使用脑灌注单光子发射计算机断层扫描（SPECT）分析头晕患者局部脑灌注损伤与步态和平衡表现的相关性：基于体素的初步样本分析
Association of regional cerebral perfusion impairment with gait and balance performance in dizzy patients using brain perfusion SPECT: Voxel-based analysis of a pilot sample.
作者信息
Nemati Reza, Nayeri Mohamad Ali, Chabi Negar, Akbari Zahra, Jafari Esmail, Shooli Hossein, Dadgar Habibollah, Assadi Majid
机构信息
Department of Neurology, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
The Persian Gulf Nuclear Medicine Research Center, Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, School of Medicine , Bushehr University of Medical Sciences, Bushehr, Iran.
出版信息
Asia Ocean J Nucl Med Biol. 2021 Spring;9(2):123-130. doi: 10.22038/AOJNMB.2021.54974.1377.
OBJECTIVES
The purpose of this study was to investigate regional cerebral blood flow (rCBF) reduction in patients with dizziness and perfusion-related clinical impairment using brain perfusion single photon emission tomography (SPECT).
METHODS
Thirty-four patients with subjective dizziness and 13 age- and sex-matched healthy controls were studied. Dizziness-related impairments were assessed using the Dizziness Handicap Inventory (DHI) and Short Physical Performance Battery (SPPB). Brain perfusion SPECT scan was acquired from all participants. The carotid intima-media thickness (CIMT) was also measured. Brain perfusion data were qualitatively interpreted in all cases. Voxel-wise analysis was also conducted in 11 patients compared to healthy controls.
RESULTS
Thirty-four patients (mean age=53.8±13.4 years, m/f: 19/15) and 13 age- and sex-matched controls (mean age=51.5±13.1, m/f: 7/6) were included. The dizziness severity was mild in 58.8% (n=20), moderate in 26.5% (n=9), and severe in 14.7% (n=5). Qualitative interpretation of SPECT images showed normal scans in 4 (11.2%) patients and abnormal scans in 30 (88.2%) patients. Patients with dizziness showed a significantly decreased brain perfusion in the precuneus, cuneus, occipital lobe (superior and inferior parts), frontal lobe (inferior and middle parts), temporal lobe, parietal lobe (inferior and superior parts), cerebellum, insula, and putamen nucleus. Based on both qualitative SPECT interpretation and voxel-wise analysis, perfusion defect had a significant association with the total SPPB score and the scores of two sub-domains (p<0.05), but not with the DHI (p>0.05) score.
CONCLUSION
The perfusion- and atherosclerosis-related impairments of gait and balance were largely independent of subjective dizziness and dizziness severity. Moreover, this study provided support for contribution of perfusion impairment to the disturbance of gait and balance in older populations along with other pathologic processes.
目的
本研究旨在利用脑灌注单光子发射断层扫描（SPECT），调查头晕及灌注相关临床损害患者的局部脑血流量（rCBF）减少情况。
方法
对34例主观头晕患者和13例年龄及性别匹配的健康对照者进行研究。使用头晕残障量表（DHI）和简短体能状况量表（SPPB）评估与头晕相关的损害。对所有参与者进行脑灌注SPECT扫描。还测量了颈动脉内膜中层厚度（CIMT）。对所有病例的脑灌注数据进行定性分析。与健康对照者相比，还对11例患者进行了体素分析。
结果
纳入34例患者（平均年龄=53.8±13.4岁，男/女：19/15）和13例年龄及性别匹配的对照者（平均年龄=51.5±13.1岁，男/女：7/6）。头晕严重程度为轻度的占58.8%（n=20），中度的占26.5%（n=9），重度的占14.7%（n=5）。SPECT图像的定性分析显示，4例（11.2%）患者扫描正常，30例（88.2%）患者扫描异常。头晕患者在楔前叶、楔叶、枕叶（上部和下部）、额叶（下部和中部）、颞叶、顶叶（下部和上部）、小脑、岛叶和壳核的脑灌注明显降低。基于SPECT定性分析和体素分析，灌注缺损与SPPB总分及两个子领域的得分显著相关（p<0.05），但与DHI得分无关（p>0.05）。
结论
与灌注和动脉粥样硬化相关的步态及平衡损害在很大程度上独立于主观头晕及头晕严重程度。此外，本研究为灌注损害连同其他病理过程对老年人群步态及平衡障碍的作用提供了支持。
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