Díez Castro M J, Castell Conesa J, Poca M A, Rubió Rodríguez A, Lorenzo Busquets C, Canela Coll T, Simó Perdigó M, Aguadé Bruix S, Mataró Serrat M, Sahuquillo J
Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Rev Esp Med Nucl. 2003 Sep-Oct;22(5):287-94. doi: 10.1016/s0212-6982(03)72205-8.
The aim of this study was to characterize regional cerebral blood flow in patients with Adult Hydrocephalus Syndrome (AHS) and to evaluate the changes in brain perfusion after surgical derivation treatment.
20 patients with AHS (age: 72 +/- 14, 12 men) were studied before and six months after surgery. All patients underwent a brain perfusion SPECT (99mTc-HMPAO) prior to surgery and at 6 months post-surgery. Semi-quantitative analysis was done for brain uptake: 0=Normal, 1=Mild, 2=Moderate, 3= Severe, 4=No uptake. The severity of ventricular dilatation was assessed by classifying the intensity and extension of subcortical defects: 0=Normal, 1=Mild, 2=Moderate, 3=Severe. The scores of the pre- and post-surgical studies were compared using the Student-t test.
A global reduction of brain uptake was observed (mean score 12.85), mainly in frontal, parietal and temporal lobes, with a significant improvement in post surgical studies (mean score 6, p<0,001). After surgery, 16 (80%) of the 20 patients improved brain uptake. In relationship to subcortical uptake, 5 patients showed mild defects, 9 moderate defects and 6 patients presented severe uptake reduction. In post-surgical studies 15 (75%) patients improved almost one degree in the subcortical score and 65% of the patients showed a normal or mild subcortical uptake reduction.
Brain perfusion SPECT is useful in patients with AHS, detecting brain perfusion defects and evaluating cerebral blood flow improvement after shunt operation.
本研究旨在描述成人脑积水综合征（AHS）患者的局部脑血流特征，并评估手术分流治疗后脑灌注的变化。
对20例AHS患者（年龄：72±14岁，男性12例）在手术前及术后6个月进行研究。所有患者在手术前及术后6个月均接受脑灌注单光子发射计算机断层扫描（99mTc-HMPAO）。对脑摄取进行半定量分析：0=正常，1=轻度，2=中度，3=重度，4=无摄取。通过对皮质下缺损的强度和范围进行分类来评估脑室扩张的严重程度：0=正常，1=轻度，2=中度，3=重度。采用Student-t检验比较手术前后研究的评分。
观察到脑摄取总体降低（平均评分12.85），主要发生在额叶、顶叶和颞叶，术后研究有显著改善（平均评分6，p<0.001）。术后，20例患者中有16例（80%）脑摄取得到改善。关于皮质下摄取，5例患者有轻度缺损，9例有中度缺损，6例患者皮质下摄取显著降低。在术后研究中，15例（75%）患者的皮质下评分几乎改善了一个等级，65%的患者皮质下摄取降低为正常或轻度。
脑灌注单光子发射计算机断层扫描对AHS患者有用，可检测脑灌注缺损并评估分流手术后脑血流的改善情况。
