Shahar E, Gilday D L, Hwang P A, Cohen E K, Lambert R
Department of Pediatrics, Hospital for Sick Children, University of Toronto Faculty of Medicine, Ontario, Canada.
Arch Neurol. 1990 May;47(5):578-84. doi: 10.1001/archneur.1990.00530050102019.
Regional cerebral blood flow (rCBF) alterations, as determined by single photon emission computed tomography (SPECT) using technetium Tc 99m hexamethyl propylenamine oxime (Tc 99m-HM-PAO), were studied in 15 infants and children presenting with cerebrovascular disorders between the ages of 2 weeks and 16 years. The rCBF patterns were correlated with clinical presentation, electroencephalographic patterns, radiologic studies, including computed tomography and magnetic resonance imaging of the head, and cerebral angiography. All patients presented with motor weakness that was accompanied in some with dysphasia, defects in visual fields, obtundation, seizures, and high temperature. Perturbations of rCBF with Tc 99m-HMPAO SPECT brain scanning were detected in all patients investigated, with no adverse effects related to the radiotracer. All patients had a focal area of decreased rCBF, with adjacent hyperemia in 3 patients. In 7 patients, there was an rCBF decrease in a vascular distribution, mainly that of the middle cerebral artery, that correlated with the clinical findings and a focal electroencephalogram, as well as computed tomography and magnetic resonance imaging of the head. Impairment of rCBF was more extensive in 3 children, while early abnormal SPECT findings preceded abnormal computed tomographic findings in another 2 children. In 2 patients, Tc 99m-HMPAO SPECT was the only positive radiologic test to correlate with focal clinical and electroencephalographic abnormalities, in view of repeated normal computed tomographic scans. We conclude that Tc 99m-HMPAO SPECT brain scanning is a sensitive, complementary diagnostic measure in the early detection, localization, and estimation of rCBF alterations in pediatric cerebrovascular disease.
采用锝 Tc 99m 六甲基丙烯胺肟（Tc 99m-HM-PAO）单光子发射计算机断层扫描（SPECT）测定区域脑血流量（rCBF）变化，对 15 例年龄在 2 周龄至 16 岁之间患有脑血管疾病的婴幼儿及儿童进行了研究。rCBF 模式与临床表现、脑电图模式、包括头颅计算机断层扫描和磁共振成像在内的放射学检查以及脑血管造影相关。所有患者均出现运动无力，部分患者伴有言语困难、视野缺损、意识迟钝、癫痫发作和高热。在所有接受调查的患者中均检测到 Tc 99m-HMPAO SPECT 脑扫描显示的 rCBF 异常，且未发现与放射性示踪剂相关的不良反应。所有患者均有 rCBF 降低的局灶性区域，3 例患者在降低区域附近伴有充血。7 例患者的 rCBF 在血管分布区域减少，主要是大脑中动脉分布区域，这与临床表现、局灶性脑电图以及头颅计算机断层扫描和磁共振成像相关。3 例儿童的 rCBF 损害更为广泛，另外 2 例儿童的 SPECT 早期异常发现先于计算机断层扫描异常发现。鉴于多次头颅计算机断层扫描结果正常，在 2 例患者中，Tc 99m-HMPAO SPECT 是唯一与局灶性临床和脑电图异常相关的阳性放射学检查。我们得出结论，Tc 99m-HMPAO SPECT 脑扫描是小儿脑血管疾病早期检测、定位和评估 rCBF 变化的一种敏感的补充诊断方法。
