Cooke Daniel, Koppula Bhasker, Seiler Douglas, Rajendran Joseph, Hallam Danial, Ghodke Basavaraj, Lewis David
Department of Radiology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Nucl Med Commun. 2010 Jan;31(1):53-8. doi: 10.1097/MNM.0b013e328330db10.
Cerebral vasospasm is a major cause of morbidity and mortality among patients after subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms. Patients are often monitored using transcranial Doppler (TCD) ultrasound and single photon emission computed tomography (SPECT) techniques. Historically SPECT has been evaluated qualitatively, though quantitative analysis software is now used to evaluate other cerebral pathologies.
Our aim was to evaluate the utility of semiquantitative SPECT using Hermes brain registration and analysis software (BRASS) relative to TCD ultrasound and qualitative SPECT interpretation within a cohort of patients, all with cerebral vasospasm as measured by digital subtraction angiography.
Retrospective analysis of 32 nonconsecutive patients, admitted for aneurysmal SAH examining perfusion deficits in terms of anterior, middle, and posterior vascular distributions using both TCD ultrasonography and brain perfusion SPECT studies.
McNemar analysis of accuracy between modalities showed a better overall performance trend for qualitative SPECT versus BRASS SPECT (Fisher exact = 0.99) and a statistically significant better performance of qualitative SPECT versus TCD in measuring anterior cerebral artery vasospasm (Fisher exact = 0.035). BRASS SPECT, however, performed better than qualitative SPECT in diagnosing posterior circulation vasospasm (Fisher exact = 0.180 vs. 0.358) and had greater specificity in determining anterior circulation vasospasm (71 vs. 57%).
BRASS SPECT is a useful method for evaluating cerebral perfusion and needs further optimization, particularly as it pertains to establishing semiquantitative cerebral perfusion parameters. It can serve as an adjunct to traditional SPECT evaluation of SAH particularly in determining subtle changes in the perfusion of the anterior and posterior arterial distributions.
脑血管痉挛是颅内动脉瘤破裂导致蛛网膜下腔出血（SAH）患者发病和死亡的主要原因。患者常使用经颅多普勒（TCD）超声和单光子发射计算机断层扫描（SPECT）技术进行监测。从历史上看，SPECT一直是进行定性评估，不过现在定量分析软件已用于评估其他脑部病变。
我们的目的是在一组经数字减影血管造影测量均存在脑血管痉挛的患者中，评估使用Hermes脑配准和分析软件（BRASS）的半定量SPECT相对于TCD超声和定性SPECT解释的效用。
对32例非连续性动脉瘤性SAH患者进行回顾性分析，使用TCD超声和脑灌注SPECT研究从前、中、后血管分布方面检查灌注缺损。
不同方式之间准确性的McNemar分析显示，定性SPECT相对于BRASS SPECT总体表现出更好的性能趋势（费舍尔精确检验 = 0.99），并且在测量大脑前动脉血管痉挛方面，定性SPECT的性能在统计学上显著优于TCD（费舍尔精确检验 = 0.035）。然而，BRASS SPECT在诊断后循环血管痉挛方面比定性SPECT表现更好（费舍尔精确检验 = 0.180对0.358），并且在确定前循环血管痉挛方面具有更高的特异性（71%对57%）。
BRASS SPECT是评估脑灌注的一种有用方法，需要进一步优化，特别是在建立半定量脑灌注参数方面。它可作为SAH传统SPECT评估的辅助手段，尤其是在确定前后动脉分布灌注的细微变化方面。
