Nuutinen Juho, Liu Yawu, Laakso Mikko P, Karonen Jari O, Vanninen Esko J, Kuikka Jyrki T, Aronen Hannu J, Vanninen Ritva L
Department of Neurology, Kuopio University Hospital, University of Kuopio, Kuopio, Finland.
Neuroradiology. 2009 Oct;51(10):687-95. doi: 10.1007/s00234-009-0569-9. Epub 2009 Jul 22.
The purposes of the present study were to compare the flow defect volumes on perfusion-weighted magnetic resonance imaging (PWI) and (99m)Tc-labeled ethylcysteinate dimer ((99m)Tc-ECD) single photon emission computed tomography (SPECT) at acute and subacute stages of ischemic stroke and to analyze the relationship between the detected flow defects on the two methods and neurological status and clinical outcomes.
Perfusion defects on PWI and SPECT were measured within 48 h and on day 8 of the onset of stroke from 22 patients with their first-ever acute supratentorial ischemic stroke. The primary neurological status was evaluated prior to the imaging. Clinical outcome was assessed at 3 months after the onset of the stroke.
The volumes of cerebral blood flow (CBF) defects did not differ between SPECT and PWI within the 48-h examinations. However, the volume of CBF defect was significantly larger on SPECT than on PWI on day 8 (p = 0.03). Within the 48-h examinations, the CBF defect volumes on SPECT and PWI were comparably related to the neurological status. On day 8, the CBF defect volume on SPECT showed higher correlation to the neurological status and more precisely predicted the clinical outcomes at 3 months than PWI.
(99m)TC-ECD-SPECT and PWI both have ability to detect cerebral hypoperfusion in patients with ischemic stroke but with some differences. The value of SPECT is more accurate in terms of the delayed outcome, such as prognosis and rehabilitation planning.
本研究的目的是比较缺血性卒中急性和亚急性期灌注加权磁共振成像（PWI）与99m锝标记的乙半胱氨酸二聚体（99mTc-ECD）单光子发射计算机断层扫描（SPECT）上的血流缺损体积，并分析两种方法检测到的血流缺损与神经功能状态和临床结局之间的关系。
对22例首次发生急性幕上缺血性卒中的患者，在卒中发作后48小时内及第8天测量PWI和SPECT上的灌注缺损。在成像前评估主要神经功能状态。在卒中发作后3个月评估临床结局。
在48小时内的检查中，SPECT和PWI上的脑血流量（CBF）缺损体积无差异。然而，在第8天，SPECT上的CBF缺损体积显著大于PWI（p = 0.03）。在48小时内的检查中，SPECT和PWI上的CBF缺损体积与神经功能状态具有相当的相关性。在第8天，SPECT上的CBF缺损体积与神经功能状态的相关性更高，并且比PWI更准确地预测了3个月时的临床结局。
99mTc-ECD-SPECT和PWI都有能力检测缺血性卒中患者的脑灌注不足，但存在一些差异。就延迟结局而言，如预后和康复计划，SPECT的价值更准确。
