^123I—IomazenilSPECT脑受体显像对癫痫灶定位的价值

目的探讨１２３ＩＩｏｍａｚｅｎｉｌＳＰＥＣＴ脑受体显像对癫痫灶定位诊断的价值。方法对４０例癫痫病人进行１２３ＩＩｏｍａｚｅｎｉｌＳＰＥＣＴ脑受体显像，并与录像脑电图强化监测（Ｖｉｄｅｏ／ＥＥＧ）、９９ｍＴｃ六甲基丙二胺肟（ＨＭＰＡＯ）ＳＰＥＣＴ脑血流显像和ＭＲＩ检查结果进行对比分析。结果以Ｖｉｄｅｏ／ＥＥＧ癫痫灶检出率９５％（３８／４０）为参照标准，６５８％（２５／３８）癫痫病人脑受体显像异常，表现为局部放射性稀疏，与Ｖｉｄｅｏ／ＥＥＧ定位符合２０例；脑血流显像和ＭＲＩ癫痫灶检出率分别为５５３％（２１／３８）和４７４％（１８／３８），与Ｖｉｄｅｏ／ＥＥＧ定位符合分别为１５例和１６例。１２３ＩＩｏｍａｚｅｎｉｌ脑受体显像联合ＭＲＩ检查，癫痫灶检出率为８４２％（３２／３８）。４例ＭＲＩ、脑血流和受体显像正常患者１８Ｆ脱氧葡萄糖（ＦＤＧ）ＰＥＴ显像全部异常，并均与Ｖｉｄｅｏ／ＥＥＧ定位符合。结论１２３ＩＩｏｍａｚｅｎｉｌＳＰＥＣＴ脑受体显像是癫痫病灶定位的有效方法，与ＭＲＩ配合，能提高病灶检出率。     

儿童良性部分性癫痫SPECT显像特点

目的探讨儿童良性部分性癫痫（ＢＰＥ）的ＳＰＥＣＴ显像特点。方法２１例ＢＰＥ患儿，在ＥＥＧ监测下，分别在觉醒期（棘波发放间期）和睡眠期（棘波发放期）进行ＳＰＥＣＴ显像，减影处理后重建断层影像。用脑血流功能变化率（ＢＦＣＲ％）数学模型进行定量分析。结果ＥＥＧ监测显示患儿觉醒期背景活动基本正常，睡眠期棘波发放频率明显增多。ＳＰＥＣＴ共见１１７个痫灶，平均每例５６±１６个。ＳＰＥＣＴ显像特点为：①多灶性镜像分布；②主要位于Ｒｏｌａｎｄｉｃ区；③“环形征”；④觉醒期的多处放射性减低区，睡眠期放射性明显填充。ＳＰＥＣＴ与ＥＥＧ的符合率为９３１％（１０９／１１７）。痫灶的ＢＦＣＲ％皆高于对应正常局部脑自然变化的范围（９９％可信区间）。棘波发放频率和ＢＦＣＲ％之间无相关性（ｒ＝０４５，Ｐ＞００５）。结论ＢＰＥ痫灶异常放电时，可致局部脑血流灌注和功能异常     

脑外伤后综合征的SPECT显像初步观察

脑外伤后综合征发病机理尚不十分清楚，本研究通过４２例临床诊断为脑外伤后综合征患者的脑ＳＰＥＣＴ显像和其他辅助诊断技术及病理资料等，探讨其发病机理。结果发现４２例患者中有３３例ＳＰＥＣＴ显像呈异常表现，占７８．６％。３３例脑ＳＰＥＣＴ显像异常患者中１３例呈多发性放射性减低灶，这提示脑外伤后综合征的发病有其病理、生理基础，而且和脑血流灌注关系密切。并且提示脑外伤后，脑实质的损害还有可能为弥漫性的，并不     

