Kraft Otakar, Samlík Jirí, Chmelová Jana
Department of Nuclear Medicine, University Hospital, 17. listopadu 1790, 70852 Ostrava-Poruba, Czech Republic.
Nucl Med Rev Cent East Eur. 2006;9(2):132-7.
The aim of this paper is a description of our experience with scintigraphic detection of brain death.
Thirty-four patients were studied from February 2003 to June 2006. We performed brain scintigraphic examination utilising (99m)Tc-HMPAO and a two-headed SPECT camera E.CAM. We used LEHR collimators. 15% energy window was centred around 140 keV. 650-750 MBq of radiopharmaceutical was injected as a bolus. Then dynamic scintigraphy of the head and neck was done in an anterior projection--2 s per frame for 60 s. Then static scintigraphy of the head in four projections followed (anterior, both lateral and posterior views), for 4 minutes per view.
A typical picture of brain death on planar dynamic and static scintigrams showed an absence of perfusion and radiopharmaceutical accumulation in both cereberal and cerebral hemispheres and brain stem. Radioactivity in the area of the scalp and face could be present. Borderline findings, which demanded careful interpretation, were the cases with preservation of minimal cerebral perfusion and simultaneous absence of radiopharmaceutical accumulation in its parenchyma and cutoff of tracer accumulation in cerebral parenchyma only supra or infratentorial.
Cerebral perfusion scintigraphy is the most contributing factor for the diagnosis of brain death in patients after cranial trauma with subsequent neurosurgical operation, when angiography is often unsuitable. In these situations perfusion scintigraphy is able to show the absence of radiopharmaceutical accumulation in cerebral tissue. Scintigraphic detection of brain death gained an important role in new Czech legislation, and the demands of transplant centres for these examinations will certainly grow with the accrual of organ collections.
本文旨在描述我们运用闪烁扫描法检测脑死亡的经验。
2003年2月至2006年6月期间对34例患者进行了研究。我们使用（99m）锝-六甲基丙烯胺肟（99mTc-HMPAO）和双头单光子发射计算机断层扫描仪（SPECT）E.CAM进行脑闪烁扫描检查。我们使用低能高分辨率（LEHR）准直器。15%的能量窗以140千电子伏特为中心。以团注方式注入650 - 750兆贝可的放射性药物。然后在前位进行头颈部动态闪烁扫描，每秒1帧，共60秒。随后在四个投照位（前位、双侧位和后位）进行头部静态闪烁扫描，每个投照位4分钟。
平面动态和静态闪烁扫描图上脑死亡的典型表现为大脑、大脑半球和脑干均无灌注及放射性药物聚集。头皮和面部区域可能有放射性。需要仔细解读的临界表现包括：大脑灌注极少保留但实质内无放射性药物聚集，以及仅幕上或幕下脑实质内示踪剂聚集中断的情况。
对于颅脑外伤后继发神经外科手术且血管造影通常不适用的患者，脑灌注闪烁扫描是诊断脑死亡的最重要因素。在这些情况下，灌注闪烁扫描能够显示脑组织中无放射性药物聚集。脑死亡的闪烁扫描检测在捷克新立法中发挥了重要作用，随着器官采集量的增加，移植中心对这些检查的需求肯定会增长。
