Setoain X, Arroyo S, Lomeña F, Pavía J, Pareto D, Boget T, Bargalló N, Rumià J, Fuster D, Fuertes S, Pons F
Department of Nuclear Medicine, Hospital Clínic of Barcelona, University of Barcelona, Spain.
Neurology. 2004 Jun 22;62(12):2241-6. doi: 10.1212/wnl.62.12.2241.
To assess the value of SPECT during intracarotid amobarbital procedure (IAP) to discriminate which patients performed the test with the hippocampus inactivated and correlate it with the risk of amnesia after anterior temporal lobectomy (ATL).
The authors studied 40 consecutive patients undergoing ATL for refractory epilepsy. SPECT was performed after IV injection of 99mTc-HMPAO during the IAP (IAP-SPECT). Interictal SPECT and IAP-SPECT were realigned to obtain the perfusion change percentage (PCP), allowing a quantitative measurement. Wechsler Memory Scale Revised (WMS-R) before and during the first year of follow-up was used to assess memory impairment after surgery.
A decrease between 10 and 12% of the mean PCP values was observed in the frontal, parietal, and lateral temporal lobes of the injected side and in the contralateral cerebellum. However, no significant PCP changes were observed in the occipital or mesial temporal lobes. Thirty-eight passed the memory evaluation of the IAP and in 6 of those 38 patients a decline in memory was demonstrated 1 year after ATL. However, high preoperative neuropsychological score (in two patients) and IAP asymmetry scores (in other three patients) predicted postoperative memory risk in five of these six patients. Fourteen of the 38 patients (40%) had hypoperfusion of the hippocampus during the IAP-SPECT (i.e., the hippocampus was inactivated) and only 1 of these 14 patients (2.5%) developed memory impairment after temporal lobectomy. On the other hand, 5 of the 24 patients (13%) who had a functional hippocampus on IAP-SPECT developed memory impairment.
The results suggest that the combination of SPECT, intracarotid amobarbital procedure, and neuropsychological testing predicted risk for all patients who had postoperative memory decline, indicating that risk prediction should be based on multiple factors. IAP-SPECT results demonstrated that the hippocampus is not inactivated in over 60% of patients and that the lack of accuracy of the IAP alone in predicting the risk of amnesia is probably related to an insufficient inactivation of the ipsilateral hippocampus during the test.
评估单光子发射计算机断层扫描（SPECT）在颈动脉内注射阿米妥试验（IAP）期间的价值，以鉴别哪些患者在海马失活状态下进行该试验，并将其与颞叶前部切除术（ATL）后失忆风险相关联。
作者研究了40例连续接受ATL治疗难治性癫痫的患者。在IAP期间静脉注射99mTc-六甲基丙二胺肟（99mTc-HMPAO）后进行SPECT检查（IAP-SPECT）。将发作间期SPECT和IAP-SPECT进行重新定位以获得灌注变化百分比（PCP），从而进行定量测量。使用随访第一年之前和期间的韦氏记忆量表修订版（WMS-R）评估术后记忆损害情况。
在注射侧的额叶、顶叶和颞叶外侧以及对侧小脑观察到平均PCP值下降了10%至12%。然而，在枕叶或颞叶内侧未观察到明显的PCP变化。38例患者通过了IAP的记忆评估，其中38例患者中有6例在ATL术后1年出现记忆下降。然而，术前神经心理学高分（2例患者）和IAP不对称分数（其他3例患者）在这6例患者中的5例中预测了术后记忆风险。38例患者中有14例（40%）在IAP-SPECT期间海马灌注不足（即海马失活），这14例患者中只有1例（2.5%）在颞叶切除术后出现记忆损害。另一方面，IAP-SPECT显示海马功能正常的24例患者中有5例（13%）出现记忆损害。
结果表明，SPECT、颈动脉内注射阿米妥试验和神经心理学测试相结合可预测所有术后记忆下降患者的风险，这表明风险预测应基于多种因素。IAP-SPECT结果表明，超过60%的患者海马未失活，IAP单独预测失忆风险缺乏准确性可能与试验期间同侧海马失活不足有关。
