[乙酰唑胺负荷99mTc-HMPAO SPECT对慢性脑动脉闭塞患者灌注储备的术前及术后评估：与PET的对比研究]

[Pre and post operative evaluation of the perfusion reserve by acetazolamide 99mTc-HMPAO SPECT in patients with chronic occlusive cerebral arteries: a comparative study with PET].

作者信息

Kuwabara Y, Ichiya Y, Sasaki M, Akashi Y, Yoshida T, Fukumura T, Masuda K, Fujii K, Fukui M

机构信息

Department of Radiology, Kyushu University, Fukuoka, Japan.

出版信息

Kaku Igaku. 1994 Sep;31(9):1039-50.

PMID:7967187

Abstract

We studied the pre and post-operative perfusion reserve using Diamox 99mTc-HMPAO SPECT in 7 patients with chronic occlusive cerebral arteries and then compared the results with PET. STA-MCA anastomosis was performed on 5 patients, while a carotid endarterectomy was done on 2 patients. The cerebral blood flow, the vascular response to CO2 or Diamox, the oxygen extraction fraction and transit time (CBV/CBF) were measured by PET. In the pre-operative state, the visual evaluations for hypoperfusion area at rest were agreed in 5 out of 7 patients in HMPAO SPECT and PET studies. In the remaining 2 patients, hypoperfusion areas were only detected in the PET study. The pre-operative evaluation of perfusion reserve was agreed in 2 patients. In the remaining 5 patients, 3 patients showed definite positive(++) in PET and positive(+) in HMPAO SPECT, and one patient showed positive (+) in PET and negative (-) in HMPAO SPECT. The post-operative change of hypoperfusion areas was well agreed in HMPAO SPECT and PET studies. However, the change of perfusion reserve was underestimated in HMPAO SPECT compared with PET. In the semiquantitative and quantitative analyses, the count rate ratios (affected/unaffected side) in HMPAO SPECT were apparently higher than those of CBF in PET. The postoperative change of the count rate ratios in HMPAO SPECT were smaller than those of CBF in PET. There was no significant correlation between the change in the ratio of the HMPAO SPECT after the administration of Diamox and the oxygen extraction fraction, and it was thus thought to be impossible to predict the areas with an increased oxygen extraction fraction. Thus, Diamox HMPAO SPECT may underestimate the areas of hypoperfusion or decrease in perfusion reserve when compared with PET. We should consider these limitations in the evaluation of pre and post operative cerebral hemodynamics.

摘要

我们使用乙酰唑胺99mTc-HMPAO单光子发射计算机断层扫描（SPECT）研究了7例慢性闭塞性脑动脉患者术前和术后的灌注储备，然后将结果与正电子发射断层扫描（PET）进行比较。5例患者进行了颞浅动脉-大脑中动脉吻合术，2例患者进行了颈动脉内膜切除术。通过PET测量脑血流量、血管对二氧化碳或乙酰唑胺的反应、氧摄取分数和通过时间（脑血容量/脑血流量）。在术前状态下，7例患者中有5例在HMPAO SPECT和PET研究中对静息时低灌注区域的视觉评估一致。在其余2例患者中，仅在PET研究中检测到低灌注区域。2例患者术前灌注储备评估一致。在其余5例患者中，3例在PET中显示明确阳性（++），在HMPAO SPECT中显示阳性（+），1例在PET中显示阳性（+），在HMPAO SPECT中显示阴性（-）。HMPAO SPECT和PET研究中低灌注区域的术后变化高度一致。然而，与PET相比，HMPAO SPECT中灌注储备的变化被低估。在半定量和定量分析中，HMPAO SPECT中的计数率比值（患侧/健侧）明显高于PET中的脑血流量比值。HMPAO SPECT中计数率比值的术后变化小于PET中的脑血流量比值。乙酰唑胺给药后HMPAO SPECT比值的变化与氧摄取分数之间无显著相关性，因此认为无法预测氧摄取分数增加的区域。因此，与PET相比，乙酰唑胺HMPAO SPECT可能低估低灌注区域或灌注储备的降低。在评估术前和术后脑血流动力学时，我们应考虑这些局限性。