高血压脑出血后失语症与局部脑血流变化的相关研究

目的探寻失语患者的脑血流动态变化特点及其与临床转归的关系。方法对３２例优势侧高血压脑出血患者进行语言功能测定，并行ＳＰＥＣＴ局部脑血流（ｒＣＢＦ）显像及ＣＴ检查，利用感兴趣区技术测定病灶及对侧相应部位的ｒＣＢＦ比值。结果①失语者１９例，非失语者１３例。②血肿量及出血部位与失语有一定关系。③ＣＴ仅发现出血病灶，ＳＰＥＣＴ则显示多部位大脑皮层的低灌注损害，失语组为著，额颞叶累及达１００％。④失语组Ｂｒｏｃａ区及Ｗｅｒｎｉｃｋｅ区的ｒＣＢＦ比值明显低于非失语组（ｔ＝４３１，５５２，Ｐ＜０００１）。不同型失语Ｗｅｒｎｉｃｋｅ区ｒＣＢＦ降低程度有差异，感觉性失语者ｒＣＢＦ降低更明显（ｔ＝２５３，Ｐ＜００５）。⑤１０例失语者经病后１周、１个月及３个月临床病情和ＳＰＥＣＴ及ＣＴ随访，其中５例失语基本恢复，５例恢复较差。前者大脑皮层各时期ｒＣＢＦ比值顺时增大，以第１个月内最明显；后者则无显著改善。结论ＳＰＥＣＴｒＣＢＦ断层显像可为临床准确诊断失语提供客观依据，且有助于分型及预后评估，明显优于ＣＴ检查     

SPECT脑血流灌注显像在老年人脑梗塞中的应用

目的：评价ＳＰＥＣＴ脑血流灌注显像在老年病中的临床应用价值。材料和方法：４６例脑梗塞患者行９９ｍＴｃ－ＥＣＤ脑血流灌注显像，并与ＣＴ、ＭＲＩ、对照。其中４例行Ｄｉａｍｏｘ脑血流负荷检查。结果：４６例脑梗塞患者４５例脑血流灌注异常，占９７．８％．３３例同时做过ＣＴ，其灵敏度９６．７％．２５例做过ＭＲＩ，灵敏度９６％。ＳＰＥＣＴ脑血流显像灵敏度与ＣＴ及与ＭＲＩ间无显著性差异（Ｐ＞０．０５）。７例ＳＰＥＣＴ图像上出现＂交叉性小脑神经失联络征＂。４例行Ｄｉａｍｏｘ脑血流负荷检查，１例原梗塞灶血流明显改善；两例显示病灶范围更广泛；另１例除小脑血流分布改善外．余处未见明显改变。４例中３例有＂交叉性小脑神经失联络征＂，使用Ｄｉａｍｏｘ后小脑血流改善。结论：本组病例ＳＰＥＣＴ灵敏度与ＣＴ及ＭＲＩ无显著差异；ＳＰＥＣＴ脑血流灌注显像可探测梗塞后存活的脑组织，为临床治疗提供客观依据；结合Ｄｉａｍｏｘ脑血流负荷检查有望进一步提高诊断的阳性率     

核素心肌灌注显像与电子束CT诊断冠心病的对比研究

目的比较核素心肌ＳＰＥＣＴ显像与电子束ＣＴ（ＥＢＣＴ）扫描对冠心病（ＣＨＤ）的诊断价值。方法对６４例受检者（ＣＨＤ患者５０例，非ＣＨＤ患者１４例）进行了冠状动脉造影、ＳＰＥＣＴ及ＥＢＣＴ检查。结果以冠状动脉造影为金标准，ＳＰＥＣＴ与ＥＢＣＴ诊断ＣＨＤ的灵敏度相近，分别为９２０％和９４０％；ＳＰＥＣＴ的特异性（９２９％）优于ＥＢＣＴ（２８６％），Ｐ＜００５。在判断ＥＢＣＴ结果时，采用不同的钙化积分阈值，对诊断ＣＨＤ的灵敏度和特异性影响很大，故应采用接收器工作特性分析确定适当的钙化积分阈值。结论ＥＢＣＴ虽具有一定优越性，但目前尚不能取代心肌ＳＰＥＣＴ显像。     

~（99m）Tc－HMPAO SPECT在研究偏头痛中的临床应用

采用９９ｍＴｃ－ＨＭＰＡＯ　ＳＰＥＣＴ对４８例偏头痛患者做了脑灌注显像。结果显示，８５．４％患者局部脑血流灌注（ｒＣＢＦ）减低，有先兆偏头痛间歇期（ｎ＝５）ｒＣＢＦ均降低，无先兆偏头痛发作期９１．７％（ｎ＝１２）患者ｒＣＢＦ降低，而间歇期８３．９％（ｎ＝３１）患者ｒＣＢＦ降低，注射Ｓｕｍａｔｒｉｐｔａｎ治疗（ｎ＝４）后，头痛缓解后ｒＣＢＦ改善。因此，ＳＰＥＣＴ的脑灌注显像可用来评价临床偏头痛患者的脑血流状态，以及寻求针对性的治疗。     

