一日法PET脑血流-脑代谢联合显像评价不同程度脑血管狭窄患者的脑血流及代谢特点

目的采用一日法PET脑血流-脑代谢联合显像评价不同程度脑血管狭窄患者的脑血流及代谢特点。方法回顾性分析2012年1月至2015年2月首都医科大学宣武医院神经科门诊89例缺血性脑血管病(ICVD)患者重度脑血管狭窄组(A组,n=41),轻中度脑血管狭窄组(B组,n=48)]的PET脑血流灌注显像和葡萄糖代谢显像资料。采用一日法,先后进行13N-氨水(13N-NH3)和18氟-氟代脱氧葡萄糖(18F-FDG)脑PET显像,获得脑血流灌注和脑葡萄糖代谢影像,以及脑血流值、脑代谢值、脑血流减低率、脑代谢减低率和脑代谢/脑血流比值。结果A组患者的13N-NH3和18F-FDG显像阳性率分别为74.2%(98/132)和92.4%(122/132);B组分别为60.6%(43/71)和85.9%(61/71),其中5例显像正常。A组以单侧多灶和双侧多灶多见,且呈不对称性分布;B组以单侧单灶和单侧多灶多见。A组匹配型病灶68个,B组30个;A组不匹配型病灶64个,B组41个。A组匹配型病灶中,轻度、中度、重度受损病灶数目分别为29个、15个、24个;B组匹配型病灶中,其中轻度、中度受损病灶数目分别为26个、4个,无重度受损病灶。A、B组匹配型病灶之间的脑血流值(0.754±0.182,0.849±0.052)、脑代谢值(0.823±0.191,1.028±0.102)、脑血流减低率(0.252±0.194,0.154±0.115)和脑代谢减低率(0.294±0.183,0.188±0.123)比较,差异均具有统计学意义(P<0.05)。结论ICVD患者脑血管狭窄程度不能代表脑功能受损程度。一日法PET脑血流-脑代谢联合显像是评价ICVD脑功能受损程度的良好方法。

Characteristics of cerebral blood flow and glucose metabolism in different severity of ischemic cerebral vascular disease patients evaluated by one-day positron emission tomography brain blood flow and glucose metabolism combined imaging

Objective To evaluate the characteristics of cerebral blood flow and glucose metabolism in patients with different degrees of cerebrovascular stenosis by one-day PET brain blood flow and glucose metabolism combined imaging.Methods From January 2012 to February2015,positron emission tomography brain blood flow and glucose metabolism imaging of 89 patientsgroup A(n=41)with severe vascular stenosis and group B(n=48)with mild to moderate stenosis]with ischemic cerebrovascular disease(ICVD)in the Department of Neurology of Xuanwu Hospital,Capital Medical University were analyzed retrospectively.13 N-Ammonia(13 N-NH3 and 18 F-fluorodeoxyglucose(18 F-FDG)PET imaging were continuously performed in one day protocol to get CBF and CGM images.Semi-quantitative analysis including CBF values,CGM values,CBF reduction rate,CGM reduction rate and ratio of CGM/CBF were also used.Results The positive rates of13 N-NH3 imaging is 74.2%(98/132)and18 F-FDG imaging is 92.4%(122/132)in group A while they are 60.6%(43/71)and 85.9%(61/71)in group B.There were 5 cases with normal images in group B.In group A,unilateral multifocal and bilateral multifocal were more common,and the distribution was asymmetric;in group B,unilateral multifocal and unilateral multifocal were more common.There were 68 matched and 64 mismatched foci in group A,while 30 matched and 41 mismatched foci in group B.Based on semi-quantitative data,29 mild,15 moderate and 24 severe lesions were found in group A while 26 mild and 4 moderate lesions in group B.No severe lesions were shown in group B.There were significant differences in the blood flow value(0.754±0.182,0.849±0.052),metabolic value(0.823±0.191,1.028±0.102),blood flow reduction rate(0.252±0.194,0.154±0.115)and metabolic reduction rate(0.294±0.183,0.188±0.123)between matched lesions in group A and B(P<0.05).Conclusion The degree of cerebrovascular stenosis in ICVD patients can not represent the degree of brain function damage.one-day positron emission tomography brain blood flow and glucose metabolism combined imaging is a good method to evaluate the degree of brain damage in ICVD.