Egge Arild, Sjøholm Hans, Waterloo Knut, Solberg Tore, Ingebrigtsen Tor, Romner Bertil
Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway.
Neurosurgery. 2005 Aug;57(2):237-42; discussion 237-42. doi: 10.1227/01.neu.0000166538.60333.d6.
To assess the clinical value of serial single photon-emission computed tomographic (SPECT) measurements after aneurysmal subarachnoid hemorrhage (SAH).
Thirty-two patients were studied prospectively during the first 26 days after SAH with repeated SPECT measurements, clinical examinations, and transcranial Doppler recordings. Time trends were analyzed with a general linear model. A final SPECT measurement was performed after 1 year.
A mean of 2.6 (range, 1-5) SPECT measurements revealed a significant (P = 0.001) quadratic curve consistent with initial hypoperfusion and then with hyperperfusion during the acute stage. SPECT findings were significantly associated with transcranial Doppler recordings (P = 0.016) and clinical assessments (P = 0.008). Patients fulfilling clinical and transcranial Doppler criteria for vasospasm demonstrated a more pronounced relative hypoperfusion-hyperperfusion time course. A multivariate logistic regression analysis identified SPECT measurements obtained during Days 7 to 14 after the SAH as the only independent predictor (beta = 0.042, P = 0.02) for impaired perfusion after 1 year.
Serial SPECT measurements after aneurysmal SAH demonstrate that regional changes in cerebral perfusion follow a nonlinear time trend, and repeated measurements are necessary. This observation, as well as the low feasibility of SPECT, restricts the clinical value of such measurements.
评估动脉瘤性蛛网膜下腔出血（SAH）后连续单光子发射计算机断层扫描（SPECT）测量的临床价值。
对32例患者在SAH后的前26天进行前瞻性研究，重复进行SPECT测量、临床检查和经颅多普勒记录。采用一般线性模型分析时间趋势。1年后进行最后一次SPECT测量。
平均2.6次（范围1 - 5次）SPECT测量显示出一条显著的（P = 0.001）二次曲线，与急性期最初的灌注不足然后灌注过度一致。SPECT结果与经颅多普勒记录（P = 0.016）和临床评估（P = 0.008）显著相关。符合血管痉挛临床和经颅多普勒标准的患者表现出更明显的相对灌注不足 - 灌注过度时间进程。多因素逻辑回归分析确定SAH后第7至14天进行的SPECT测量是1年后灌注受损的唯一独立预测因素（β = 0.042，P = 0.02）。
动脉瘤性SAH后的连续SPECT测量表明，脑灌注的区域变化遵循非线性时间趋势，且需要重复测量。这一观察结果以及SPECT的低可行性限制了此类测量的临床价值。
