SPECT脑血流灌注显像在脑动脉狭窄支架植入术评估中的作用  

SPECT cerebral perfusion imaging and its quantitative analysis for the assessment of stent implantation for cerebral artery stenosis

作　　者：靳丽丽[1] 孙晓光[1] 黄钢[1] 修雁[2] 石洪成[2] 

机构地区：[1]上海交通大学医学院附属仁济医院核医学科,200127 [2]复旦大学附属中山医院核医学科

出　　处：《中华核医学与分子影像杂志》2015年第2期108-111,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的 探讨SPECT脑血流灌注显像及定量分析在脑动脉狭窄支架植入术评估中的作用.方法 回顾性分析35例（男31例,女4例,平均年龄63.9岁）经DSA证实脑血管狭窄行动脉支架植入术的患者资料,患者均于手术前后行99Tcm-ECD SPECT脑血流灌注显像.所有图像先经过SPM 2.0进行配准和标准化,然后用Brain Search软件进行图像定量分析.软件根据Talarich图自动将大脑分为210个功能区,计算每个区的归一化平均值（NAC）,并与28例对照组数据进行比较,＜1.96s的区域为是低灌注区.对术前低灌注区的NAC与术后相应脑区的NAC进行比较,并对灌注明显改善和无明显改善患者的平均病灶数与Essen卒中风险评分量表（ESRS）进行比较,分析颈内动脉（ICA）闭塞和ICA狭窄患者的平均病灶数与术后改善率的差异.统计学分析采用配对秩和检验、两样本t检验、两样本秩和检验和x2检验.结果 35例患者中有20例患者在支架植入后低灌注区明显改善.20例明显改善患者的平均病灶数明显高于15例无明显改善的患者（34.05±14.41和22.93±17.24;t=2.067,P＜0.05）,明显改善患者的ESRS平均秩和明显低于无明显改善患者（14.8和22.3,Z=2.24,P＜0.05）.28例ICA支架植入患者改善率为60.7％ （17/28）,好于7例大脑中动脉（MCA）支架植入患者（3/7）,但差异无统计学意义（P＞0.05）.ICA闭塞患者的平均病灶数高于ICA狭窄患者（34.36±14.31和31.35±16.37）,但差异无统计学意义（t=0.498,P＞0.05）;ICA闭塞患者的术后改善率7/11高于ICA狭窄患者的10/17,但差异无统计学意义（P＞0.05）.结论 SPECT脑血流灌注显像定量分析可较好地反映支架植入前的低灌注情况、预测支架植入后的灌注改善情况.Objective To evaluate the role of SPECT cerebral perfusion imaging in assessing the stent implantation for cerebral artery stenosis.Methods A total of 35 patients （31 males,4 females,average age （63.9±10.8）years） with cerebral artery stenosis confirmed by DSA for cerebral artery stent implantation were retrospectively analyzed.99Tcm-ECD cerebral perfusion imaging was performed for all patients before and after stent implantation.The images were realigned and normalized by SPM 2.0 and then analyzed by Brain Search software for quantitative analysis.The brain was automatically separated to 210 functional areas according to Talarich map.The normalized averaged counts （NAC） of each area were calculated and compared with the data of 28 health controls （8 males,20 females,average age （35.8± 9.4） years）.Less than 1.96s was defined as low perfusion lesions.The NAC values before and after stent implantation were compared for classifying improved from non-improved group.The mean number of lesions and Essen stroke risk score （ESRS） were analyzed between the two groups.The mean number of lesions and postoperative improvement rate of the internal carotid artery （ICA） occlusion and stenosis were compared.Paired rank sum test,two-sample t test,two-sample rank sum test and x2 test were used for statistical analysis.Results In 35 patients with low perfusion areas,20 were significantly improved after stent implantation.The mean number of lesions in the improved group （34.05± 14.41）was significantly higher than that in the non-improved group （22.93±17.24; t=2.067,P〈0.05）.The mean ESRS of the improved patients （14.8）was significantly lower than that of the non-improved patients （22.3,Z=2.24,P〈0.05）.The improvement rate of 28 cases with ICA stent implantation was （60.7%,17/28）higher than that of 7 cases with middle cerebral artery （MCA） stent implantation （3/7; P〉0.05）.The mean number of the ICA occlusion lesions （34.36± 14.31）was higher than that of the ICA steno

关 键 词：颈动脉狭窄 支架 体层摄影术 发射型计算机 单光子 ECD 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R817.4[医药卫生—临床医学]