Volpe J J, Herscovitch P, Perlman J M, Raichle M E
Pediatrics. 1983 Nov;72(5):589-601.
Of all patients with intraventricular hemorrhage, those with hemorrhagic intracerebral involvement exhibit the highest rates of mortality and neurologic morbidity and, indeed, account for the vast majority of all neurologic impairment in infants with intraventricular hemorrhage. Insight into the basic nature of the critical cerebral involvement requires determination of regional cerebral blood flow, previously not possible. Positron emission tomography (PET) now provides the capability of measuring regional cerebral blood flow with high resolution and little risk. In this study, we utilized PET in six premature infants (920 to 1,200 g) with major intraventricular hemorrhage and hemorrhagic intracerebral involvement to measure regional cerebral blood flow during the acute period (5 to 17 days of age). Cerebral blood flow was determined after intravenous injection of H2O, labeled with the positron-emitting isotope, 15O (oxygen 15). Findings were similar and dramatic in all six infants. In the area of hemorrhagic intracerebral involvement, little or no cerebral blood flow was detected. However, in addition, surprisingly, a marked two- to fourfold reduction in cerebral blood flow was observed throughout the affected hemisphere, well posterior and lateral to the intracerebral hematoma, including cerebral white matter and, to a lesser extent, frontal, temporal, and parietal cortex. In the one infant studied a second time, ie, at 3 months of age, the extent and severity of the decreased cerebral blood flows in the affected hemisphere were similar to those observed on the study during the neonatal period. At the three autopsies, the affected left hemisphere showed extensive infarction, corroborating the PET scans. These observations, the first demonstration of the use of PET in the determination of regional cerebral blood flow in the newborn, show marked impairments in regional cerebral blood flow in the hemisphere containing an apparently restricted intracerebral hematoma, indicating that the hemorrhagic intracerebral involvement is only a component of a much larger lesion, ischemic in basic nature, ie, an infarction. This large ischemic lesion explains the poor neurologic outcome in infants with intraventricular hemorrhage and hemorrhagic intracerebral involvement.
在所有脑室内出血的患者中，伴有出血性脑实质受累的患者死亡率和神经功能障碍发生率最高，事实上，在脑室内出血的婴儿中，绝大多数神经功能损害都是由这类患者导致的。要深入了解关键脑实质受累的基本性质，需要测定局部脑血流量，而这在以前是无法做到的。正电子发射断层扫描（PET）现在能够以高分辨率且低风险的方式测量局部脑血流量。在本研究中，我们对6名患有严重脑室内出血和出血性脑实质受累的早产儿（体重920至1200克）进行了PET检查，以测量急性期（出生后5至17天）的局部脑血流量。在静脉注射用正电子发射同位素15O（氧15）标记的H2O后测定脑血流量。所有6名婴儿的检查结果都相似且很显著。在出血性脑实质受累区域，几乎检测不到脑血流量或完全没有脑血流量。然而，令人惊讶的是，在整个受累半球，即脑内血肿后方和外侧较远的区域，包括脑白质以及程度较轻的额叶、颞叶和顶叶皮质，脑血流量显著减少了两到四倍。在对其中一名婴儿进行的第二次检查中，即在其3个月大时，受累半球脑血流量减少的范围和严重程度与新生儿期检查时观察到的相似。在三次尸检中，受累的左半球显示出广泛的梗死，这证实了PET扫描的结果。这些观察结果是首次证明PET可用于测定新生儿局部脑血流量，显示出在含有明显局限性脑内血肿的半球中局部脑血流量有显著损害，表明出血性脑实质受累只是一个更大病变的一部分，其本质是缺血性的，即梗死。这种大面积的缺血性病变解释了脑室内出血和出血性脑实质受累婴儿神经功能预后不良的原因。
