Lee J D, Kim D I, Ryu Y H, Whang G J, Park C I, Kim D G
Department of Diagnostic Radiology, Yonsei University Medical College, Seoul, Korea.
J Nucl Med. 1998 Apr;39(4):619-23.
Hypoxic brain injury is one of the major causes of cerebral palsy. Therefore, this study was performed to evaluate cerebral perfusion impairments in these patients using 99mTc-ECD brain SPECT.
Fifty-one patients (31 boys, 20 girls; age range 6 mo to 6 yr, 11 mo) with clinical manifestations of cerebral palsy underwent brain SPECT after intravenous injection of 99mTc-ECD. The clinical subtypes of cerebral palsy were spastic diplegia (n = 35), spastic quadriplegia (n = 11), spastic hemiparesis (n = 2), choreoathetoid (n = 2) and mixed (n = 1). Transaxial, coronal and sagittal images obtained with a brain-dedicated annular crystal gamma camera were qualitatively analyzed and compared with the findings of magnetic resonance imaging (MRI).
In SPECT, thalamic hypoperfusion was seen in all patients except one (98%), followed by hypoperfusion in the temporal lobe (52.9%, n = 27), basal ganglia (41.2%, n = 21), cerebellum (39.2%, n = 20) and extratemporal cortices (21.6%, n = 11). However, MR imaging demonstrated thalamic abnormality in seven (13.7%), basal ganglia in two (3.9%), extratemporal cortical defect in five (9.8%) and cerebellar atrophy in one (1.9%). Instead, white matter changes such as periventricular leukomalacia or ischemia (56.9%, n = 25) and thinning of corpus callosum (49%, n = 25) were the major findings.
Brain SPECT is useful in the diagnosis of cerebral palsy and is more sensitive in the detection of cortical, subcortical nuclei and cerebellar abnormalities. MRI is superior in the detection of white matter changes.
缺氧性脑损伤是脑瘫的主要病因之一。因此，本研究旨在使用99mTc-ECD脑单光子发射计算机断层扫描（SPECT）评估这些患者的脑灌注损伤情况。
51例有脑瘫临床表现的患者（31例男孩，20例女孩；年龄范围6个月至6岁11个月）在静脉注射99mTc-ECD后接受脑SPECT检查。脑瘫的临床亚型为痉挛性双瘫（n = 35）、痉挛性四肢瘫（n = 11）、痉挛性偏瘫（n = 2）、舞蹈手足徐动型（n = 2）和混合型（n = 1）。使用脑专用环形晶体γ相机获得的横断面、冠状面和矢状面图像进行定性分析，并与磁共振成像（MRI）结果进行比较。
在SPECT检查中，除1例患者外所有患者均可见丘脑灌注不足（98%），其次是颞叶灌注不足（52.9%，n = 27）、基底神经节灌注不足（41.2%，n = 21）、小脑灌注不足（39.2%，n = 20）和颞叶外皮质灌注不足（21.6%，n = 11）。然而，MRI显示7例（13.7%）丘脑异常、2例（3.9%）基底神经节异常、5例（9.8%）颞叶外皮质缺损和1例（1.9%）小脑萎缩。相反，主要发现为脑室周围白质软化或缺血等白质改变（56.9%，n = 25）和胼胝体变薄（49%，n = 25）。
脑SPECT对脑瘫的诊断有用，在检测皮质、皮质下核团和小脑异常方面更敏感。MRI在检测白质改变方面更具优势。
