Abdel-Dayem H M, Abu-Judeh H, Kumar M, Atay S, Naddaf S, El-Zeftawy H, Luo J Q
Department of Radiology, St. Vincent's Hospital and Medical Center of New York, New York 10011, USA.
Clin Nucl Med. 1998 May;23(5):309-17. doi: 10.1097/00003072-199805000-00009.
The purpose of this atlas is to present a review of the literature showing the advantages of SPECT brain perfusion imaging (BPI) in mild or moderate traumatic brain injury (TBI) over other morphologic imaging modalities such as x-ray CT or MRI. The authors also present the technical recommendations for SPECT brain perfusion currently practiced at their center. For the radiopharmaceutical of choice, a comparison between early and delayed images using Tc-99m HMPAO and Tc-99m ECD showed that Tc-99m HMPAO is more stable in the brain with no washout over time. Therefore, the authors feel that Tc-99m HMPAO is preferable to Tc-99m ECD. Recommendations regarding standardizing intravenous injection, the acquisition, processing parameters, and interpretation of scans using a ten grade color scale, and use of the cerebellum as the reference organ are presented. SPECT images of 228 patients (age range, 11 to 88; mean, 40.8 years) with mild or moderate TBI and no significant medical history that interfered with the results of the SPECT BP were reviewed. The etiology of the trauma was in the following order of frequency: motor vehicle accidents (45%) followed by blow to the head (36%) and a fall (19%). Frequency of the symptoms was headache (60.9%), memory problems (27.6%), dizziness (26.7%), and sleep disorders (8.7%). Comparison between patients imaged early (<3 months) versus those imaged delayed (>3 months) from the time of the accident, showed that early imaging detected more lesions (4.2 abnormal lesions per study compared to 2.7 in those imaged more than 3 months after the accident). Of 41 patients who had mild traumatic injury without loss of consciousness and had normal CT, 28 studies were abnormal. Focal areas of hypoperfusion were seen in 77% (176 patients, 612 lesions) of the group of 228 patients. The sites of abnormalities were in the following order: basal ganglia and thalami, 55.2%, frontal lobes, 23.8%, temporal lobes, 13%, parietal, 3.7%, insular and occipital lobes together, 4.6%.
本图谱的目的是对文献进行综述，以展示单光子发射计算机断层扫描（SPECT）脑灌注成像（BPI）在轻度或中度创伤性脑损伤（TBI）中相对于其他形态学成像方式（如X线计算机断层扫描（CT）或磁共振成像（MRI））的优势。作者还介绍了他们中心目前所采用的SPECT脑灌注技术建议。对于所选放射性药物，使用锝-99m六甲基丙烯胺肟（Tc-99m HMPAO）和锝-99m双半胱乙酯（Tc-99m ECD）的早期和延迟图像比较显示，Tc-99m HMPAO在脑中更稳定，不会随时间洗脱。因此，作者认为Tc-99m HMPAO比Tc-99m ECD更可取。文中给出了关于标准化静脉注射、采集、处理参数以及使用十级彩色量表解读扫描结果，以及将小脑作为参考器官的建议。回顾了228例轻度或中度TBI患者（年龄范围11至88岁；平均40.8岁）且无显著病史干扰SPECT脑灌注结果的SPECT图像。创伤病因按发生频率依次为：机动车事故（45%），其次是头部撞击（36%）和跌倒（19%）。症状出现频率依次为头痛（60.9%）、记忆问题（27.6%）、头晕（26.7%）和睡眠障碍（8.7%）。对事故发生后早期（<3个月）成像的患者与延迟（>3个月）成像的患者进行比较，结果显示早期成像检测到的病变更多（每项研究平均有4.2个异常病变，而事故发生3个月后成像的患者平均为2.7个）。在41例轻度创伤且未昏迷且CT正常的患者中，28项研究结果异常。在228例患者组中，77%（176例患者，612个病变）可见灌注减低的局灶区域。异常部位依次为：基底节和丘脑，55.2%；额叶，23.8%；颞叶，13%；顶叶，3.7%；岛叶和枕叶共占4.6%。
