Lewis D H, Eskridge J M, McAuliffe W, Newell D W, Cohen W A, Haynor D R, Winn H R
Divisions of Nuclear Medicine and Neuroradiology, Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, U.S.A.; Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, U.S.A.
J Stroke Cerebrovasc Dis. 1995;5(1):24-8. doi: 10.1016/S1052-3057(10)80082-5. Epub 2010 Jun 11.
Cerebral vasospasm is an important cause of delayed stroke after subarachnoid hemorrhage. Single-photon emission computed tomography (SPECT) of regional cerebral blood flow with (99m)Tc-hexamethyl propylenenamine oxime (HMPAO) was performed before and after intra-arterial papaverine treatment in 10 patients with symptomatic cerebral vasospasm. Two patients were treated twice. The ultimate clinical outcome was improved due to papaverine in 5 of the 10 patients. SPECT imaging correlated with clinical course in 10 of 12 treatments. One of the discordant cases had significant residual mesial frontal lobe perfusion defects on SPECT despite improvement in blood flow in the lateral aspects of the frontal lobes and did not improve clinically. The other was stable but required definitive treatment with balloon angioplasty on the following day before clinical improvement was noted. Papaverine has effectiveness in pharmacologically dilating constricted cerebral arteries and is preferred for distal vasospasm and in vessels that may be difficult to dilate via balloon angioplasty. Technetium-99m-HMPAO SPECT imaging detects cerebral perfusion deficits associated with vasospasm and monitors the effect of intra-arterial papaverine on regional cerebral blood flow.
脑血管痉挛是蛛网膜下腔出血后迟发性中风的一个重要原因。对10例有症状性脑血管痉挛患者在动脉内注射罂粟碱治疗前后进行了用（99m）锝-六甲基丙烯胺肟（HMPAO）的局部脑血流单光子发射计算机断层扫描（SPECT）。2例患者接受了两次治疗。10例患者中有5例因罂粟碱治疗临床结局得到改善。12次治疗中有10次SPECT成像与临床病程相关。其中1例不一致的病例尽管额叶外侧血流有所改善，但SPECT显示额叶内侧有明显的残余灌注缺损，临床症状未改善。另1例病情稳定，但在临床症状改善前的次日需要用球囊血管成形术进行确定性治疗。罂粟碱在药理学上能有效扩张狭窄的脑动脉，对于远端血管痉挛以及难以通过球囊血管成形术扩张的血管更为适用。锝-99m-HMPAO SPECT成像可检测与血管痉挛相关的脑灌注缺损，并监测动脉内罂粟碱对局部脑血流的影响。
