急性髓细胞性白血病成人患者在阿糖胞苷前后的脑灌注。

Brain perfusion in adult patients with acute myeloblastic leukemia before and after cytosine arabinoside.

机构信息

Department of Nuclear Medicine, Rouen University Hospital, University of Rouen, Rouen, France.

出版信息

Mol Imaging Biol. 2011 Aug;13(4):747-53. doi: 10.1007/s11307-010-0409-7.

DOI:10.1007/s11307-010-0409-7

PMID:20737220

Abstract

PURPOSE

High-dose (HD) cytosine arabinoside (ara-C) is a major treatment in acute myeloblastic leukemia (AML) that can lead to cerebellar complications, although electroencephalogram, computed tomography, and magnetic resonance imaging remain normal. We conducted a prospective study to evaluate brain perfusion with single-photon emission computed tomography (SPECT) in adult patients before and after receiving ara-C.

PROCEDURES

Forty-three patients were pre-included, and 20 reached a complete remission. These 20 patients were definitively included and underwent three technetium-99m hexamethyl-propylene-amine oxime (HMPAO) SPECT acquisitions with a double-head camera: SPECT1 at AML diagnosis, SPECT2 after induction (conventional ara-C dose), and SPECT3 during HD ara-C treatment. All the included patients underwent six series of neurological and cognitive examinations: N1, N2, and N3 at the time of SPECT1, SPECT2, and SPECT3, respectively; N4 during HD ara-C treatment; N5 (at 10 days); and N6 during follow-up (at 6 months). Statistical parametric mapping (SPM2) was used to test perfusion changes. A specific method based on random walk (RW) was used to analyze diffuse brain perfusion heterogeneity.

RESULTS

No neurological adverse effect was observed, and all neurological and cognitive examinations remained normal. Between SPECT1 and SPECT2, SPM2 analysis showed a decrease in cerebral blood flow, i.e., in the cerebellum, in the occipitoparietal cortex, and in the thalamus. No significant difference was observed between SPECT2 and SPECT3 or between SPECT1 and SPECT3. RW analysis showed no significant difference in perfusion heterogeneity between the three SPECTs.

CONCLUSIONS

HMPAO SPECT demonstrated a decrease in thalamus, cerebellar, and parieto-occipital perfusion after conventional doses of ara-C in AML patients, although the neurological examinations were normal and the patients had no neurological adverse effects.

摘要

目的

高剂量（HD）阿糖胞苷（ara-C）是急性髓系白血病（AML）的主要治疗方法，可导致小脑并发症，尽管脑电图、计算机断层扫描和磁共振成像仍正常。我们进行了一项前瞻性研究，以评估接受 ara-C 前后成人患者的脑灌注情况，使用单光子发射计算机断层扫描（SPECT）。

方法

43 例患者预先纳入，其中 20 例达到完全缓解。这 20 例患者最终纳入并接受了 3 次锝-99m 六甲基丙基乙胺肟（HMPAO）SPECT 采集，使用双头相机：SPECT1 在 AML 诊断时，SPECT2 在诱导后（常规 ara-C 剂量），SPECT3 在 HD ara-C 治疗时。所有纳入患者接受了 6 系列的神经和认知检查：N1、N2 和 N3 在 SPECT1、SPECT2 和 SPECT3 时，N4 在 HD ara-C 治疗期间，N5（在第 10 天）和 N6 在随访期间（在 6 个月时）。使用统计参数映射（SPM2）测试灌注变化。使用基于随机游走（RW）的特定方法分析弥散性脑灌注异质性。

结果

未观察到神经不良事件，所有神经和认知检查均保持正常。在 SPECT1 和 SPECT2 之间，SPM2 分析显示脑血流减少，即小脑、顶枕皮质和丘脑。SPECT2 和 SPECT3 之间或 SPECT1 和 SPECT3 之间无显著差异。RW 分析显示 3 次 SPECT 之间的灌注异质性无显著差异。