一日法PET脑血流-脑代谢联合显像评价不同程度脑血管狭窄患者的脑血流及代谢特点

Characteristics of cerebral blood flow and glucose metabolism in different severity of ischemic cerebral vascular disease patients evaluated by one-day positron emission tomography brain blood flow and glucose metabolism combined imaging

目的采用一日法PET脑血流-脑代谢联合显像评价不同程度脑血管狭窄患者的脑血流及代谢特点。方法回顾性分析2012年1月至2015年2月首都医科大学宣武医院神经科门诊89例缺血性脑血管病(ICVD)患者[重度脑血管狭窄组(A组,n=41),轻中度脑血管狭窄组(B组,n=48)]的PET脑血流灌注显像和葡萄糖代谢显像资料。采用一日法,先后进行13N-氨水(13N-NH3)和18氟-氟代脱氧葡萄糖(18F-FDG)脑PET显像,获得脑血流灌注和脑葡萄糖代谢影像,以及脑血流值、脑代谢值、脑血流减低率、脑代谢减低率和脑代谢/脑血流比值。结果A组患者的13N-NH3和18F-FDG显像阳性率分别为74.2%(98/132)和92.4%(122/132);B组分别为60.6%(43/71)和85.9%(61/71),其中5例显像正常。A组以单侧多灶和双侧多灶多见,且呈不对称性分布;B组以单侧单灶和单侧多灶多见。A组匹配型病灶68个,B组30个;A组不匹配型病灶64个,B组41个。A组匹配型病灶中,轻度、中度、重度受损病灶数目分别为29个、15个、24个;B组匹配型病灶中,其中轻度、中度受损病灶数目分别为26个、4个,无重度受损病灶。A、B组匹配型病灶之间的脑血流值(0.754±0.182,0.849±0.052)、脑代谢值(0.823±0.191,1.028±0.102)、脑血流减低率(0.252±0.194,0.154±0.115)和脑代谢减低率(0.294±0.183,0.188±0.123)比较,差异均具有统计学意义(P<0.05)。结论ICVD患者脑血管狭窄程度不能代表脑功能受损程度。一日法PET脑血流-脑代谢联合显像是评价ICVD脑功能受损程度的良好方法。

Objective To evaluate the characteristics of cerebral blood flow and glucose metabolism in patients with different degrees of cerebrovascular stenosis by one-day PET brain blood flow and glucose metabolism combined imaging.Methods From January 2012 to February2015,positron emission tomography brain blood flow and glucose metabolism imaging of 89 patients[group A(n=41)with severe vascular stenosis and group B(n=48)with mild to moderate stenosis]with ischemic cerebrovascular disease(ICVD)in the Department of Neurology of Xuanwu Hospital,Capital Medical University were analyzed retrospectively.13 N-Ammonia(13 N-NH3 and 18 F-fluorodeoxyglucose(18 F-FDG)PET imaging were continuously performed in one day protocol to get CBF and CGM images.Semi-quantitative analysis including CBF values,CGM values,CBF reduction rate,CGM reduction rate and ratio of CGM/CBF were also used.Results The positive rates of13 N-NH3 imaging is 74.2%(98/132)and18 F-FDG imaging is 92.4%(122/132)in group A while they are 60.6%(43/71)and 85.9%(61/71)in group B.There were 5 cases with normal images in group B.In group A,unilateral multifocal and bilateral multifocal were more common,and the distribution was asymmetric;in group B,unilateral multifocal and unilateral multifocal were more common.There were 68 matched and 64 mismatched foci in group A,while 30 matched and 41 mismatched foci in group B.Based on semi-quantitative data,29 mild,15 moderate and 24 severe lesions were found in group A while 26 mild and 4 moderate lesions in group B.No severe lesions were shown in group B.There were significant differences in the blood flow value(0.754±0.182,0.849±0.052),metabolic value(0.823±0.191,1.028±0.102),blood flow reduction rate(0.252±0.194,0.154±0.115)and metabolic reduction rate(0.294±0.183,0.188±0.123)between matched lesions in group A and B(P<0.05).Conclusion The degree of cerebrovascular stenosis in ICVD patients can not represent the degree of brain function damage.one-day positron emission tomography brain blood flow and glucose metabolism combined imaging is a good method to evaluate the degree of brain damage in ICVD.