Dumarey Nicolas E, Massager Nicolas, Laureys Steven, Goldman Serge
Department of Nuclear Medicine and PET/Biomedical Cyclotron Unit, Hôpital Erasme, Université Libre de Bruxelles, 808 route de Lennik, B-1070 Brussels, Belgium.
Nucl Med Commun. 2005 Sep;26(9):757-63. doi: 10.1097/01.mnm.0000170937.90958.22.
Normal pressure hydrocephalus (NPH) is a cause of dementia that may be amended by medical intervention. Its diagnosis is therefore of major importance and the establishment of response criteria to cerebrospinal fluid (CSF) shunting is essential. One of these criteria is the clinical response to spinal tap. The accuracy of the spinal tap test could potentially be improved by adding neuroimaging of regional cerebral blood flow (rCBF) changes to the response criteria. Statistical parametric mapping (SPM) is a voxel-based method of image analysis that may be used to statistically assess the significance of rCBF changes. The objective of this study was to evaluate, by SPM, spinal tap test-induced rCBF changes in patients with NPH syndrome.
Forty patients with NPH syndrome underwent hexamethylpropylene amine oxime (HMPAO) brain single photon emission computed tomography (SPECT) before and after a spinal tap test (1-day split-dose protocol). The differences in rCBF between these pairs of scans were analysed by SPM in the whole group and between subgroups divided according to gait improvement at the spinal tap test.
In the whole group of patients, there was no statistical difference between pre- and post-spinal tap SPECT images. SPM analysis of patients grouped as a function of their clinical response to the spinal tap test revealed a significant post-spinal tap rCBF increase in the bilateral dorsolateral frontal and left mesiotemporal cortex in clinically responding compared with non-responding patients.
According to SPM analysis, gait improvement at the spinal tap test in patients with NPH syndrome is associated with an rCBF increase localized in the bilateral dorsolateral frontal and left mesiotemporal cortex.
正常压力脑积水（NPH）是痴呆的一个病因，可能通过医学干预得到改善。因此，其诊断至关重要，建立脑脊液（CSF）分流反应标准必不可少。其中一个标准是对腰椎穿刺的临床反应。通过在反应标准中加入局部脑血流（rCBF）变化的神经影像学检查，可能会提高腰椎穿刺试验的准确性。统计参数映射（SPM）是一种基于体素的图像分析方法，可用于统计学评估rCBF变化的显著性。本研究的目的是通过SPM评估NPH综合征患者腰椎穿刺试验引起的rCBF变化。
40例NPH综合征患者在腰椎穿刺试验前后（1天分次给药方案）接受了六甲基丙烯胺肟（HMPAO）脑单光子发射计算机断层扫描（SPECT）。通过SPM分析这两组扫描之间的rCBF差异，分析对象包括整个研究组以及根据腰椎穿刺试验时步态改善情况划分的亚组。
在整个患者组中，腰椎穿刺前后的SPECT图像之间没有统计学差异。根据患者对腰椎穿刺试验的临床反应进行分组，SPM分析显示，与无反应患者相比，有临床反应的患者在腰椎穿刺后双侧背外侧额叶和左侧颞中回皮质的rCBF显著增加。
根据SPM分析，NPH综合征患者腰椎穿刺试验时步态改善与双侧背外侧额叶和左侧颞中回皮质的rCBF增加有关。
