Department of Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, China.
Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China.
Eur J Nucl Med Mol Imaging. 2020 Jul;47(7):1668-1677. doi: 10.1007/s00259-019-04551-w. Epub 2019 Nov 6.
Cerebral blood flow (CBF) and glucose metabolism are important and significant factors in ischaemic cerebrovascular disease. The objective of this study was to use quantitative hybrid PET/MR to evaluate the effects of surgery treatment on the symptomatic unilateral internal carotid artery/middle cerebral artery steno-occlusive disease.
Fifteen patients diagnosed with ischaemic cerebrovascular disease were evaluated using a hybrid TOF PET/MR system (Signa, GE Healthcare). The CBF value measured by arterial spin labelling (ASL) and the standardized uptake value ratio (SUVR) measured by F-FDG PET were obtained, except for the infarct area and its contralateral side, before and after bypass surgery. The asymmetry index (AI) was calculated from the CBF and SUVR of the ipsilateral and contralateral cerebral hemispheres, respectively. The ΔCBF and ΔSUVR were calculated as the percent changes of CBF and SUVR between before and after surgery, and paired t tests were used to determine whether a significant change occurred. Spearman's rank correlation was also used to compare CBF with glucose metabolism in the same region.
The analysis primarily revealed that after bypass surgery, a statistically significant increase occurred in the CBF on the affected side (P < 0.01). The postprocedural SUVR was not significantly higher than the preprocedural SUVR (P > 0.05). However, the postprocedural AI values for CBF and SUVR were significantly lower after surgery than before surgery (P < 0.01). A significant correlation was found between the AI values for preoperative CBF and SUVR on the ipsilateral hemisphere (P < 0.01).
The present study demonstrates that a combination of ASL and F-FDG PET could be used to simultaneously analyse changes in patients' cerebral haemodynamic patterns and metabolism between before and after superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery. This therefore represents an essential tool for the evaluation of critical haemodynamic and metabolic status in patients with symptomatic unilateral ischaemic cerebrovascular disease.
脑血流（CBF）和葡萄糖代谢是缺血性脑血管病的重要和关键因素。本研究的目的是使用定量混合 PET/MR 评估手术治疗对有症状的单侧颈内动脉/大脑中动脉狭窄闭塞性疾病的影响。
使用混合 TOF PET/MR 系统（Signa，GE Healthcare）评估 15 例缺血性脑血管病患者。在旁路手术后，通过动脉自旋标记（ASL）测量 CBF 值，并通过 F-FDG PET 测量标准化摄取比值（SUV），除梗塞面积及其对侧外。分别从同侧和对侧大脑半球的 CBF 和 SUV 计算不对称指数（AI）。将 CBF 和 SUVR 的ΔCBF 和ΔSUVR 分别计算为手术前后 CBF 和 SUVR 的百分比变化，并使用配对 t 检验确定是否发生显著变化。还使用 Spearman 秩相关比较同一区域的 CBF 与葡萄糖代谢。
分析主要表明，旁路手术后，受影响侧的 CBF 统计学上显著增加（P <0.01）。术后 SUVR 不比术前 SUVR 高（P>0.05）。然而，手术后 CBF 和 SUVR 的术后 AI 值明显低于术前（P <0.01）。术前同侧半球 CBF 和 SUVR 的 AI 值之间存在显著相关性（P <0.01）。
本研究表明，ASL 和 F-FDG PET 的组合可用于同时分析患者大脑血液动力学模式和 STA-MCA 旁路手术后的代谢变化。因此，这是评估有症状的单侧缺血性脑血管病患者关键血液动力学和代谢状态的重要工具。
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