Kimura T, Shinoda J, Funakoshi T, Yano H, Sawada M
Department of Neurosurgery, Daiyukai General Hospital.
No Shinkei Geka. 1994 Jun;22(6):525-30.
PURPOSE Quantitative measurement of regional cerebral blood flow (rCBF) needs special equipment or invasive blood sampling. Therefore, with a popularly used rotating gamma camera, we tried to establish a convenient modality of qualitative evaluation of hemodynamics in patients with atherosclerotic large-artery disease, according to the distribution pattern of isotope-uptake on SPECT image. PATIENTS AND METHODS Forty-one patients with atherosclerotic large-artery disease [9 internal carotid artery (ICA) stenosis, 17 ICA occlusion, 8 middle cerebral artery (MCA) stenosis, and 7 MCA occlusion] and 32 control patients documented as having small cerebral infarction without atherosclerotic large-artery disease were investigated. Using the rotating gamma camera, they underwent 123I-IMP SPECT at baseline and after acetazolamide loading. According to the distribution pattern of low isotope-uptake, early images were classified into four types: Type I: no low uptake, Type II: low uptake in a single watershed, Type III: low uptake in two watersheds with or without a partial MCA territory, Type IV: low uptake in a whole MCA territory. RESULT In patients with large-artery disease, baseline images presented Type I in 12 cases, Type II in 16, Type III in 9, Type IV in 4, and loading images Type I in 3, Type II in 2, Type III in 8, Type IV in 28. Of 37 patients except for 4 belonging to Type IV at baseline, 32 (86.5%) had a more extensive low isotope-uptake area after acetazolamide loading than at baseline. In control patients, baseline images presented Type I in 25, Type II in 7, and the Type III & IV in 0, and the Type after loading was the same as the Type at baseline. CONCLUSION We established the qualitative evaluation of 123I-IMP SPECT image by detecting the "extent" of the ischemic region, taking notice of watershed. The pathognomonic findings on SPECT image of atherosclerotic large-artery disease showed that low isotope-uptake area at baseline extended into two watersheds or MCA territory by acetazolamide loading. The modality of qualitative evaluation based on these pathognomic findings of SPECT image may be useful for easily assessing patients with atherosclerotic large-artery disease using a rotating gamma camera.
目的 定量测量局部脑血流量（rCBF）需要特殊设备或进行有创性血液采样。因此，我们使用常用的旋转γ相机，根据单光子发射计算机断层扫描（SPECT）图像上同位素摄取的分布模式，尝试建立一种方便的方法来定性评估动脉粥样硬化性大动脉疾病患者的血流动力学。
患者与方法 对41例动脉粥样硬化性大动脉疾病患者[9例颈内动脉（ICA）狭窄、17例ICA闭塞、8例大脑中动脉（MCA）狭窄和7例MCA闭塞]以及32例经记录为患有小面积脑梗死且无动脉粥样硬化性大动脉疾病的对照患者进行了研究。使用旋转γ相机，他们在基线时和乙酰唑胺负荷后接受了123I-异碘普胺（123I-IMP）SPECT检查。根据低同位素摄取的分布模式，早期图像被分为四种类型：I型：无低摄取；II型：单个分水岭区低摄取；III型：两个分水岭区低摄取，有或无部分MCA区域；IV型：整个MCA区域低摄取。
结果 在大动脉疾病患者中，基线图像I型12例、II型16例、III型9例、IV型4例，负荷后图像I型3例、II型2例、III型8例、IV型28例。在37例基线时不属于IV型的患者中，32例（86.5%）在乙酰唑胺负荷后低同位素摄取区域比基线时更广泛。在对照患者中，基线图像I型25例、II型7例，III型和IV型0例，负荷后类型与基线时相同。
结论 我们通过检测缺血区域的“范围”并注意分水岭，建立了123I-IMP SPECT图像的定性评估方法。动脉粥样硬化性大动脉疾病SPECT图像的特征性表现为，基线时低同位素摄取区域在乙酰唑胺负荷后扩展至两个分水岭区或MCA区域。基于这些SPECT图像特征性表现的定性评估方法，可能有助于使用旋转γ相机轻松评估动脉粥样硬化性大动脉疾病患者。
