Lauriero F, Federico F, Rubini G, Conte C, Simone I, Inchingolo V, d'Addabbo A
Department of Nuclear Medicine, University of Bari, Italy.
Nucl Med Commun. 1996 Feb;17(2):140-6. doi: 10.1097/00006231-199602000-00008.
Brain 99Tcm-HMPAO single photon emission tomography (SPET) and 1H-MRS (proton magnetic resonance spectroscopy) were used to determine correlations between alterations in regional cerebral blood flow (rCBF) and changes in neuronal metabolites in 21 patients (28 examinations) with ischaemic cerebral infarction examined in different phases. rCBF was determined semi-quantitatively using Lassen's linearization algorithm. SPET provided evidence of the hypoperfused site of necrosis within a few hours after the acute event and alterations in rCBF were detected in both the infarcted and diaschistic areas at all stages. 1H-MRS was used to monitor the concentration of the following metabolites: N-acetyl-aspartate (NAA), creatine and phosphocreatine (CR + PCr), compounds containing choline (Cho) and lactate (Lac). A significant correlation was found between reduction in rCBF and a fall in NAA and Cr + PCr in both the acute and chronic phases, but not during "luxury perfusion' in the subacute phase. The presence of LAC in the infarcted area up to 9 months post-ictus was totally unexpected. Simultaneous SPET and 1H-MRS thus provides additional information regarding the physiopathogenesis of cerebral ictus by clarifying the relation between alterations in rCBF and biochemical neuronal changes. We believe that NAA and Cr + PCr concentrations are the best expression of agreement between flow and metabolism in infarcted areas, particularly with regard to hypoperfused areas not clearly detectable by magnetic resonance imaging in the early post-ictus stage.
采用脑99锝-六甲基丙二胺肟单光子发射断层扫描（SPET）和氢质子磁共振波谱（1H-MRS），对21例不同阶段的缺血性脑梗死患者（共28次检查），测定局部脑血流量（rCBF）改变与神经元代谢物变化之间的相关性。使用拉森线性化算法对rCBF进行半定量测定。SPET显示，急性事件发生后数小时内坏死区域存在灌注不足，且在所有阶段梗死区和远隔性损害区均检测到rCBF改变。1H-MRS用于监测以下代谢物的浓度：N-乙酰天门冬氨酸（NAA）、肌酸和磷酸肌酸（CR+PCr）、含胆碱化合物（Cho）和乳酸（Lac）。在急性期和慢性期均发现rCBF降低与NAA及Cr+PCr下降之间存在显著相关性，但在亚急性期的“奢侈灌注”期间未发现这种相关性。梗死区在发病后9个月内均存在LAC，这完全出乎意料。因此，同步进行SPET和1H-MRS可通过阐明rCBF改变与神经元生化变化之间的关系，提供有关脑梗死病理生理机制的额外信息。我们认为，NAA和Cr+PCr浓度是梗死区域血流与代谢一致性的最佳表现形式，尤其是对于发病早期磁共振成像难以清晰检测到的灌注不足区域而言。
