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目的 建立乙酰唑胺(ACZ)脑负荷试验的方法及脑血流量变化的正常值,提出评价脑血管储备功能的指标。 方法 正常对照者6例,脑血管疾病患者43例 用99mT-乙撑双半胱氨酸二乙酯(ECD)先做基态脑血流(CBF)及SPECT显像,36～48小时后做脑负荷显像(静脉注射ACZ 1 g,20min后按基态同样条件进行)。病人均行CT检查,部分行MRI、经颅多普勒超声(TCT)、DSA检查,7例病人治疗后进行了随访并复查SPECT显像。图象分析:(1)视觉分析 比较ACZ试验前后的变化,分三型:A型,反应差,ACZ试验后出现病变(A1)或病变扩大(A2);B型,反应好,病变缩小或消失;C型,无反应 (2)半定量分析,计算颈动脉及大脑半球峰时、半球血流占全脑血流百分数;计算ACZ试验前后病变区及病侧半球血流量增加率(△％)及放射性摄取比值(UR)。结果 (1)正常对照两侧比较各值无差别。ACZ试验后全脑△％为25.0％+809％,ACZ试验前后各区UR均>0.901。(2)32例短暂性脑缺血发作(TIA)脑CBF显像,42％有闭塞性脑血管病变,与TCD、DSA结果相符。(3)ACZ试验提高了TIA和小脑梗死灶的阳性率,前者由59.37％升至87.15％,后者由73%升至90%。(4)A型病人疗效差,B型疗效佳 。(5)小梗死伴有对侧小脑或同侧丘脑失联络者,ACZ试验后血流均恢复正常。结论 ACZ脑负荷实验安全可靠,用于CVD,其图像、
OBJECTIVE: To establish a method of acetazolamide (ACZ) brain load test and to find out the normal value of cerebral blood flow changes, and put forward the evaluation indexes of cerebrovascular reserve function. Methods Six patients with normal controls and 43 patients with cerebrovascular diseases were subjected to CBF and SPECT imaging with 99mT-ethylene dicysteine diethyl ester (ECD). After 36 to 48 hours, brain was made Load imaging (intravenous ACZ 1 g, 20min after the same conditions according to the ground state). Patients underwent CT examination, partial MRI, transcranial Doppler ultrasound (TCT), DSA examination, 7 patients were followed up and reviewed SPECT imaging. Image analysis: (1) visual analysis of ACZ test before and after the change, divided into three types: type A, poor response, ACZ test lesions (A1) or lesion expansion (A2); B type, good response, lesion or Disappeared; C type, no response (2) semi-quantitative analysis of the carotid and hemispheric peak hemisphere hemisphere blood flow accounted for the percentage of cerebral blood flow; calculated before and after the ACZ test lesion area and hemisphere hemisphere blood flow increase rate (△% ) And radioactive uptake ratio (UR). Results (1) There is no difference between the two sides of normal control. The percentage of whole brain △% after ACZ test was 25.0% + 809%, and the UR of each area before and after ACZ test was> 0.901. (2) 32 cases of transient ischemic attack (TIA) brain CBF imaging, 42% of occlusive cerebrovascular disease, consistent with the TCD, DSA results. (3) The ACZ test increased the positive rate of TIA and cerebellar infarction, the former rose from 59.37% to 87.15%, the latter rose from 73% to 90%. (4) A type of patients with poor efficacy, type B effect is good. (5) small infarction accompanied by contralateral cerebellar or ipsilateral thalamus loss of contact, ACZ blood flow returned to normal. Conclusion The ACZ brain load test is safe and reliable for CVD. The images,