de la Riva A, González F M, Llamas-Elvira J M, Latre J M, Jiménez-Heffernan A, Vidal E, Martínez M, Torres M, Guerrero R, Alvarez F
Department of Nuclear Medicine, Reina Sofia Hospital, Cordoba, Spain.
Br J Radiol. 1992 Apr;65(772):289-94. doi: 10.1259/0007-1285-65-772-289.
The use of technetium-99m hexamethyl-propyleneamine oxime (99Tcm-HMPAO) in the diagnosis of brain death has been evaluated in 41 studies of 37 patients with severe brain injury, who were under the effect of drugs or when other diagnostic methods were equivocal. HMPAO studies were compared with conventional radionuclide angiography performed simultaneously by intravenous administration of HMPAO as a bolus. The ages of patients ranged from 4 months to 75 years. Dynamic flow images and 5-min static uptake images were acquired following bolus injection of 555 Mbq of 99Tcm-HMPAO. All patients showing no brain uptake were confirmed as brain-dead by standard clinical criteria, with no contradictory cases in the static study. In addition, all patients who were not brain-dead showed HMPAO uptake at least in the brainstem. Dynamic flow images were equivocal in five patients, four of whom had no uptake on static images and clinically confirmed brain death. In addition, two other cases showed "mismatched" dynamic and static images: in one case no perfusion was observed on flow images but uptake restricted to the posterior fossa was seen on static images; the other case showed perfusion on the dynamic study and static imaging revealed hemispheric uptake with no posterior fossa uptake. Static perfusion 99Tcm-HMPAO studies offer advantages over conventional brain scintigraphy, better results being due to adequate assessment of posterior fossa activity and avoiding equivocal studies.
已在37例重度脑损伤患者的41项研究中评估了锝-99m六甲基丙烯胺肟（99Tcm-HMPAO）在脑死亡诊断中的应用，这些患者处于药物作用下或其他诊断方法不明确时。将HMPAO研究与通过静脉推注HMPAO同时进行的传统放射性核素血管造影进行比较。患者年龄从4个月到75岁不等。在推注555兆贝可的99Tcm-HMPAO后采集动态血流图像和5分钟静态摄取图像。所有脑内无摄取的患者均经标准临床标准确认为脑死亡，静态研究中无矛盾病例。此外，所有未脑死亡的患者至少在脑干显示有HMPAO摄取。动态血流图像在5例患者中不明确，其中4例在静态图像上无摄取且临床确诊为脑死亡。另外，还有2例显示动态和静态图像“不匹配”：1例在血流图像上未观察到灌注，但在静态图像上可见摄取局限于后颅窝；另1例在动态研究中有灌注，静态成像显示半球摄取而无后颅窝摄取。静态灌注99Tcm-HMPAO研究比传统脑闪烁显像具有优势，由于对后颅窝活动的充分评估以及避免不明确的研究，结果更好。
