Lee Ho-Young, Paeng Jin Chul, Lee Dong Soo, Lee Jae Sung, Oh Chang Wan, Cho Maeng Jae, Chung June-Key, Lee Myung Chul
Department of Nuclear Medicine, Seoul National University College of Medicine, 20 Yeongeon-dong, Jongno-gu, 110-744 Seoul, Korea.
J Nucl Med. 2004 Feb;45(2):202-6.
The efficacy of cerebral arterial bypass surgery was assessed on brain perfusion SPECT using statistical parametric mapping (SPM) and a probabilistic brain atlas.
Fifteen patients with ischemia in the internal carotid artery (ICA) territory and 21 age-matched healthy volunteers were enrolled. (99m)Tc-HMPAO basal/acetazolamide brain perfusion SPECT was performed 2 wk before and after bypass surgery and also on a healthy control group. Using SPM analysis, group comparisons were made between pre- and postoperative SPECT for each basal/acetazolamide image, and improvements of perfusion and perfusion reserve were assessed. The number of significant voxels on the SPM analysis was defined as the extent of ischemia. With the use of the probabilistic brain atlas, the counts for the cerebral lobes and the ICA territory were automatically calculated for each image and compared.
The group comparisons by SPM between patients and healthy volunteers showed a significant improvement in general perfusion status in the ICA territory. The improvement in perfusion reserve was more extensive than the improvement in perfusion. The extent of ischemia was also significantly decreased after surgery (1,693 +/- 2,604 to 371 +/- 523 voxels in basal images, P = 0.060; 11,879 +/- 6,449 to 5,997 +/- 3,864 voxels in acetazolamide images, P = 0.005). In the analysis using the probabilistic brain atlas, the preoperatively decreased perfusion was normalized after surgery, but a residual decrease in the perfusion reserve was also observed in the ICA territory. The counts in the volume of interest of the ICA territory were significantly improved (38.5 +/- 4.1 to 41.5 +/- 2.7 in basal images, P = 0.024; 34.2 +/- 4.4 to 38.8 +/- 2.9 in acetazolamide images, P = 0.003). One patient showing a decrease in perfusion had a perioperative cerebral infarct.
Using SPM and a probabilistic brain atlas, the perfusion, the perfusion reserve, and changes in both after cerebral arterial bypass surgery were effectively assessed and correlated well with physiologic reasoning.
使用统计参数映射（SPM）和概率性脑图谱，通过脑灌注单光子发射计算机断层扫描（SPECT）评估脑动脉搭桥手术的疗效。
纳入15例颈内动脉（ICA）供血区域缺血患者和21例年龄匹配的健康志愿者。在搭桥手术前后2周以及健康对照组均进行（99m）锝-六甲基丙烯胺肟（Tc-HMPAO）基础/乙酰唑胺脑灌注SPECT检查。使用SPM分析，对每个基础/乙酰唑胺图像的术前和术后SPECT进行组间比较，并评估灌注及灌注储备的改善情况。SPM分析中显著体素的数量被定义为缺血范围。使用概率性脑图谱，自动计算每个图像中脑叶和ICA供血区域的计数并进行比较。
患者与健康志愿者之间的SPM组间比较显示，ICA供血区域的总体灌注状态有显著改善。灌注储备的改善比灌注的改善更为广泛。术后缺血范围也显著减小（基础图像中从1693±2604体素降至371±523体素，P = 0.060；乙酰唑胺图像中从11879±6449体素降至5997±3864体素，P = 0.005）。在使用概率性脑图谱的分析中，术前降低的灌注在术后恢复正常，但在ICA供血区域也观察到灌注储备的残余降低。ICA供血区域感兴趣体积的计数有显著改善（基础图像中从38.5±4.1升至41.5±2.7，P = 0.024；乙酰唑胺图像中从34.2±4.4升至38.8±2.9，P = 0.003）。1例灌注降低的患者发生了围手术期脑梗死。
使用SPM和概率性脑图谱，能够有效评估脑动脉搭桥手术后的灌注、灌注储备及其变化，且与生理学推理结果相关性良好。
