尼莫地平负荷SPECT脑血流灌注显像在急性非致残性脑血管病中的诊断价值  

The diagnostic value of nimodipine stress single-photon emission computed tomography perfusion imaging in acute non disabling cerebrovascular disease

作　　者：张秋洪 陈汉水[1] 岳岑 马琪林[1] ZHANG Qiuhong;CHEN Hanshui;YUE Cen;MA Qinlin(Department of Neurology,Xiamen University First Affiliated Hospital,Xiamen361000,China)

机构地区：[1]厦门大学附属第一医院神经内科,福建厦门361000

出　　处：《中国实用神经疾病杂志》2019年第21期2334-2344,共11页Chinese Journal of Practical Nervous Diseases

基　　金：厦门市2017年科技计划第一批重大专项项目(20172020)3502Z2017100520170801。

摘　　要：目的 分析尼莫地平负荷脑血流灌注显像在急性非致残性脑血管病中的诊断价值.方法 选取2017-01-01-2017-11-01在厦门大学附属第一医院就诊的35例急性非致残性脑血管病患者,行MRI、99Tcm-ECD静息及尼莫地平负荷SPECT脑血流灌注显像.分别在双侧额叶 、颞叶 、顶叶 、枕叶 、基底节区 、小脑 、脑干对称部位勾画感兴趣区(regions of interests,ROI),并记录各个ROI平均放射性计数,分析负荷前后SPECT图像及局部脑血流量(regional cerebral blood flow,rCBF),观察负荷前后脑血流灌注的变化情况,比较MRI、静息及尼莫地平负荷SPECT脑血流灌注显像对急性非致残性脑血管病责任病灶诊断阳性率的差异.采用卡方检验分析数据.结果 在急性非致残性脑血管病中,MRI、静息及尼莫地平负荷SPECT脑血流灌注显像诊断阳性率分别为45.7%(16/35)、71.4%(25/35)、91.4%(32/35).负荷前后rCBF变化的4种类型情况:A型:静息显像rCBF正常,负荷后rCBF减低5个;B型:静息rCBF减少,负荷后rCBF降低无明显改善11个;C型:静息rCBF减少,负荷后rCBF降低更明显8个;D型:静息时rCBF降低,负荷后rCBF改善11个.结论 联合尼莫地平负荷前后SPECT脑血流灌注显像可明显提高急性非致残性脑血管病病灶诊断阳性率,且能够有效评估脑血管储备功能.Objective To analyze the diagnostic value of nimodipine stresssingle photon emission computed tomography perfusion imaging in acute non disabling cerebrovascular disease.Methods Thirty five patients with acute non disabling cerebrovascular disease in the first hospital of Xiamen from January 2017 to November 2017(21 males,14 females,average age(62.9±2.0)years)who underwent 99Tcm ECD and nimodipine stress CBF were enrolled.Regions of interests(ROIs)were drawn in the bilateral frontal lobe,temporal lobe,parietal lobe,occipital lobe,basal ganglia,cerebellum,brainstem,the ratio of regional cerebral blood flow(rCBF%)of all ROIs were calculated.The detection rate by post and pre nimodipine stress SPECT,MRI were calculated respectively.The reaction to nimodipine stress cerebral blood flow were observed.And analyzed usingχ2 test.Results The detection rate of MRI,rest and nimodipine stress SPECT was 45.7%(16/35),77.1%(27/35)and 91.4%(32/35).There were four types of cerebrovascular reactivity to nimodipine:the first,rCBF%was normal before nimodipine stress,and then decreased after the test in 5 patients;the sencond,cCBF%was decreased before the nimodipine stress,and there was no change after nimodipine stress in 11 patients;the third,cCBF%was decreased in the rest,and then further decreased after the text in 8 patients;and the forth,rCBF%was decreased before the nimodipine stress and then increased after the text in 11 patients.Conclusion Nimodipine stress SPECT is safe and effective,combined with rest and Nimodipine stress SPECT can raise positive rate remarkly and help to evaluate the cerebroblood flow reserve.Nimodipine stress SPECT is helpful to the diagnosis and treatment of acute non disabled cerebrovascular diseases.

关 键 词：急性非致残性脑血管病 尼莫地平 SPECT MRI 感兴趣区 局部脑血流量 脑血管储备功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]