直立负荷试验脑显像诊断脑缺血病变  

Diagnosis of ischemic cerebrovascular diseases with 99m Tc HMPAO brain SPECT using upright stress test

作　　者：陈绍亮[1,2,3] 修雁[1,2,3] 孙晓光 林田孝平[1,2,3] 石田良雄 西村恒彦 

机构地区：[1]上海医科大学附属中山医院核医学科 [2]日本国立循环器病中心 [3]日本国立大阪大学医学部

出　　处：《中华核医学杂志》1998年第1期14-16,共3页Chinese Journal of Nuclear Medicine

基　　金：大阪大学研究基金

摘　　要：目的考察直立负荷试验诊断脑缺血疾病的价值。方法对２０例颈内动脉闭锁或狭窄及直立性低血压患者应用９９ｍＴｃ六甲基丙二胺肟（ＨＭＰＡＯ）进行直立负荷试验脑血流ＳＰＥＣＴ显像。２０例患者中，５例颈内动脉闭锁或狭窄＞７５％（Ａ组），８例直立位与平卧位收缩压差＞２６７ｋＰａ（Ｂ组）；对照组７例经超声心动图及ＣＴ或ＭＲＩ检查为正常非直立性低血压患者。受试者在２～３秒内由卧位转为直立位，即刻注入９９ｍＴｃＨＭＰＡＯ３７０ＭＢｑ后进行ＳＰＥＣＴ负荷显像，而后患者保持卧位不动，再次注入９９ｍＴｃＨＭＰＡＯ５５５ＭＢｑ，以同样采集条件再次行ＳＰＥＣＴ显像。比较两次显像结果，自选定的３个断面分别划取感兴趣区，作半定量分析，并与两小脑的平均值相比较。结果颈动脉闭锁或狭窄组ＳＰＥＣＴ直立显像所示放射性降低的区域，卧位显像可见放射性充填，病灶部位与小脑放射性比值明显上升（Ｐ＜００５）。８例直立性低血压患者中，６例直立显像示额叶放射性降低，卧位时额叶与小脑放射性比值上升，与直立位相比，差异有显著性（Ｐ＜００５）；对照组直立位与卧位显像均正常。直立位与卧位各部位与两小脑平均值之比差异无显著性。结论直立负荷试验有可能用于检测隐匿?Purpose To evaluate the value of upright brain SPECT stress test, we performed 99m Tc HMPAO brain SPECT in association with measurement of blood pressure in both upright and supine positions Methods We studied 5 patients with unilateral stenosis occlusion of the internal carotid (Group A), 8 patients with orthostatic hypotension (group B) and 7 normal controls 370MBq 99m Tc HMPAO was injected immediately after uprighting from a supine position Then the first SPECT scan were performed After the first SPECT, another 555MBq of 99m Tc HMPAO were administered while the patients remained on original supine position Results Semiquantitive analysis showed that the asymmetric ratios between upright and supine positions in group A changed significantly In group B, showed postural cerebral hypoperfusion in the bilateral frontal areas, the mean count ratio of the frontal to cerebellar area between the upright and supine positions also significantly changed In the normal group, there were no significantly changes during the upright test Conclusions The upright stress test is useful for detecting not only silent cerebral hypoperfusion, but also othostatic hypoperfusion

关 键 词：脑缺血 直立负荷试验 SPECT HMPAO 

分 类 号：R743.304[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]