de Bray J M, Le Jeune J J, Pourcelot L, Saumet J L, Jallet P
Laboratory of Physiology, Faculté de Médecine, Chu Angers, France.
Br J Radiol. 1994 Jun;67(798):540-5. doi: 10.1259/0007-1285-67-798-540.
The purpose of this study was to compare transcranial Doppler sonography (TCD) and 99Tcm-HMPAO cerebral scintigraphy in detecting the effects of acute intracranial hypertension by pressure transmission using a previously validated model. In 20 New Zealand rabbits, cerebral blood flow velocities of basilar artery and carotid siphon were simultaneously monitored in baseline conditions and during acute intracranial hypertension by pressure transmission. This hypertension was induced by progressive steps of 5 mmHg, for a 5 min duration by elevating a saline infusion bottle connected to the subdural space. In baseline conditions, significant correlations were found between basilar artery resistive index and 99Tcm-HMPAO uptake in brain stem, r = 0.5 (p < 0.05) and posterior cerebral areas, r = 0.78 (p < 0.001). Severe intracranial hypertension equal to the diastolic arterial pressure with a cerebral perfusion pressure of 22.8 +/- 12.7 mmHg significantly decreased the basilar artery blood flow velocities and global 99Tcm-HMPAO cerebral uptake. At this level of intracranial pressure, few correlations between the two methods were observed. TCD detected relatively high blood-flow velocities in the carotid siphon appearing to result from proximal cerebral artery vasospasm. Transcranial pulsed Doppler provides data about haemodynamic changes such as hypoperfusion, vascular resistance increase in the basilar artery territory and vasospasm of the carotid siphon. 99Tcm-HMPAO scintigraphy, which has not yet been studied during intracranial hypertension, gave immediate information on local cerebral perfusion. Cerebral scintigraphy demonstrated a significant diffuse and heterogeneous decrease in cerebral blood flow, without dissociation between supratentorial and infratentorial territories, and tissue perfusion deficit owing to arterial vasospasm. TCD provides emergency investigation in patients with severe head injuries or hydrocephalus. 99Tcm-HMPAO complements TCD in cases of vasospasm and in determining an area of perfusion tissue deficit.
本研究的目的是使用先前验证的模型，通过压力传递比较经颅多普勒超声（TCD）和99锝-六甲基丙烯胺肟（99Tcm-HMPAO）脑闪烁显像在检测急性颅内高压影响方面的效果。在20只新西兰兔中，在基线条件下以及通过压力传递诱导急性颅内高压期间，同时监测基底动脉和颈动脉虹吸部的脑血流速度。通过升高连接至硬膜下腔的生理盐水输液瓶，以5 mmHg的递增步长诱导这种高血压，持续5分钟。在基线条件下，发现基底动脉阻力指数与脑干中99Tcm-HMPAO摄取之间存在显著相关性，r = 0.5（p < 0.05），与大脑后部区域之间存在显著相关性，r = 0.78（p < 0.001）。等于舒张压的严重颅内高压，脑灌注压为22.8 +/- 12.7 mmHg，显著降低了基底动脉血流速度和整体99Tcm-HMPAO脑摄取。在这个颅内压水平，两种方法之间几乎没有观察到相关性。TCD检测到颈动脉虹吸部血流速度相对较高，这似乎是由近端脑动脉血管痉挛引起的。经颅脉冲多普勒提供有关血流动力学变化的数据，如灌注不足、基底动脉区域血管阻力增加和颈动脉虹吸部血管痉挛。99Tcm-HMPAO闪烁显像在颅内高压期间尚未进行研究，它能立即提供有关局部脑灌注的信息。脑闪烁显像显示脑血流显著弥漫性和异质性减少，幕上和幕下区域之间无分离，且由于动脉血管痉挛导致组织灌注不足。TCD为重度颅脑损伤或脑积水患者提供紧急检查。99Tcm-HMPAO在血管痉挛病例以及确定灌注组织缺损区域方面补充了TCD。
