Takaki A, Mizuta Y, Murakami M, Yonehara T, Urata J, Okada K, Takaki R, Hirano T, Fujioka S
Diagnostic Imaging Center, Saiseikai Kumamoto Hospital.
Kaku Igaku. 2001 Jan;38(1):31-8.
Kuwabara et al. have examined the cerebral artery dilation with acetazolamide (ACZ) challenge test using PET. And, they reported that ACZ reaction came out time dependently. We have developed a unique SPECT's method using Technetium-99m ethyl cysteinate dimer (99mTc-ECD) to verify the results obtained by Kuwabara et al.
1000 MBq of 99mTc-ECD was exactly divided into three syringes. Each of which was intravenous infused (i.v.) at rest, 7.5, and 20 minutes after ACZ administration. Data collection was started using dynamic SPECT immediately after 99mTc-ECD i.v. at rest. Using necessary data only, SPECT images representing each of the three 99mTc-ECD i.v. was reconstructed. SPECT counts were obtained by the ROI method from each images to calculate relative CBF from rest to 7.5 and 20 minutes after ACZ administration.
The 18 hemispheres of nine patients in the negative control group in whom ACZ was not loaded. CBF was stable during the three evaluation. The measurement error our method was estimated as small. The 18 hemispheres of nine patients in the positive control group who has normal vasodilatory reserve, CBF was increased by 26.2 +/- 8.1% at 7.5 minutes and 29.3 +/- 13.1% at 20 minutes after ACZ administration. Seven patients with and chronic stage unilateral internal carotid artery severe stenosis and/or occlusion were evaluated as the test group. Case of unaffected side, CBF was increased by 17.6 +/- 6.9% at 7.5 minutes and 24.8 +/- 11.3% 20 minutes after ACZ administration. And, increase rate of CBF in the affected side was 2.8 +/- 1.6% at 7.5 minutes and 17.3 +/- 5.0% at 20 minutes after ACZ administration. In the affected side, timing of the maximum CBF increase caused by ACZ was remarkably delayed.
Our method based on 99mTc-ECD SPECT also revealed delayed cerebral artery dilation in the affected side. It was suggested that ACZ reaction came out time dependently, as reported by Kuwabara et al.
桑原等人使用正电子发射断层扫描（PET）对乙酰唑胺（ACZ）激发试验时的脑动脉扩张情况进行了研究。并且，他们报告称ACZ反应呈时间依赖性出现。我们开发了一种独特的单光子发射计算机断层扫描（SPECT）方法，使用锝-99m 乙基半胱氨酸二聚体（99mTc-ECD）来验证桑原等人所获得的结果。
将1000兆贝可的99mTc-ECD精确分成三个注射器。每个注射器分别在静息状态下、ACZ给药后7.5分钟和20分钟进行静脉注射（i.v.）。在静息状态下99mTc-ECD静脉注射后立即使用动态SPECT开始数据采集。仅使用必要数据，重建代表三次99mTc-ECD静脉注射中每一次的SPECT图像。通过感兴趣区（ROI）方法从每个图像中获取SPECT计数，以计算从静息状态到ACZ给药后7.5分钟和20分钟的相对脑血流量（CBF）。
9例未注射ACZ的阴性对照组患者的18个半球。在三次评估期间CBF稳定。我们方法的测量误差估计较小。具有正常血管舒张储备的9例阳性对照组患者的18个半球，在ACZ给药后7.5分钟时CBF增加了26.2±8.1%，在20分钟时增加了29.3±13.1%。7例患有慢性期单侧颈内动脉严重狭窄和/或闭塞的患者被评估为试验组。在未受影响侧，ACZ给药后7.5分钟时CBF增加了17.6±6.9%，20分钟时增加了24.8±11.3%。并且，在受影响侧，ACZ引起的CBF最大增加时间显著延迟，在ACZ给药后7.5分钟时为2.8±1.6%，20分钟时为17.3±5.0%。
我们基于99mTc-ECD SPECT的方法也显示出受影响侧脑动脉扩张延迟。这表明ACZ反应如桑原等人所报告的那样呈时间依赖性出现。
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