~（99m）Tc－ECD脑SPECT显像和CT扫描对脑部疾病应用价值的对比研究

比较了脑病患者的９９ｍＴｃ-乙撑双半胱氨酸二乙酯（ＥＣＤ）脑ＳＰＥＣＴ显像和脑ＣＴ扫描结果，并对其临床意义进行初步评价．方法：２１９例脑病患者进行了９９ｍＴｃ-ＥＣＤＳＰＥＣＴ和ＣＴ检查，两者间隔时间在２周之内．结果：ＣＴ探查脑出血或梗塞、脑肿瘤和脑血肿等颅内结构性损伤非常灵敏．但不能探查到尚未引起脑结构异常的代谢和功能性损伤．９９ｍＴｃ-ＥＣＤＳＰＥＣＴ对后者的优越性很大，可以灵敏地探查到损伤部位的血流灌注变化．这在急性脑梗塞早期、短暂性缺血发作、偏头痛、痴呆、锥体外系疾病、脑外伤后遗症和癫痫病人中尤为明显．部分脑外伤和癫痫患者经保守治疗改善局部脑血流而取得显著效果．结论：９９ｍＴｃ-ＥＣＤＳＰＥＣＴ在许多脑病的诊断和治疗中可起重要作用．     

脑溢血在SPECT脑显像中表现特点初探

脑溢血在ＳＰＥＣＴ脑显像中表现特点初探彭勇，栾兆生，周雯，孙熙琴，段新华ＳＰＥＣＴ脑显像对脑血管病的诊断有较高的灵敏度，尤其对缺血性脑病（中华神经外科杂志，１９８７，３：２０７）．我们分析了７例脑溢血及２０例脑梗塞病人ＳＰＥＣＴ脑显像结果，旨在探讨脑...     

SPECT研究脑外伤后脑血流改变

ＳＰＥＣＴ研究脑外伤后脑血流改变赵群应用ＳＰＥＣＴ（单光子发射型断层显像）对２９例脑外伤患者行脑血流断层显像，以评价核素显像对脑外伤后脑血流改变的临床应用价值。１材料与方法１１研究对象正常人（对照组）１８例，男１４例，女４例，年龄３８～６３岁，平均...     

脑出血患者缺血性脑损害局部脑血流灌注的SPECT显像

目的 用SPECT技术探讨脑出血患者治疗前后继发性缺血灶局部脑血流的变化及临床意义.方法 60例脑出血患者随机分为尼莫地平组与常规治疗组,在治疗前后用SPECT显像观察原发灶缺血体积、血肿周围及脑部其他区域的脑血流灌注减低区变化.结果 尼莫地平组和常规治疗组治疗后原发灶缺血体积明显缩小,前者比后者更明显;原发灶及远隔部位缺血灶局部脑血流增加值尼莫地平组明显高于常规治疗组（P＜0.01）.结论 SPECT脑血流灌注显像可灵敏地反映治疗前后局部脑血流变化,可用于药物疗效评价.     

Cerebral perfusion SPECT in transient ischemic attack

PURPOSE: The purpose of our study is to evaluate the efficacy of cerebral perfusion single photon emission computerized tomography (SPECT) in patients with transient ischemic attack (TIA). METHODS: Thirty-seven patients with TIA were collected for study. All patients had transient focal neurological symptoms or signs with complete recovery within 24 h after onset. The patients underwent cerebral perfusion SPECT between 6 h and 11 days after onset, with 10 cases performed within 24 h (group A), nine cases performed between 1 and 3 days (group B), 11 cases performed between 3 and 5 days (group C), and seven cases performed after more than 5 days (group D). A semi-quantitative method was used for analyzing the SPECT data, and the difference ratios between lesion side and contralateral normal side were calculated on each pair of regions of interest. RESULTS: In total, 78.4% (29/37) of patients had reduced perfusion in the cerebral cortical regions or deep nuclei, and the regions with reduced perfusion corresponded with clinical presentations of the patients. The abnormal rate with reduced perfusion was 90.0% in group A, 77.8% in group B, 72.7% in group C and 71.4% in group D. Cross cerebellar diaschisis (CCD) was present in seven patients, and all of the primary cerebral perfusion defects of these patients were located at the territory of left or right middle cerebral artery. CONCLUSION: Cerebral perfusion SPECT is a potential tool to detect cerebral perfusion defects and CCD in patients with TIA. Although the perfusion defect may persist more than 5 days after onset, we suggest cerebral perfusion SPECT should be performed as soon as possible.     

