随访。结果 根据视觉及定量分析结果将脑血流对潘生丁的反应分为 4型 :A型 ,潘生丁试验后原有病灶扩大 ,不对称指数 (AI)及摄取指数(UR)均下降 ;B型 ,基态显像正常 ,用药后出现明显灌注低下区 ,AI值下降 ,UR由正常变为低于正常 ;C型 ,原有病灶用药后缩小或消失 ,AI、UR值均上升 ;D型 ,用药前后图像及AI、UR值均无差异。 14例小脑交叉性失联络现象在潘生丁试验后 8例恢复正常。结论 潘生丁负荷试验有助于CVD的诊断、预后估测及治疗方案制定。

Objective Using dipyridamole stress test to evaluate cerebral blood flow reserve in cerebrovascular disease(CVD). Methods There were 8 normal subjects and 66 CVD patients included in this study. Dipyridamole (0.14 mg·kg -1 ·min -1 ) was given intravenously at 4 min before injection of 99 Tc m ECD, then the brain SPECT scanning was performed after 30 minutes. The baseline SPECT images were obtained under similar conditions 2～5 days later. The images were analyzed qualitatively and semiquantitatively. Results By visual and semiquantitative analysis, the responses of cerebral blood flow to dipyridamole were divided into the following four patterns: A: The dipyridamole SPECT showed an expanded area of hypoperfusion, Asymmetry Index(AI) and Uptake Rate(UR) were all decreased; B: Rest image was normal but new hypoperfused areas appeared on stress test with decreased AI and UR;C: Hypoperfused areas were decreased in size or disappeared after stress test with increased AI and UR; D: No changes showed in cerebral perfusion imaging patterns,and in AI and UR between stress and rest studies. 14 patients had a cross cerebellar diaschisis (CCD) which became normal after dipyridamole test. Conclusion Dipyridamole brain perfusion imaging may be helpful to the diagnosis of CVD, to the decision of therapeutic plan, and to predicting the therapeutic effect.