使用碘-123-N-异丙基-p-碘安非他明单光子发射计算机断层扫描对单侧大脑中动脉闭塞性疾病患者脑血管对乙酰唑胺反应性的定性与定量评估

Qualitative versus quantitative assessment of cerebrovascular reactivity to acetazolamide using iodine-123-N-isopropyl-p-iodoamphetamine SPECT in patients with unilateral major cerebral artery occlusive disease.

作者信息

Ogasawara Kuniaki, Okuguchi Taku, Sasoh Masayuki, Kobayashi Masakazu, Yukawa Hirotsugu, Terasaki Kazunori, Inoue Takashi, Ogawa Akira

机构信息

Department of Neurosurgery and the Cyclotron Research Center, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan.

出版信息

AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1090-5.

PMID:12812931

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8149004/

Abstract

BACKGROUND AND PURPOSE

Qualitative measurement of regional cerebrovascular reactivity (rCVR) to acetazolamide with single-photon emission CT (SPECT) has been widely used to determine the severity of hemodynamic impairment. We attempted to validate the accuracy of qualitative assessment by using SPECT to detect reduced rCVR compared with rCVR determined quantitatively in patients with unilateral major cerebral artery occlusion.

METHODS

Regional cerebral blood flow was assessed with iodine-123-N-isopropyl-p-iodoamphetamine ((123)I-IMP) at rest and after acetazolamide activation in 133 patients with previously symptomatic, unilateral internal carotid or middle cerebral artery occlusion. Quantitative values were calculated by using the (123)I-IMP autoradiographic method and analyzed for each cerebral hemisphere as the percentage change in rCBF between resting and activation studies (%(Hem)). Qualitative rCVR was determined for the target hemisphere distal to the occlusion as the cerebral-interhemispheric asymmetry index (AI(Hem)) and as an index of flow difference between the target cerebral and ipsilateral cerebellar hemispheres (FI(Hem-Cbl)). Values 2 SDs below the mean in healthy volunteers were defined as decreased.

RESULTS

Fair agreement was observed between %(Hem) and both AI(Hem) change (resting vs activation, kappa = 0.409) and FI(Hem-Cbl) change (resting vs activation, kappa = 0.440). When %(Hem) was assumed to represent the true determinant of assessing rCVR, AI(Hem) change and FI(Hem-Cbl) change demonstrated sensitivities of 68% and 78%; specificities, 72% and 76%; positive predictive values, 48% and 56%; false-positive incidences, 28% and 24%; and false-negative incidences, 32% and 22% for detecting patients with reduced rCVR, respectively.

CONCLUSION

Subgroups of patients with hemodynamic impairment cannot be accurately defined by using rCVR qualitatively measured with SPECT.

摘要

背景与目的

利用单光子发射计算机断层扫描（SPECT）对乙酰唑胺的局部脑血管反应性（rCVR）进行定性测量已被广泛用于确定血流动力学损害的严重程度。我们试图通过SPECT检测rCVR降低情况来验证定性评估的准确性，并将其与单侧大脑中动脉闭塞患者的定量rCVR进行比较。

方法

对133例既往有症状的单侧颈内动脉或大脑中动脉闭塞患者，在静息状态和乙酰唑胺激发后，用碘-123-N-异丙基-p-碘安非他明（(123)I-IMP）评估局部脑血流量。采用(123)I-IMP放射自显影法计算定量值，并将每个脑半球在静息和激发研究之间的rCBF变化百分比（%(Hem)）进行分析。将闭塞远端的目标半球的定性rCVR确定为脑间不对称指数（AI(Hem)）以及目标脑半球与同侧小脑半球之间的血流差异指数（FI(Hem-Cbl)）。健康志愿者中低于平均值2个标准差的值被定义为降低。

结果

观察到%(Hem)与AI(Hem)变化（静息与激发，kappa = 0.409）和FI(Hem-Cbl)变化（静息与激发，kappa = 0.440）之间具有中等一致性。当假定%(Hem)代表评估rCVR的真正决定因素时，AI(Hem)变化和FI(Hem-Cbl)变化检测rCVR降低患者的敏感性分别为68%和78%；特异性分别为72%和76%；阳性预测值分别为48%和56%；假阳性发生率分别为28%和24%；假阴性发生率分别为32%和22%。