脑SPECT灌注显像在老年人脑血管疾病中的应用

目的：旨在研究脑SPECT血流灌注显像对老年脑血管疾病的诊断价值。材料和方法：对132例脑血管疾病患者进行脑SPECT血流灌注显像，并将SPECT结果与MRI、CT相比较。结果：脑梗塞患者96．1％有阳性发现，有些灌注减低灶较MRI，CT显示的范围大．可能由于包括了梗塞区及周围缺血半影区的缘故。对神经机能联系不能征象进行了观察．短暂性脑缺血发作患者在发作间期有61.9%阳性．病灶与发作期临床症状相符。脑供血不足、脑动脉硬化、脑出血的阳性率分别为64.3%、80%．95.5%。结论：脑SPECT灌注显像为老年人脑血管疾病的诊断提供了客观依据，有重要应用价值。     

99mTc-MIBI心肌灌注显像在心肌缺血治疗中的指导意义

目的确定~(99m)Tc-MIBI心肌灌注显像在心肌缺血治疗中的指导意义。方法利用美国GE公司生产的双探头可变角SPECT检查了86例冠状动脉供血不足引起的心肌缺血患者,并对其中48例心肌灌注治疗前后的缺损填充或改善情况进行了观察。结果43例(89.6%)患者显像缺损填充或有明显改善,仅1例缺损填充不佳。结论~(99m)Tc-MIBI心肌灌注显像在心肌缺血治疗中有重要指导意义。     

运动康复对脑梗死局部脑血流的影响

目的　探讨99Tcm 双半胱乙酯 (ECD)局部脑血流 (rCBF)显像评价运动对偏瘫的治疗效果。方法　初发脑动脉硬化性脑梗死患者 5 9例 ,均接受运动治疗 ,其中单桥运动组 30例 ,被动运动组 2 9例。患者均于静息状态下行首次99Tcm ECDSPECT显像 ,显像结束后立即做 1次运动 ,包括单桥或下肢被动运动 ,运动结束时再次静脉注射99Tcm ECD 74 0MBq ,同一体位、同一条件下行第 2次脑显像 ,2次图像在相同条件下进行处理。以目测法、半定量分析法对其运动前后rCBF(后者以半定量值R表示 )进行比较和分析 ,并与Fugl Meyer评分和Barthel指数评定方法进行相关性分析。结果　 2组患者运动后99Tcm ECDrCBF显像均示原放射性分布稀疏缺损区有不同程度填充 ,单桥运动组较被动运动组更明显 ;2组患者运动后R值均高于运动前 (P均 <0 0 1) ,运动后单桥运动组R值比被动运动组高 ,差异有显著性 (P <0 0 1)。运动前后R改变值与 2次Fugl Meyer评分和Barthel指数评定差值间均呈正相关。结论　99Tcm ECDrCBF显像可作为判断脑梗死偏瘫患者康复的有效方法 ;单桥运动比被动运动能更好地改善病灶rCBF。     

"Luxury perfusion" with 99mTc-HMPAO and 123I-IMP SPECT imaging during the subacute phase of stroke

To compare the merits of 123I-isopropyl-iodoamphetamine (123I-IMP) and 99mTc-HMPAO in showing abnormal brain uptake distribution during cerebral ischemia, we studied ten patients during the subacute phase of their stroke, a period where metabolism and blood flow are frequently uncoupled. SPECT imaging was performed using both radiopharmaceuticals in the 10 patients from 48 h to 4 weeks after onset of symptoms. Two patients out of the 10 had similar defects with 123I-IMP and 99mTc-HMPAO SPECT, the location of the defects corresponding to the area of infarction observed on CT. Six patients had normal 99mTc-HMPAO SPECT and abnormal 123I-IMP SPECT with defects in the area of infarction shown by CT. The remaining 2 patients had hyperactive abnormalities on 99mTc-HMPAO in areas corresponding to defects on the 123I-IMP images. Two of the patients with SPECT mismatches were studied again more than 1 month after onset. On reexamination, 99mTc-HMPAO SPECT which was previously normal or hyperactive became hypoactive with a focal area of decreased activity corresponding to the defect on 123I-IMP. Crossed cerebellar diaschisis was found in 7 patients with 99mTc-HMPAO and was absent for both 123I-IMP and 99mTc-HMPAO in 3. We suggest that SPECT with 99mTc-HMPAO could show transient hyperemia not demonstrated by 123I-IMP whereas in some cases cerebral infarction would be more difficult to demonstrate with 99mTc-HMPAO than with 123I-IMP. SPECT with both tracers is recommended to follow the evolution of strokes in terms of regional cerebral blood flow and tissue metabolism.     

