海洛因海绵状白质脑病的PET影像表现  

PET Image of Spongiform Leukoencephalopathy From Heroin Vapor Inhalation

作　　者：王全师[1] 吴湖炳[2] 胡海涛[1] 

机构地区：[1]西安交通大学医学院解剖教研室,陕西西安710061 [2]第一军医大学附属南方医院PET中心

出　　处：《实用放射学杂志》2003年第5期459-461,共3页Journal of Practical Radiology

摘　　要：目的　本研究旨在阐述海洛因所致的海绵状白质脑病的PET影像表现及其诊断价值。方法　海洛因海绵状白质脑病患者 6例 ,均为男性 ,年龄 2 6～ 3 7岁 ,平均 3 0 .4岁。临床表现为不同程度的小脑共济失调 ,构音障碍 ,反应迟钝 ,并且进行性加重。既往均曾吸食海洛因史 1～ 3年 ,有 2例就诊时已戒毒 1.5～ 3个月。吸毒方式均为通过铝箔加热经鼻吸入海洛因蒸汽。以上 6例患者经CT及MRI检查均有特征性表现 ,其中 2例经活检病理证实为脑白质海绵状变性。6例患者均进行常规 18F -FDGPET脑3D显像 ,其中有 1例于 18F -FDGPET检查完第 2天进行 13 N -NH3 PET脑血流灌注显像。结果　18F -FDGPET代谢显像 6例患者均有不同程度的大脑双侧内囊后肢及双侧小脑白质对称性放射性稀疏或缺损 ,大脑双侧枕叶及双侧小脑皮质见对称性放射性减低影。其中 1例 13 N -NH3 PET脑血流灌注显像白质改变与 18F -FDGPET显像所见基本一致 ,还可见双侧枕叶、双侧额叶、双侧颞叶部分皮质放射性明显减低影 ,其中双侧枕叶呈对称性改变。结论　海洛因白质脑病PET影像表现有一定特点 。Objective To clarify PET image characteristic of spongiform leukoencephalopathy from heroin vapor inhalation and evaluate PET in the dignosis of the disease. Methods 18 F-FDG PET was performed in six patients with spongiform leukoencephalopathy from heroin vapor inhalation. They developed progressive cerebellar ataxia ,dysarthria and unresponsive in different degree respectively.They were a known drug abuser and had a history of heroin use for 1～3 years.Abstinence of heroin was performed from 1.5 to 3 months in the 2 patients .It was known that they took their heroin not by injection but by inhalation of heated heroin vapours,a method known as 'chasing the dragon'.Brain CT and MRI revealed some characteristics in all patients. Needle biopsy (n=2) was performed and pathological examination proved spongiform degeneration in the white matter. 13 N-ammonia PET was performed in 1 of 6 patients after 24 hours.Results Brain 18 F-FDG PET revealed bilateral and symmetrical 18 F-FDG accumulation decrease or defect areas invoving the internal capsule behind limb ,cerebral occipital lobes ,and cerebellar hemispheres(cerebellar white matter was severely involved).Brain 13 N-ammonia PET imaging demonstrated abnormal areas of decreased accumulation in the bilateral frontal lobes, bilateral temporal lobes , bilateral occipital lobes, bilateral cerebellar cortex and no 13 N-ammonia accumulation in the bilateral internal capsule behind limb and cerebellar white matter in 1 of 6 patients. The region of the lesion was larger than 18 F-FDG PET imaging in the same patient. Conclusion Spongiform leukoencephalopathy from heroin vapor inhalation has some characteristics on PET ,which are helpful for the diagnosis when combined addictive history.

关 键 词：海洛因海绵状白质脑病 PET 影像表现 小脑共济失调 海洛因 

分 类 号：R742[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]