Denays R, VanPachterbeke T, Toppet V, Tondeur M, Spehl M, Piepsz A, Noël P, Haumont D, Ham H R
Department of Neurology, St-Pierre Hospital, Free University of Brussels, Belgium.
J Nucl Med. 1993 Aug;34(8):1223-7.
In infants who have experienced prenatal or perinatal injury, it is often difficult, on the basis of clinical examination and conventional investigations (electroencephalogram, cranial ultrasound scan), to diagnose those with brain damage and to predict the type and the severity of subsequent neurological handicaps. We investigated the predictive value of 99mTc-HMPAO brain SPECT performed in the first weeks of life in high-risk neonates. Right-left asymmetries in tracer uptake had no predictive value, regardless of their localization or severity. On the other hand, a change in antero-posterior rCBF distribution was found in 7/10 of neonates with adverse outcome (death, major neurological sequelae) and in none of the 78 neonates with no major motor neurological sequelae. Compared to conventional investigations, 99mTc-HMPAO brain SPECT did not provide additional predictive information when neurological examination, electroencephalogram and cranial ultrasonography were all normal or all abnormal. Conversely, in the 30 patients with anomalies on one or two of the above investigations, SPECT showed an abnormal antero-posterior pattern in 4/6 neonates with major neurological sequelae and no change in the antero-posterior rCBF distribution in the 24 infants who developed normally. In conclusion, our results suggest that 99mTc-HMPAO brain SPECT, when performed in the first weeks of life, can be useful in high-risk neonates to predict occurrence of major neurological handicaps. Because of the relative invasive character of HMPAO scan in neonates and the overall accuracy of the noninvasive tests, radionuclide examination should not be performed in every high-risk neonate. According to our results, 99mTc-HMPAO brain SPECT might be indicated in those children where noncongruent results were obtained with conventional studies.
对于经历过产前或围产期损伤的婴儿，基于临床检查和传统检查（脑电图、头颅超声扫描）往往很难诊断出脑损伤患儿，也难以预测随后神经功能障碍的类型和严重程度。我们研究了在高危新生儿出生后第一周内进行的99mTc-HMPAO脑单光子发射计算机断层扫描（SPECT）的预测价值。示踪剂摄取的左右不对称性无论其定位或严重程度如何均无预测价值。另一方面，在10例预后不良（死亡、严重神经后遗症）的新生儿中，有7例发现前后脑血流灌注分布发生变化，而在78例无严重运动神经后遗症的新生儿中均未发现这种变化。与传统检查相比，当神经检查、脑电图和头颅超声检查均正常或均异常时，99mTc-HMPAO脑SPECT并未提供额外的预测信息。相反，在上述一项或两项检查有异常的30例患者中，SPECT显示，在6例有严重神经后遗症的新生儿中有4例前后模式异常，而在24例发育正常的婴儿中前后脑血流灌注分布无变化。总之，我们的结果表明，在高危新生儿出生后第一周内进行99mTc-HMPAO脑SPECT，有助于预测严重神经功能障碍的发生。由于HMPAO扫描对新生儿具有相对侵入性，且非侵入性检查总体准确性较高，因此不应在每个高危新生儿中都进行放射性核素检查。根据我们的结果，对于传统检查结果不一致的儿童，可能需要进行99mTc-HMPAO脑SPECT检查。