口服乙酰唑胺负荷试验SPECT脑灌注显像早期诊断TIA的价值

目的 评价口服乙酰唑胺（ACZ）脑负荷试验SPECT脑灌注显像对短暂性脑缺血发作（TIA）患者的诊断价值。方法 10例正常志愿者和30例TIA患者进行静息和口服ACZ脑负荷试验SPECT显像。并进行视觉及半定量分析,观察口服ACZ前后血气分析变化。结果 正常ACZ脑负荷试验后^99Tc^m－双半胱乙酯（ECD）在大脑两侧对应部位呈对称分布,脑血流普通增加;TLA组ACZ脑负荷试验后,血pH值降低,PCO2增高。TIA患者ACZ脑负荷试验后总阳性率为93％。结论 口服ACZ脑负荷试验方法简单可靠,对TIA患者早期的影像学诊断有重要价值。     

脑SPECT显像对高压氧治疗脑外伤后脑缺血疗效判断的价值

目的探讨SPECT脑血流灌注显像对高压氧（HBO）治疗脑外伤继发脑缺血患者疗效判断的价值。方法将65例脑外伤继发脑缺血患者按随机数字表法分为HBO治疗组和常规治疗组,在治疗前后分别进行脑血流灌注SPECT显像,应用计算机感兴趣区（ROI）技术,在横断面图像上采用局部镜像比值（Ra）法判断脑缺血病灶,Ra≤0．9视为异常。对治疗前后的脑血流灌注减低区Ra值进行比较。数据间的比较行t检验。结果HBO治疗组治疗前后局部脑血流（rCBF）减低区Ra值分别为0．58±0．11和0．82±0．12（t=7．327,P〈0．01）,常规治疗组治疗前后rCBF减低区Ra值分别为0．61±0．13和0．73±0．12（t=2．153,P=0．038）;HBO治疗组和常规治疗组缺血灶rCBF增加值分别为0．24±0．08和0．12±0．06（t=2．571,P=0．015）。结论SPECT脑血流灌注显像可灵敏地反映HBO治疗脑外伤后脑缺血前后rCBF变化,可用于HBO治疗疗效的评价。     

Correlation of magnetic resonance imaging findings with hexamethylpropyleneamine oxime brain single photon emission computed tomography in ischemic stroke patients in the subacute stage

PURPOSE: To evaluate the correlation between magnetic resonance imaging (MRI) findings and 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission computed tomography (SPECT) during the subacute stage in ischemic stroke patients. MATERIAL AND METHODS: The T1 and T2-weighted images and brain SPECT findings of 84 patients (mean age 60.69 +/- 12.47 years) with subacute cerebral ischemia during the period 1998-2004 were reviewed. All HMPAO SPECT and MRI studies were performed between 3 and 7 days (mean time delay 4.76 +/- 1.29 days) after the onset of stroke symptoms. RESULTS: An ischemic lesion was seen both in T1 and T2-weighted images with perfusion defects above 60% (severe defect) according to count/pixel data of the lesion in HMPAO SPECT studies in 30 (90.9%) of 33 patients. Otherwise, the ischemic lesion was seen only on T2-weighted images with perfusion defects between 30% and 60% (moderate defect) in HMPAO SPECT studies in 25 (89.3%) of 28 patients. In 20 (87%) of 23 patients who had perfusion defects below 30% (mild defect) on HMPAO SPECT, only non-specific findings such as cerebral atrophy and/or periventricular ischemic-gliotic lesions could be seen in MRI. The difference between these ratios was statistically significant (P < 0.01). CONCLUSION: Brain 99mTc-HMPAO SPECT findings indicate good correlation with MRI findings. When the ischemic lesions could be seen in both T1 and T2-weighted images, the patients frequently had severe perfusion defects. When only seen in T2-weighted images, the perfusion defect was moderate. When only non-specific findings were revealed by MRI, only mild perfusion defects were found by SPECT.