脑血管重度狭窄患者脑代谢与脑血流损害特点初步研究  

Initial research on the damaged characteristics of cerebral glucose metabolism and cerebral blood flow in patients with severe cerebral artery stenosis

作　　者：崔璨[1] 马云川[1] 王曼[1] 苏玉盛[1] 彭程[1] 张琳瑛[1] 刘亭廷[1] 尚建文[1] 仇英[1] 

机构地区：[1]首都医科大学宣武医院PET中心,北京100053

出　　处：《国际放射医学核医学杂志》2014年第3期141-147,共7页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的：探讨脑血管重度狭窄或闭塞患者脑葡萄糖代谢与脑血流灌注的受损特点。方法采用18F-FDG和13N-Ammonia PET联合脑显像，对33例缺血性脑血管病（ICVD）患者进行检查，获得同期脑葡萄糖代谢和脑血流灌注影像。经半定量分析，得到脑代谢减低率、脑血流减低率和脑代谢/脑血流比值。结果①共发现病灶121个，18F-FDG显像阳性率为91．7%，13N-Ammonia显像阳性率为78．5%。②ICVD病灶呈多灶性和不对称性分布。③根据两种影像的匹配性，将病灶分为两大类（5种类型）：匹配型（I型）病灶66个，占54．5%；不匹配型（II型-V型）病灶55个，占45．5%。④以脑代谢/脑血流比值为指标，匹配型病灶的比值为1．10±0．13；不匹配型病灶比值增高组的95%CI为1．28-1．56，比值减低组的95%CI为0．95-1．08。将脑代谢/脑血流比值1．1-1．3作为区分匹配型与不匹配型的标准。⑤以脑代谢减低率和脑血流减低率为指标，将66个匹配型病灶分为轻度、中度、重度受损3组，各组之间的脑代谢、脑血流减低率差异均有统计学意义（χ2=56．854和56．800，P均＜0．01）。其中，轻度受损病灶27个，占40．9%；中度受损病灶15个病灶，占22．7%；重度受损病灶24个，占36．4%。⑥4例单侧脑内病变者可见交叉性小脑失联络。结论脑血管重度狭窄患者脑代谢与脑血流的匹配关系明显受损，但其中存在着不同程度的脑代谢与脑血流损害；脑代谢-脑血流联合PET显像在脑血管重度狭窄患者脑损伤程度的评估中具有重要意义和应用价值。Objective To investigate the damaged characteristics of cerebral glucose metabolism （CGM）and cerebral blood flow （CBF）in ischemic cerebrovascular disease （ICVD）patients with severe cerebral artery stenosis or occlusion. Methods Thirty-three cases of ICVD patients were examined by 18F-FDG PET and 13N-Ammonia PET, obtaining the same stages of cerebral blood perfusion and glucose metabolism image. According to the semi-quantitative analysis, the rate of reductions in CGM and CBF, and the ratio of CGM/CBF were figured out. Results ①There were 121 foci in total, positive rate of 18F-FDG imaging was 91.7%, and 13N-Ammonia imaging was 78.5%. ②ICVD foci were mostly characterized with multifocal and asymmetric distribution.③Based on visual analysis to the relationship of FDG images and Ammonia images, 121 foci were divided into two types： matched damage in 66 foci （54.5%, type I）and mismatched damage in 55 foci （45.5%, type II-type V）.④Based on semi-quantitative study to matched and mismatched group, the ratio of CGM/CBF with 1.1-1.3 may be considered as the parameter in evalu-ation.⑤Based on the rate of reductions in CGM and CBF, 66 matched foci were divided into mild （27 fo-ci, 40.9%）, moderate（15 foci, 22.7%）and severe（24 foci, 36.4%） damage group.⑥4 cases with unilat-eral foci appeared crossed cerebellar diaschisis. Conclusions The matched relationship of CGM and CBF was markedly damaged in IVCD patients with sever cerebral artery stenosis but different degrees of injury on metabolism and blood flow were also found. The application of combined imaging with 18F-FDG and 13N-Ammonia brain PET is able to greatly improve ICVD diagnosis and management.

关 键 词：正电子发射断层显像术 脑葡萄糖代谢 脑血流灌注 缺血性脑血管病 

分 类 号：R743.3[医药卫生—神经病学与精神病学]