Banzo I, Quirce R, Martínez-Rodríguez I, Jiménez-Bonilla J, Portilla-Quattrociocchi H, Medina-Quiroz P, Ortega F, Rodríguez E, Mateo I, Vázquez-Higuera J L, de Arcocha M, Carril J M
Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España.
Rev Esp Med Nucl. 2011 Sep-Oct;30(5):301-6. doi: 10.1016/j.remn.2011.03.010. Epub 2011 Jun 2.
The aim of this study was to analyze cerebral perfusion and glucose metabolism in patients with cognitive impairment using cerebral blood flow (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans.
Twenty-two patients with cognitive impairment were included: 4 subjective memory complaints (SMC), 8 amnestic mild cognitive impairment (MCI), 5 prodromic Alzheimer's disease (AD) and 5 AD. In each clinical group, (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans were performed.
(99m)Tc-HMPAO SPECT showed regions of cerebral hypoperfusion in 15 patients and was normal in 7 of the 22 patients. (18)F-FDG PET/CT scan showed cerebral regional hypometabolism in 19 patients and was normal in the other 3 patients. The distribution of abnormalities on (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans was similar in 9 patients (2 SMC, 2 amnestic MCI, 2 prodromic AD, and 3 AD). In 6 patients (1 amnestic MCI, 2 prodromic AD, and 3 AD), FDG hypometabolism was more extensive than the cerebral hypoperfusion. Four patients (1SMC, 3 amnestic MCI) had an abnormal (18)F-FDG PET/CT scan and normal (99m)Tc-HMPAO SPECT. There were 3 patients (1 SMC 2, amnestic MCI) with normal (99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans.
(99m)Tc-HMPAO SPECT and (18)F-FDG PET/CT scans showed cerebral hypoperfusion and hypometabolism in patients with cognitive impairment, even in patients with clinical diagnosis of SMC. In patients with a normal cerebral blood flow SPECT, brain glucose cerebral hypometabolism can be detected. In some patients, the extension of FDG hypometabolism is more pronounced than that corresponding to the hypoperfusion area.
本研究旨在利用脑血流（99m）锝-六甲基丙烯胺肟单光子发射计算机断层扫描（SPECT）和（18）氟-脱氧葡萄糖正电子发射断层显像/计算机断层扫描（PET/CT）分析认知障碍患者的脑灌注和葡萄糖代谢情况。
纳入22例认知障碍患者，包括4例主观记忆障碍（SMC）、8例遗忘型轻度认知障碍（MCI）、5例前驱期阿尔茨海默病（AD）和5例AD患者。对每个临床组均进行了（99m）锝-六甲基丙烯胺肟SPECT和（18）氟-脱氧葡萄糖PET/CT扫描。
（99m）锝-六甲基丙烯胺肟SPECT显示15例患者存在脑灌注不足区域，22例患者中有7例正常。（18）氟-脱氧葡萄糖PET/CT扫描显示19例患者存在脑局部代谢减低，另外3例正常。9例患者（2例SMC、2例遗忘型MCI、2例前驱期AD和3例AD）的（99m）锝-六甲基丙烯胺肟SPECT和（18）氟-脱氧葡萄糖PET/CT扫描异常分布相似。6例患者（1例遗忘型MCI、2例前驱期AD和3例AD）的氟脱氧葡萄糖代谢减低范围比脑灌注不足更广泛。4例患者（1例SMC、3例遗忘型MCI）的（18）氟-脱氧葡萄糖PET/CT扫描异常而（99m）锝-六甲基丙烯胺肟SPECT正常。有3例患者（1例SMC、2例遗忘型MCI）的（99m）锝-六甲基丙烯胺肟SPECT和（18）氟-脱氧葡萄糖PET/CT扫描均正常。
（99m）锝-六甲基丙烯胺肟SPECT和（18）氟-脱氧葡萄糖PET/CT扫描显示认知障碍患者存在脑灌注不足和代谢减低，即使是临床诊断为SMC的患者。在脑血流SPECT正常的患者中，可检测到脑葡萄糖代谢减低。在一些患者中，氟脱氧葡萄糖代谢减低的范围比相应的灌注不足区域更明显。
